Assisting the Person with Dementia with Activities of Daily Living

1. Assisting the Person with Dementia with Activities of Daily Living Sarah Brown, CNS Deer Lodge Centre Luana Whitbread, CNS WRHA PCH Program

2. Overview • Dementia • General strategies • Communication • Environment • Activities of Daily Living • Bathing • Hygiene • Dressing • Eating • Toileting

3. Understanding Dementia • Acquired syndrome of memory decline sufficient to affect daily life • Not an inherent aspect of aging • Not normal cognitive lapses

4. Dementia • Characterized by • memory loss • inability to adequately communicate (aphasia) • inability to recognize familiar faces or objects (agnosia) • loss of ability to carry out complex action (apraxia) • Impairment of social functioning or ADLs/IADLs

5. Dementia • Symptoms vary from person to person in terms of • Specific abilities affected • Severity of symptoms • Progression of disease • Symptoms also affected by individuals personality, life history and coping skills

6. Dementia • Ability to control feelings and behavior may decline • Frustration and confusion expressed through behaviors such as aggression or agitation— • Remember---they are trying to communicate something to us!

8. Dementia • Consider other causes of confusion • including illness, fatigue, constipation, dehydration, pain • Potential causes should be investigated and treated appropriately

9. General Strategies • Approach slowly and calmly • Make eye contact, introduce yourself, & smile • Assess their mood • Stay outside their personal space until they are comfortable • If they are anxious or agitated, leave and return later. May need a different staff member.

10. General Strategies • Get everything ready prior to starting • Be flexible and allow lots of time • Individualize care—consider influences such as culture, gender, past experiences, religious background • Also consider characteristics of the caregiver

11. General Strategies • Explain what you are doing • Break tasks into simple directions, one step at a time: may need to demonstrate • Cueing is important (visual cues with verbal instructions) • Encourage them to do as much as possible themselves • If 2 people needed, one person speaks and gives instructions

12. Communication • Consider verbal and non-verbal communication • Body language and tone very important • Expressing needs • Watch for triggers

13. Environment • Quiet, private setting • Personal space: respect privacy and modesty • Decrease excessive stimulation • Familiar environment • NB-Recognize that not all environmental factors can be changed-change what you can

14. Resident History • Assessment of resident ADL history through family, team members • Personal preferences: How often? When? How? • When is resident least agitated, most cooperative? • What factors promote fear? • Review what strategies have worked in the past? Team/family.

15. Activities of Daily Living • Bathing • Hygiene • Dressing • Eating • Toileting

16. Bathing • Why?? • Infection control • Skin breakdown • Pleasurable, relaxing • Socially acceptable, decrease odor • Part of a routine • 43% of residents with dementia resist their bath

17. Bathing • What makes bathing unpleasant? • Pain, aging skin = sensitive, fragile • Cold environment, impersonal • Invasion of privacy, multiple caregivers (over stimulation) • Removal of clothes = embarrassing • Fear, past negative experiences • Can’t remember last bath (? Yesterday) • A task to be done & finished whether they like it or not

18. Preparation for the Bath • Create a list of reasons for caregivers to use to explain why the person should bathe • If bathing is an automatic refusal, take the resident to the bathroom before. • Use persuasion, do not pressure. • Ensure privacy, minimize time resident is undressed.

19. Preparation for the Bath • If sound of running water causes agitation, fill the tub before the resident enters the room. • Validate resident’s experiences (cold, pain). Give pain meds one hour prior to bathing. • Remind, redirect, distract

20. The Bath • Encourage participation • Give repeated reassurance that the resident is safe and not alone • Positive reinforcement • Use bath products that were present in their home/familiar

21. Now What? • If behavior escalates during bathing(increased agitation/refuses): • Slow down, change technique, move to another body part • Find out which process is most upsetting • Distract, give something to hold, pleasant topic • Stop, give resident time to calm down

22. Now What? • Seek assistance from one other person (2 people should not bathe different parts) • Finish up quickly, do essentials • Try another caregiver • If washing hair increases agitation: try soapy washcloth, tilt head back, keep soap out of eyes. • Wash hair last, cover with a towel • Could wash hair separately

23. Alternatives • Bath in a bag • Towel bath • Shampoo cap

24. Activities of Daily Living • Bathing • Hygiene • Dressing • Eating • Toileting

25. Hygiene: Oral Care • Why?? Dental problems = • Decrease ability to eat • Effect speech and swallowing • Bad breath = decreased social interaction • Poor overall health = ↑ risk of pneumonia/stroke/poor glycemic control • Dental pain = increased behavior problems

