Table 6. Management of ADL/IADL through the Stages of AD 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 Self-Assessment Quiz Question #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.
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) 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.
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.
If a patient is sundowning, implement the following to structure 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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Book Code: SWUS1525
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