Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded ____
Self-Assessment Quiz Question
Always remain calm when supporting ADL and IADL. Gentle statements such as “We are going to go for a walk now—put one foot in front of the other” or “I will hold the cup while you put your coat on” can redirect and minimize potential agitation and conflict. Validate feelings, for example, “I see you are uncomfortable—let me check the front of your shirt.” Let the person see you as a humble ally. Self-Assessment Quiz Question
13. Instrumental activities of daily living (IADL) are different from activities of daily living (ADL) because IADL:
A) Require musical instruments. B) Are acquired with dementia.
C) Require more executive function and reasoning skills. D) There is no difference between IADL and ADL.
14. What would be a helpful rule of thumb for mealtimes? A) Provide adequate time for eating. B) Be spontaneous. C) Use familiar family heirloom cutlery. D) Eat in different rooms.
ADL/IADL STRATEGIES FOR ASSISTING IN THE EARLY STAGES OF AD Support for ADL/IADL will increase as the disease progresses. Progression occurs over an extended period, so it is important to design a meaningful, accommodating life. Table 6 identi- fies strategies that can assist the AD patient as the disease progresses over time. Healthcare Consideration: Caring for a patient with AD is expensive, and costs increase as more care is needed. Identify supportive services in the community, such as adult day care programs. These organizations can provide stimulation, socialization, and safety that can be beneficial to the person, as well as the caregiver (Gomez-Galleo & Gomez-Galleo, 2021).
OTHER BEHAVIORS SPECIFIC TO AD AND OTHER DEMENTIAS SUNDOWNING Sundowning is a disruptive evening stage that can present with restlessness, confusion, agitation, and anxiety. It can disrupt sleep and present challenges to the daily routine and care. Minimize overstimulation at the end of the day and eliminate caffeine and sugar, especially late in the day.
MANAGEMENT OF ADL/IADL THROUGH THE STAGES OF AD
Disease Stage
Activity of Daily Living
Suggested Supportive Methods
Early
Dressing
• Encourage choice • Give autonomy to actively participate in dressing • Provide comb and brush along with encouragement to groom themselves • Aid with shaving, if needed
Personal hygiene
Bathing and toileting
• Assist with bathing/shower as needed • Establish specific bath timev
• 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 Table 7 continues on next page
Eating
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