Every Day Tasks
Over time, those with Alzheimer's become unable to independently conduct everyday tasks that we take for granted such as bathing, eating, getting dressed, paying bills, etc. As the caregiver, there may be tips and "tricks of the trade" that will keep your family member safe and help you to help your family member.
The Alzheimer's Association offers a wealth of information on this issue. The following links will take you to the pages on bathing, toileting, dental care, and dressing.
Late Stage Care
Other Alzheimer's Association Publications
The Mayo Clinic offers additional tips in their Alzheimer's Center.
Exercise and Alzheimer's
Making Mealtimes Easier
Managing Sleep Problems
Sundowning: Late Day Confusion
The Alzheimer's Center
Understanding and Controlling Wandering
The Duke Family Support Program offers a Tool Kit for Alzheimer's & Dementia Caregivers. Here is some of what is offered within the Kit to help you.
Step-By Step Basics of Daily Care
The individual may vary from day to day in what she can do. Planning ahead, remaining flexible, and providing a predictable routine will help with personal care tasks that can be frustrating for her and for the caregiver. Many tasks, however, can be made easier and in some cases, enjoyable.
Respect lifelong routines, habits, and preferences in taking a bath. Does the person prefer a bath or shower, in the morning or before going to bed? Gather everything you will need ahead of time: towels, bath mat, washcloth, soap, shampoo, comb, lotion, and powder. Make sure the room is warm and comfortable. Be sure the water is at a safe and comfortable temperature. A hand help shower and a shower bench may provide a safety edge for many persons. Recognize that bathing two or three times a week is enough unless the person is incontinent.
If privacy is an issue, drape a towel over your relative’s lap or shoulders and use a washcloth to clean under the towel. If she seems frightened, distract her by talking, singing or asking her to hold things.
It is often necessary to be directive at bath time using such phrases as, “Your bath is ready” instead of asking “Are you ready to take a bath?”
Give step-by-step instruction:
Evaluate the kinds of clothing used as skills decrease. For example, if a woman is having difficulty putting on a bra and the family does not object, don’t bother with it. Also, women may find pantyhose or garter belts frustrating. Socks are a good substitute, especially if she paces a lot, increasing the chance of blisters. Clothing that fastens in the back may keep the person from disrobing in public.
Men who have trouble with zippers may do well with elastic waist pull-on pants. Consider jogging suits, slacks with elastic waistbands, shirts that pull over the head or snap up the front. Shoes that slip on or fasten on with Velcro may be easier. Tube socks are excellent because the person doesn't’t have to find the heel.
Limit choices. Some persons continue to dress themselves if you hand them one article at a time. For some, it is helpful to lay out the clothing in the order that they are to be put on, with underwear on top…
Give the person a clue if it is necessary, “Here is your shirt.” Or help by demonstrating or guiding the person, i.e. putting an arm into the sleeve of the shirt. Allow plenty of time for this activity and let the person do as much as he or she can. Respect privacy to the degree possible.
Compliment the person when he is done. You may need to change your standards in allowing the person some freedom while supporting her self-esteem. If your mother is happy wearing an orange blouse with pink pants, let her. In the words of one caregiver, “I finally had to ask myself, ‘What difference does it make?’”
If the person insists on wearing the same clothes or seems attached to a particular article, try to have multiples; this solves the problem on washday when he or she refuses to give up the favorite piece of clothing.
Select a short, easy-to-care hair style. If the person cannot shave himself, ask the barber for tips, including the best shaving tool. Many grooming tasks may be pleasurable and can be considered activities. Women in particular may enjoy make up, manicures, or having their hair done.
Sometimes the person with Alzheimer’s will be unable to find the bathroom, unable to position her body to sit, unable to undress to use the toilet or will void in his clothes or other inappropriate places (like waste baskets or outdoors).
Clearly label bathrooms to make them easy to locate even if the person has lived in the same house for many years.
Watch for cues—fidgeting with clothing, pacing, agitation which may indicate the need to use the bathroom.
Eating & Nutrition
Serve meals at a consistent time. A calm, comforting atmosphere encourages concentration on the task at hand. If the person refuses to eat, too many choices on his plate may be the problem. He may not know how to begin the process. Model the eating process for him. Once the process begins, he may continue on his own. Allow him enough time to finish his meal.
If the person eats all the time (or under eats) prepare nutritious finger foods that he can eat throughout the day. Fresh fruits and vegetables are good choices.
Sore gums, poorly fitted dentures, or the food’s lack of visual appeal or familiar smell can contribute to the refusal to eat. Correct any of these problems.
Use color and textures as visual clues. Choose dishes, for example, that contrast sharply with placemats or tablecloth.
Remove inedible materials, condiments, and hazardous items when the person loses discretion about use or appropriateness.
Give back some limited control—“Would you like to eat breakfast first or take your bath first? Don’t rush or criticize how well the person does the task.
Persons with Alzheimer’s disease often appear to sleep less or more. Sleep problems may be caused by pain, medication, lack of exercise, or too much daytime napping.
Have the person evaluated for physical problems which may cause pain or discomfort.
Provide a night light for the person who is afraid of the dark. Fear, hallucinations and confusion may be worse with darkness. Sitting with the person for a while may help.
Is the room too warm? Are the sheets free of wrinkles? Her bed clothes comfortable?
Try white noise which can be soothing—the hum of a fan, soft music. When the person is restless , try a back rub, brushing his hair, talking softly.
Hunger may be keeping the person awake. Provide a snack but no food or drink with caffeine.
Duke Family Support Program
How to Handle Challenging Behaviors
How to Safely Assist With Activities of Daily Living
The Copper Ridge Institute, a non-profit affiliated with Johns Hopkins University, "conducts research on 'care' issues and the development of educational programs to train family and health care professionals on 'best practices' in dealing with individuals with Alzheimer's disease."
They have developed a training video for caregivers providing step-by-step methods for caring for loved ones with Alzheimer’s disease. Available as a DVD and webcast, the program is free and may be downloaded at their website. The video re-creates some of the daily situations that caregivers may encounter and provides coaching for each of these activities based on best practices developed by the Institute. This video is part of their Caregiver Educational Series (CES) and is available in English and in Spanish.