____ Alzheimer’s Disease and Other Dementias: Symptoms, Stages, and Communication Strategies Expanded
Middle
Dressing
• Limit options; encourage choice of comfortable clothing • Create environment to support independence • Allow time for dressing • Aid as needed • Encourage independence • Use adaptive supplies (e.g., hairbrush) • Limit time; stay focused on cleanliness and ease
Personal hygiene
Bathing and toileting
• 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
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, atten- tion should be given to maintaining dignity and engagement when pos- sible.
Dressing
Personal hygiene
Bathing and toileting
Eating
Adapted from Borda et al., (2020)
Table 7 (continued)
• Ensure the diet is nutritionally sound food and supplement as suggested by a healthcare professional. • Engage in daily physical activity and limit sedentary activities. • Have a portable toilet/commode near the bed to minimize confusion and limit nighttime bathroom visits.
If a patient is sundowning, implement the following to struc- ture a more comfortable day. • Establish daily sleep schedule with bedtime routine. • Have proper lighting, minimize shadows, and recognize that complete darkness can upset the person.
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