Table 3. Management of ADL/IADL Through the Reisberg Stages AD Stage ADL/IADL
Caregiver Supportive Activities
Early
Dressing
• Encourage choice • Give autonomy to actively participate in dressing
Personal hygiene
• Provide comb and brush along with encouragement to groom themselves • Aid with shaving, if needed • Assist with bathing/shower as needed • Establish specific bath time • Help with toileting when needed; respect modesty • Provide easy-to-remove clothing to assist with bladder control • Provide wet wipes for easy cleaning • Monitor for safety • Engage patient in food selection; encourage choice and participation • Engage in grocery shopping, meal preparation, and clean-up • Provide adaptive utensils, as needed • Encourage patient to serve and feed themselves • Cut food, if necessary • Monitor for safety • Limit options; encourage choice of comfortable clothing • Create environment to support independence • Allow time for dressing • Aid as needed
Bathing and toileting
Eating
Middle
Dressing
Personal hygiene
• Encourage independence • Use adaptive supplies (e.g., hairbrush) • Limit time; stay focused on cleanliness and ease • Initiate and monitor bathing activities • May have to offer sponge bath in kitchen sink • Schedule bathroom visits • Provide direct assistance, as needed • Use dry shampoo if necessary
Bathing and toileting
Eating
• Provide patient with a plated meal • Create protective environment for eating—switch to plastic, easy- to-hold cups and cutlery, if needed • Encourage independences, but provide eating support as needed • Limit choices, but offer options even when assistance is needed to select • Selections should be comfortable, easy to launder, and easy to put on and remove • Continue to encourage independence • Provide as much assistance as needed to maintain appearance • Move slowly; help as needed with shaving, nail clipping, moisturizing • Gestures and directives should be simple and limited to one word • Display pictures of hygiene activities, if possible • Provide complete bathing care using supportive durable medical equipment (DME), as needed • Monitor closely with timed, structured bathroom checks • Patient will lose ability to control bowels and will be incontinent • If using adult diaper supplies, monitor to avoid rashes and maintain cleanliness • Meal should be plated (and at the right temperature) and set out for patient • Adaptive utensils should be utilized • Monitor liquid intake • Provide adequate time for eating • Don’t rush • Patient may need assistance to be able to eat
Late Note: At this stage of the disease process, the patient will need assistance with most (if not all) ADL/ IADL due to the severity of their impaired abilities. Hands-on assistance will be required for all these activities; however, attention should be given to maintaining dignity and engagement when possible.
Dressing
Personal hygiene
Bathing and toileting
Eating
Note: Adapted from Borda et al., (2020)
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Book Code: PYIL1824
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