26. Oral Care • Determine which steps resident is able to do and which require assistance • If they are independent, get them started: give toothbrush, hands on guidance • Use non-foaming toothpaste (eg. Biotene) • Clean dentures • Regular dental check-ups

27. Hygiene: Hair Care • Why? • Appearance • Infection control • Socially acceptable

28. Hair Care • Choose hairstyle that is easy to care for • Salon or hairdresser may work better • Shampoo cap • For beards: • Electric razor • Barber • Let beard grow if too difficult

29. Nail Care • Why? • Appearance • Scratching • Infection control

30. Nail Care • Check nail length • May need foot care nurse • Manicure from volunteers • Check feet for circulation, calluses, bunions, pain, wounds • Proper shoes

31. Activities of Daily Living • Bathing • Hygiene • Dressing • Eating • Toileting

32. Dressing • Seems very easy but when you break it down there are many steps: • Thinking about what you’re going to wear • Choosing • Deciding the correct order • Putting the clothes on • May be overwhelming for person with dementia

33. Dressing • Break process into manageable steps • Limitations posed by health (arthritis, coordination, balance, pain, tremors) • Help where you need to but allow for • Independence • Choice • Dignity • Control

34. Dressing Strategies • Be flexible—do what works • Choose 1 location-ie. room or bathroom • Simplify-decrease number of clothes in closet • Allow time –don’t rush • Label drawers • Check history,routine ie-did they get dressed before breakfast?

35. Dressing Strategies – Cont’d • Make things easy, appropriate, familiar • Favorite items, ask family to buy more • Maintain privacy • Offer choices, cueing • Lay out clothing in the order it would be put on • Have clothing right side out

36. Clothing Options • Modify clothing if necessary • Elastic waistbands, easy to remove • Velcro (? Used previously)

37. Activities of Daily Living • Bathing • Hygiene • Dressing • Eating • Toileting

38. Eating • Significance • Not just nutrition, social activity • Associated with rituals • Provides structure to the day

39. Eating • Skills for eating may be lost • Little awareness of etiquette involved • No memory of how to eat, why, or recognition of what they are eating • Decreased senses: sight, hearing, taste and smell

40. Eating • Things to consider: • Teeth, broken teeth • Sores in mouth • Dentures, fit, wear them? • Medications affect appetite eg: antidepressants, antibiotics, narcotics, NSAIDS, ASA • Illness affects appetite (depression, anxiety, infection)

41. Eating Strategies: Resident • Talk with the family about likes, dislikes and routines • Encourage the resident to eat on their own for as much as they can and as long as they can • Be flexible • Recognize that resident may not want to eat or accept food if they haven’t paid for it • Short attention span • Recognize eating problems are not the fault of the resident but a progression of the disease

42. Eating Strategies: Table • Keep table setting simple • Remove unnecessary utensils • Cutlery and dishes that are easy to hold • Non-slip mats under dishes • Contrasting color b/w table and setting • Adaptive devices should be adult ones • Clothing protectors not bibs

43. Eating Strategies: Environment • Adequate lighting: can they see what they are eating? • Decrease distraction, noise , conversation, TV • Be calm not hurried

44. Eating Strategies: Food • Hot foods hot, cold foods cold • Favorites • Small pieces and servings/bite size • Finger foods to eat on the run • Portable liquids if possible • Provide apron or fanny pack with snacks • Frequent snacks instead of meals • If poor intake regular occurrence, consider changing texture of foods

45. Assisting to Eat • Tell them what you’re doing and what they’re eating • If resistive, go away and come back in 5 minutes • Sit down at resident’s level. If assisting 2 residents, sit b/w them • Cueing, hand over hand guidance • Feed slowly, don’t overload the spoon • Wait until the resident swallows

46. Activities of Daily Living • Bathing • Hygiene • Dressing • Eating • Toileting

48. Toileting • Accidents may happen because: • Gets to the bathroom too late • Doesn’t recognize the bathroom • Incontinence • Too much fluid intake in evening • Medications (Lasix)

49. Toileting Strategies • Determine resident’s pattern • Toileting routine • If independent, is BR easy to find, recognizable, well lit • Commode or urinal in room & accessible • Cover waste baskets, containers • Watch for cues that resident need to go: restless, fidgeting, pacing

50. Toileting Strategies • Easy to remove clothing • For men: decal inside toilet bowl so they have something to aim at • Cue with running water • Privacy but stand nearby • Quickly, quietly with only as many staff to do the job