ADL's for Dementia

• The IADL's eventually are shared and taken care of by other family members.

But most people do not consider this support because it can come with old age as well.

• You should help the patient in a way that still gives them as much independence as possible, so that they do not feel that they are being controlled.

• You should adjust the amount of care you are giving the patient to match the patients need, not to much not enough.

• If you do not provide the right amount of help the patient can get frustrated easily.

• Changes will happen frequently so you need to be prepared to adjust the assistance you provide.

• You should prepare for the activity before involving the patient.
• Splitting the activity into tasks, so it more simple.

• By narrating what the patient is doing, in simple terms it will help the patients recognize what they are doing.

TIPS On How to Handle Specific Activities

We should not only think of how to get the task accomplished by also whether we can make it more pleasant for ourselves and the patient.

What Should You Avoid?

• Avoid giving patients explanations of why they need to do something.
• Avoid giving too many choices or asking questions.
• Use gestures and prompts to orient the patient and get them started.
• Do not rush the patient.
• Do not point out mistakes.
• Do not argue
• You should, Remain calm and talk in a pleasant tone
• Dont let the patient feel frustrated or tired.

Bathing

• A bathroom can be very unsafe for a patient. Patients may feel embarrassed or angry at the presence of a caregiver. Handing them the soap and turning away may give them back a sense of privacy.
• Patients who seem reluctant to enter the bathroom may no longer remember what a bathroom is used for.
• They may need to be told that the bathroom is for bathing. Familiar smells of soap may comfort them.
• A bath stool may be needed so that the patient sits down comfortably for the bath. Grab rails may be needed as well.
• Give partial baths if it is difficult to complete. A daily full bath may not be needed.

Dental Care

• You may need to hold the patients hands and complete the motion with them.
• Denture cleaning may have to be done by caregiver.
• Eventually the caregiver may have to actually take out and put in the dentures or they may not be put in at all.

Someone with Dementia will find it increasingly difficult to handle normal and daily living.

There are many things that a caregiver can do to help.

Grooming

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• Patients may cut themselves with an ordinary razor, electronic razor may be needed. Eventually the caregiver will take over.
• Nail cutting and filing require fine coordination, and will beed to be taken over.
• Even though they may not know how to groom themselves they still want to look presentable and that is up to the caregiver to control. (They may not care about what they look like)

Dressing

Eating

• Too many options may confuse the patient, eliminate clothes that are not easy to put on and are not comfortable.
• Clothing may need to be simplified as coordination decreases.
• Make sure clothes fit and are safe. (Not tripping)
• No zippers or elaborate buttons
• Use shoes with velcro, no laces

Types of ADL's

• Patients may forget to eat if family members have gone out, even if you have let them food out.
• Someone needs to make sure they eat.
• Eating will become messier over time. They may not be able to handle utensils and like to eat with their hand. If using utensils the handle may need to be larger.
• Food may need to be in smaller pieces.
• Use plates with rims , heavy plates.
• Avoid food that is too hot. Thermos mugs may be suitable for hot foods so they do not burn themselves.

Set a positive mood for interaction-Your actions and your body language communicate your feelings. Set a positive mood by speaking to a loved one is a pleasant and respectful manner.

Get the person's attention- limit distractions and noise, turning off the tv and radio, Make sure you have their attention before speaking to them, adress them by name, identify yourself, and use nonverbal cues and touch to help keep them focused.

State your message clearly - use simple words and sentences. Speak slowly distinctly and in a distinct tone. Refrain from raising your voice higher or louder, instead pitch lower. If they do not understand repeat the exact wording. If they still not not understand wait and rephrase the question.

Ask simple, answerable questions- Ask only one question at a time and yes or no answers work best. example- would you like to wear your white shirt ot blue shirt. It would be better to visually see the shirts.

Listen with your ears, eyes and heart- Be patient and wait for your loved one to respond. If they are struggling for an answer, it is okay to suggest words.

Toileting

There are two types of ADL's.

Personal Activities of Daily Living- They are not necessary for fundamental functioning but they let an individual live independently in a community.

examples: washing, dressing, grooming, toileting and eating.

