Transcript No Slide Title

Assisting the Person with
Dementia with Activities of
Daily Living
Sarah Brown, CNS
Deer Lodge Centre
Luana Whitbread, CNS
WRHA PCH Program
Overview
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Dementia
General strategies
Communication
Environment
Activities of Daily Living
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Bathing
Hygiene
Dressing
Eating
Toileting
Understanding Dementia
 Acquired syndrome of memory decline
sufficient to affect daily life
 Not an inherent aspect of aging
 Not normal cognitive lapses
Dementia
 Characterized by
• memory loss
• inability to adequately communicate (aphasia)
• inability to recognize familiar faces or objects
(agnosia)
• loss of ability to carry out complex action (apraxia)
• Impairment of social functioning or ADLs/IADLs
Dementia
 Symptoms vary from person to person in
terms of
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Specific abilities affected
• Severity of symptoms
• Progression of disease
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Symptoms also affected by individuals
personality, life history and coping skills
Dementia
 Ability to control feelings and behavior
may decline
 Frustration and confusion expressed
through behaviors such as aggression or
agitation—
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Remember---they are trying to communicate
something to us!
Dementia
 Consider other causes of confusion
including illness, fatigue, constipation,
dehydration, pain
Potential causes should be investigated
and treated appropriately
General Strategies
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Approach slowly and calmly
Make eye contact, introduce yourself, & smile
Assess their mood
Stay outside their personal space until they are
comfortable
 If they are anxious or agitated, leave and return
later. May need a different staff member.
General Strategies
 Get everything ready prior to starting
 Be flexible and allow lots of time
 Individualize care—consider influences
such as culture, gender, past experiences,
religious background
 Also consider characteristics of the
caregiver
General Strategies
 Explain what you are doing
 Break tasks into simple directions, one step at a
time: may need to demonstrate
 Cueing is important (visual cues with verbal
instructions)
 Encourage them to do as much as possible
themselves
 If 2 people needed, one person speaks and
gives instructions
Communication
Consider verbal and
non-verbal
communication
Body language and
tone very important
Expressing needs
Watch for triggers
Environment
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Quiet, private setting
Personal space: respect privacy and modesty
Decrease excessive stimulation
Familiar environment
NB-Recognize that not all environmental factors
can be changed-change what you can
Resident History
 Assessment of resident ADL history through
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family, team members
Personal preferences: How often? When? How?
When is resident least agitated, most
cooperative?
What factors promote fear?
Review what strategies have worked in the past?
Team/family.
Activities of Daily Living
 Bathing
 Hygiene
 Dressing
 Eating
 Toileting
Bathing
Why??
Infection control
Skin breakdown
Pleasurable, relaxing
Socially acceptable, decrease odor
Part of a routine
43% of residents with dementia resist their
bath
Bathing
What makes bathing unpleasant?
 Pain, aging skin = sensitive, fragile
 Cold environment, impersonal
 Invasion of privacy, multiple caregivers (over
stimulation)
 Removal of clothes = embarrassing
 Fear, past negative experiences
 Can’t remember last bath (? Yesterday)
 A task to be done & finished whether they like it
or not
Preparation for the Bath
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Create a list of reasons for caregivers to
use to explain why the person should
bathe
If bathing is an automatic refusal, take
the resident to the bathroom before.
Use persuasion, do not pressure.
Ensure privacy, minimize time resident is
undressed.
Preparation for the Bath
 If sound of running water causes agitation,
fill the tub before the resident enters the
room.
 Validate resident’s experiences (cold,
pain). Give pain meds one hour prior to
bathing.
 Remind, redirect, distract
The Bath
 Encourage participation
 Give repeated reassurance that the
resident is safe and not alone
 Positive reinforcement
 Use bath products that were present in
their home/familiar
Now What?
If behavior escalates during bathing(increased
agitation/refuses):
 Slow down, change technique, move to another
body part
 Find out which process is most upsetting
 Distract, give something to hold, pleasant topic
 Stop, give resident time to calm down
Now What?
 Seek assistance from one other person (2 people
should not bathe different parts)
 Finish up quickly, do essentials
 Try another caregiver
 If washing hair increases agitation: try soapy
washcloth, tilt head back, keep soap out of eyes.
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Wash hair last, cover with a towel
Could wash hair separately
Alternatives
 Bath in a bag
 Towel bath
 Shampoo cap
Activities of Daily Living
 Bathing
 Hygiene
 Dressing
 Eating
 Toileting
Hygiene: Oral Care
Why?? Dental problems =
Decrease ability to eat
Effect speech and swallowing
Bad breath = decreased social
interaction
Poor overall health = ↑ risk of
pneumonia/stroke/poor glycemic control
Dental pain = increased behavior
problems
Oral Care
Determine which steps resident is able to do and
which require assistance
If they are independent, get them started: give
toothbrush, hands on guidance
Use non-foaming toothpaste (eg. Biotene)
Clean dentures
Regular dental check-ups
Hygiene: Hair Care
Why?
