Welcome to Alicia’s monthly advice column where she’ll provide tips on caring for a loved one with dementia. Alicia Seaver is the Director of Memory Care at Bridges® by EPOCH and is a certified memory impairment specialist. This month’s topic is personal care.
Most of us adhere to personal care routines in the mornings: rise when the alarm rings, use the bathroom, eat breakfast, brush teeth, take a shower, get dressed. We’ve followed the same routines for years, and we no longer give them any thought. For people living with dementia, however, maintaining routines that were once automatic can become a challenge.
As physical abilities decline, people with dementia may no longer be able to get out of bed or clean themselves without assistance. They may also forget important steps for seemingly simple activities such as dressing, putting on shoes before socks or pants before underwear. Due to sleep disturbances and sundowning, they may also have trouble rising from bed at a certain time every day. Despite these challenges, it’s important to establish a personal care routine and daily plan for your loved one so you both have more time to focus on meaningful, life-enhancing activities throughout the day.
Bathing and toileting
Bathing and toileting are intimate experiences, so these may be the most challenging parts of your loved one’s routine. Create positive associations by preceding bath time with an activity they enjoy, or by incorporating an enjoyable activity (such as listening to music) into bath time. It also helps if the bathroom is a visually soothing place for your loved one — add decorations in their favorite colors and hang photos of familiar faces on the wall.
Prepare the bathroom ahead of time so your loved one can safely help themselves as much as possible. Remove obstacles, set out colorful non-slip mats, and have chairs or bars for support if needed. Use as little water as necessary if you’re drawing a bath, as the sensory experience of entering water can cause distress or confusion, and make sure the water is your loved one’s preferred temperature. It’s also advisable to draw the bath before your loved one enters the bathroom, as the loud sound of running water can cause distress.
Coach your loved one through bathing, but allow them to participate in the shampooing and soaping. Provide a curtain or towel for modesty. It’s often more comfortable for your loved one to use a terry cloth robe to dry off instead of a towel. If they refuse to bathe, distract them with another activity and try again 15 minutes later. If the refusal is persistent and you are worried about hygiene, consider using No Rinse products in the meantime.
Toileting can often be done privately. However, if assistance is needed, be supportive and help your loved one maintain their modesty. If your loved one has accidents, reduce liquids before bedtime, buy a bedside toilet, or consider the use of adult briefs or padded undergarments.
Dressing
Getting dressed can be an overwhelming task due to a variety of clothing options and the multiple steps involved. Keep only a few clothing options in your loved one’s closet, and try to minimize patterns in favor of solids. Buy multiples of their favorite articles of clothing or close replicas, as this will allow you to wash dirty sets while they wear the clean set. Lay their clothes out in a logical order so steps are easy to follow. Remember that their clothing choices are a form of self-expression and allow them to wear what they want as long as its weather-appropriate.
Grooming
Your loved one may forget how to brush their hair or teeth. Perform these activities alongside them so they can easily mimic you. Replace dangerous items like nail clippers with cardboard nail files or razors with electric shavers, but be sure to still monitor the use of these items to avoid accident or injury. For teeth brushing, provide an easy-to-grip manual toothbrush and apply the toothpaste for them (make sure it’s a flavor they enjoy — preferably it should be the same toothpaste they’ve always used). Be sure to clean their dentures regularly and schedule visits to the dentist at least twice yearly, making sure the dentist knows ahead of time that your loved one has dementia. Depending on the dentist’s capabilities and the stage of dementia your loved one is in, you might even consider switching to a geriatric dentist.
Scheduling
Remain flexible when implementing a daily care routine. Writing out the routine and hanging it on the wall somewhere prominent can serve as a good reminder for your loved one, and implementing bedtimes and rise times can make the routine easier to follow as well.
Above all, be easy on both yourself and your loved one regarding personal care — it can be a difficult, emotionally-charged area for both parties to navigate, and patience, gentle persistence and creativity can go a long way. Please reach out to me if you have questions or concerns regarding your loved one’s personal care habits — I’d love to hear from you.
If there is a topic you would like Alicia to discuss, please send suggestions to [email protected].