____ 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)
WANDERING At any time, people with AD can wander, if they are mobile. Wandering can be considered a repetitive action, or it may indicate boredom, a desire to find something, or the need to see someone familiar. They may also be thinking they have an appointment and somewhere to go. Planning, preparation, and awareness can minimize wandering. • Avoid stressful, disorientating environments. • Stick to daily routines, minimize changes, and maintain structure.
If repetitive behavior becomes distressing, disruptive, or harm- ful, the caregiver can: • Minimize confusion—maintain consistent calm, daily structure; have a “safe space” with familiar items for the person. • Address stress and anxiety—respond with comforting reassurance to defuse the situation; this may need to be repeated. • Attempts at distraction may help, as can familiar music and an activity that is tactile and repetitive.
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