 Appearance
 Infection control
 Socially acceptable
Hair Care
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Choose hairstyle that is easy to care for
Salon or hairdresser may work better
Shampoo cap
For beards:
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Electric razor
• Barber
• Let beard grow if too difficult
Nail Care
Why?
 Appearance
 Scratching
 Infection control
Nail Care
 Check nail length
 May need foot care nurse
 Manicure from volunteers
 Check feet for circulation, calluses,
bunions, pain, wounds
 Proper shoes
Activities of Daily Living
 Bathing
 Hygiene
 Dressing
 Eating
 Toileting
Dressing
Seems very easy but when you break it down there
are many steps:
 Thinking about what you’re going to wear
 Choosing
 Deciding the correct order
 Putting the clothes on
May be overwhelming for person with dementia
Dressing
 Break process into manageable steps
 Limitations posed by health (arthritis,
coordination, balance, pain, tremors)
 Help where you need to but allow for
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Independence
Choice
Dignity
Control
Dressing Strategies
 Be flexible—do what works
 Choose 1 location-ie. room or bathroom
 Simplify-decrease number of clothes in closet
 Allow time –don’t rush
 Label drawers
 Check history,routine ie-did they get dressed
before breakfast?
Dressing Strategies –
Cont’d
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Make things easy, appropriate, familiar
Favorite items, ask family to buy more
Maintain privacy
Offer choices, cueing
Lay out clothing in the order it would be
put on
 Have clothing right side out
Clothing Options
 Modify clothing if necessary
 Elastic waistbands, easy to remove
 Velcro (? Used previously)
Activities of Daily Living
 Bathing
 Hygiene
 Dressing
 Eating
 Toileting
Eating
Significance
 Not just nutrition, social activity
 Associated with rituals
 Provides structure to the day
Eating
 Skills for eating may be lost
 Little awareness of etiquette involved
 No memory of how to eat, why, or
recognition of what they are eating
 Decreased senses: sight, hearing, taste
and smell
Eating
Things to consider:
 Teeth, broken teeth
 Sores in mouth
 Dentures, fit, wear them?
 Medications affect appetite
eg: antidepressants, antibiotics, narcotics,
NSAIDS, ASA
 Illness affects appetite (depression, anxiety,
infection)
Eating Strategies:
Resident
 Talk with the family about likes, dislikes and
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routines
Encourage the resident to eat on their own for as
much as they can and as long as they can
Be flexible
Recognize that resident may not want to eat or
accept food if they haven’t paid for it
Short attention span
Recognize eating problems are not the fault of
the resident but a progression of the disease
Eating Strategies: Table
 Keep table setting simple
 Remove unnecessary utensils
 Cutlery and dishes that are easy to hold
 Non-slip mats under dishes
 Contrasting color b/w table and setting
 Adaptive devices should be adult ones
 Clothing protectors not bibs
Eating Strategies:
Environment
 Adequate lighting: can they see what they
are eating?
 Decrease distraction, noise , conversation,
TV
 Be calm not hurried
Eating Strategies: Food
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Hot foods hot, cold foods cold
Favorites
Small pieces and servings/bite size
Finger foods to eat on the run
Portable liquids if possible
Provide apron or fanny pack with snacks
Frequent snacks instead of meals
If poor intake regular occurrence, consider
changing texture of foods
Assisting to Eat
 Tell them what you’re doing and what they’re
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eating
If resistive, go away and come back in 5
minutes
Sit down at resident’s level. If assisting 2
residents, sit b/w them
Cueing, hand over hand guidance
Feed slowly, don’t overload the spoon
Wait until the resident swallows
Activities of Daily Living
 Bathing
 Hygiene
 Dressing
 Eating
 Toileting
Toileting
Accidents may happen because:
 Gets to the bathroom too late
 Doesn’t recognize the bathroom
 Incontinence
 Too much fluid intake in evening
 Medications (Lasix)
Toileting Strategies
 Determine resident’s pattern
 Toileting routine
 If independent, is BR easy to find, recognizable,
well lit
 Commode or urinal in room & accessible
 Cover waste baskets, containers
 Watch for cues that resident need to go:
restless, fidgeting, pacing
Toileting Strategies
 Easy to remove clothing
 For men: decal inside toilet bowl so they
have something to aim at
 Cue with running water
 Privacy but stand nearby
 Quickly, quietly with only as many staff to
do the job
ADL Sheet
ADL SHEET 2
NAME:
BATH DAY: _________________
A.D.L. NEEDS:
AMCARE:______________________________________________________________
HS CARE:______________________________________________________________
 Dentures: ____________________________________________________________
 Glasses:______________________________________________________________
CONTINENCECARE:____________________________________________________
________________________________________________________________________
TRANSFER ASSISTANCE:_______________________________________________
________________________________________________________________________
SAFETY NEEDS:________________________________________________________
SPECIAL CREAMS:_____________________________________________________
HELPFUL HINTS:_______________________________________________________
________________________________________________________________________
________________________________________________________________________
Questions??