Instrumental Activities of Daily Living- They are not necessary for fundamental functioning, but they let an individual live independently in a community.

examples: cooking, shopping, laundry and household finances

• Use signs that point which way the bathroom is.
• Have nightlights, grab rails, easy clothing removal.
• Be ready for accidents and have cleaning supplies ready.
• Watch the patient to ensure proper hygiene.
• If going in public, a diaper may be needed. (patients will still need to know how to take off and put on a diaper)

Cooking

Managing Money

• It can be very unsafe once coordination is poor.
• They may forge to turn the gas off.
• Do not leave them alone in the kitchen.
• If they are no longer physically and mentally able to cook, allow them to partake in prepping food.

• Patients to not have a good judgement of money and what its value is.
• They do not understand the difference between $10 and $5.

Shopping

Break down activities into a series of steps- This makes many tasks much more manageable. You can encourage your loved ones to do what they can and remind them of steps that they may usually forget. Use visual cues, by placing your hand where theirs should go.

When the going gets tough, distract and redirect- When they become upset try changing the subject or the environment. Ask them for help or mabey go for a walk. Connect with them emotionally and then redirect.

Respond with affection and reassurance- Sometimes they may get confused and remember something that never happened. Instead of telling them they are wrong, understand their emotions and then respond with verbal and physical expressions of comfort, support and reassurance. Example: Touching, holding hands, hugging and praise will ge them to respond when nothing else will.

Remember the Good Old Days- Dimentia patients may not be able to remember what happened 45 minutes ago but they can remember what happened 45 years ago. Avoid asking questions that refer to short term memory, plus since bringing up the past is fun and soothing this is a good way to redirect them.

Maintain your sense of humor- Use humor whenever possible, but not about the situation that is occurring with the patient. They are usually happy to find themselves laughing.

Example of How Assistance Changes Over Time

• eventually they will be confused as to where they are, and cannot count money.
• If they want to carry a purse or wallet make sure there is not many items and money in it.
• Go when the time is not busy.
• Allow them to look for some items. It keeps them alert.
• when they can no longer go out with you involve them in making a shopping list.

The patient is reminded to take a bath.

The caregiver will also need to be around in case they have a problem.

They then will need to make sure they are completing the components of a bath.

Later they may need to be reminded of what you do when you take a bath in the correct order.

The objects they may need for a bath will have to be prepared for them. (soap on loofah, pour shampoo)

They might not know how to complete some tasks without help.

There will not always be good days!

Finally they are bed ridden and are passive through most of the activity.

The patient shortly after will be staring blankly as to what they should do.

Eventually the patient will need guidance (holding their arms and doing the action).

• This is less stressful for the patient. They will also get used to it and be able to predict what is expected of them.

• A daily routine should not be interrupted unless completely necessary.

• Anything that the patient may need to complete an ADL should be completely accesible to them.

• Make sure the patient is aware of time and date. Make the time and date available to them. Having a clock and a calendar. Possibly an alarm that goes off everyday at a certain time.

• Environment should be comfortable and clean.

****At some point the patient will not be able to do that task, so you need to evaluate whether the task is necessary.

• Agitation
• this refers to a range of behaviors like irritability, sleeplessness, and verbal or physical aggression.
• They often get worse as dementia progresses.
• It may be triggered because of environmental factors, fear, fatigue and loss of control.
• How to avoid this?
• reduce caffeine intake, sugar and junk food.
• reduce noise, clutter and crowding.
• Daily routines
• Listen to soothing music, take a walk.
• Do not try to restrain the person in a time of agitation.
• Keep dangerous objects out of reach.
• Allow them to do what they want as much as possible.
• Repetitive Speech
• provide plenty of assurance and comfort. Verbally and physically.

Establishing a daily routine and a friendly environment is one of the most important aspects of handling and caring for someone with dementia, in order to be successful.

1. What should you do when completing an activity with a patient?

a. Give patients explanations of why they are doing that activity.

b. Rush the patient, especially if it is time appropriate.

c. Point out mistakes they are making, so they do not make them again.

d. Talk in a pleasant tone.

2. How can you avoid a dementia patient from getting agitated?

a. reduce caffeine intake, sugar and junk food.

b. create a daily routine

c. Both a and b

d. None of the above

3.At some point the patient will not be able to do that task, what is the best way to handle it?

a. evaluate if the task is necessary

b. completely stop trying

c. take a break and try again later

d. a and c

Helping People With

Dementia

Complete ADL's