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Personal
Care
The
brain is extraordinarily complex. It is made up of several
distinct parts, each with its own function. While these
parts are separate, they must work together to complete
the simplest task. As Alzheimer's disease affects each
area of the brain, certain functions or abilities can
be lost. One link in the chain of events may be missing
and the person will need help or a coping mechanism to
complete the task. It is important for caregivers to
remember that changes in a person's behaviour may be
related to the disease process.
Grooming
Each
person develops particular routines of grooming and most
of what we do to improve our appearance is done in private
or, at least, independently. As Alzheimer's disease changes
all aspects of a person's life, it also changes a person's
approach to his/her appearance and habits of grooming.
Where
to begin
As
a caregiver, you need to become a problem solver as you
deal day to day with the effects of Alzheimer's disease.
Understanding the disease can also lead to possible solutions.
For example, when the part of the brain that controls
sequencing is damaged, the person with the disease has
difficulty putting clothing on in the right order. Or
when the part of the brain that initiates an activity
is damaged, the person needs assistance in starting a
task. Other times a person can look at an item, such
as a hairbrush, and not recognize it. The following suggestions
may help you to find a way to assist the person with
Alzheimer's disease:
Consider
the person
- Are
there medical problems that contribute to a lack of
interest that could be treated (e.g., depression)?
- Does
the person know what to do with a brush or a face cloth?
- Does
memory loss cause the person to forget what he/she is
doing before completing the task?
- Is
there resistance to being helped?
- Is
vision impaired? Can the person see how he/she looks or
if there is dirt somewhere?
- Are
decisions difficult to make, for example, too many
choices about what to wear?
- Does
the person feel rushed?
Consider
the environment
- Is
the lighting adequate?
- Are
there distractions in the room, for example, noise,
people, clutter?
- Is
there privacy?
And
yourself, the caregiver
- Does
your presence cause embarrassment?
- Are
you rushed?
- Are
your instructions clear?
- Are
you being too fussy? Are you trying to maintain a standard
of appearance that is adding unnecessary stress to
both you and the person you are caring for?
What
to try
Whether
you figure out a specific reason for the problem or not,
there are a number of things you can try to make grooming
activities easier and more pleasant.
In
general
- Make
sure the setting is quiet and private with adequate
lighting.
- Examine
the task and break it down into simple steps. Allow
the person to do as many of the steps as possible.
- Prepare.
Have everything that is needed at hand: soap, towels,
brush, etc.
- Give
instructions one at a time.
- Do
not rush the task, allow plenty of time.
- Whenever
possible, give visual cues as well as verbal instructions.
For example, when saying, "It is now time to brush
your teeth," hand the toothbrush to the person.
- Demonstrate.
It can sometimes prompt the individual to begin the
task him/herself. For example, the person may begin to
comb his/her own hair by watching you comb yours.
- Consider
your own attitude to appearance. What is important?
Oral
care
Proper
oral care is important to prevent tooth decay and gum
disease. Poor dental health will also affect an individual's
ability and willingness to eat. It is wise to have a
complete dental examination early in the disease. Ask
the dentist to schedule appointments at times when there
will be no delay at the office. At home, the following
tips might be helpful:
- Remind
the person to brush twice a day with a soft-bristled
toothbrush and fluoridated toothpaste. Give step-by-step
instructions, or try "hands-on" guidance
or gestures.
- Try
fluoride swabs if the toothbrush is refused.
- Remove
partial dentures before cleaning natural teeth.
- Remove
dentures at bedtime and clean with a firm brush. Place
them in water overnight.
- Make
sure dentures are well identified to prevent misplacement.
To prevent damage when cleaning, make sure the sink
is filled or the drain is closed and the toilet lid
is shut.
- If
the person develops "dry mouth," try sugarless
candies or gum to increase the flow of saliva.
Hair
care
Clean,
well-groomed hair will make a person with Alzheimer's disease
look and feel better. It will likely help his/her caregiver
feel better too.
- Choose
a hairstyle that is easy to care for.
- Encourage
the person to comb her own hair, if necessary give
step-by-step instructions, or a cue, for example, place
comb in person's hand or start combing your own hair.
- Try
a dry shampoo if washing hair is difficult.
- Try
a scalp massage when washing -- it may be soothing.
- A
salon or barbershop can be a familiar and relaxed setting.
Make the stylist aware that the person has Alzheimer's disease. If the person feels insecure, you may want
to stay with him/her; or try to find a stylist to come
into the home to cut or style hair.
Skin
care
As
a person ages, skin becomes more delicate and needs a
little extra care beyond a wash. Creams or lotions can
help the skin and may be necessary in the prevention
of skin breakdown for those who are inactive. The application
itself can also have a pleasantly soothing effect.
- Use
a damp cloth or a "hasti-wipe" for cleaning
hands and face. This may be easier than a basin-soap
routine.
- Use
a favourite scent for soap or lotion.
- Massage
or stroke when applying cream or lotion.
- If
applying lotion is soothing, try it at a time of day
when the person is more likely to be restless.
Foot
care
As
people age, foot care is often neglected because people
can no longer reach their feet comfortably, and they
often can't see to provide proper nail care. This task
can be more of a challenge if the person has Alzheimer's disease. The following suggestions may assist you.
- Check
the person's feet on a regular basis. Look for discoloration
that might be a sign of circulatory problems. Check
for callouses or bunions or nail problems that might
cause foot pain. Report any findings to the doctor.
- Check
nail length. Be careful with nail clippers and scissors.
If you are uncomfortable trimming nails, arrange to
have this done at a foot clinic or have a professional
come to the house.
- After
bathing, make sure skin between the toes is clean and
dry.
- While
checking the person's feet, take the opportunity to
provide comfort by giving a foot massage with scented
lotions.
Dressing
- Whenever
possible, allow the person to choose the clothing to
be worn that day. Limit the number of choices to make
the decision easier.
- Lay
out clothing in the order that it should be put on.
- Remove
extra clothing from the closet. Seeing a lot of clothing
can be confusing.
- If
the person insists on wearing the same clothes every
day, try to launder these clothes often or get duplicates
of favourite outfits.
- Choose
clothing that is easy to wear and care for. Zippers
and velcro are easier to fasten than buttons. Skirts
and pants with elastic bands are easier to put on.
- Label
(or use pictures from magazines) to describe the contents
of dresser drawers. For some people it may be helpful
to group items of the same colour or ones that are
worn together.
- Hang
ties, belts or other accessories on a hanger with the
matching shirt, dress or pants.
Especially
for women
- The
application of make-up may be a regular and important
part of the grooming routine. Once again, try to simplify
and allow the person to do as much as possible for
herself. For some women, beauty treatments give particular
pleasure.
- A
manicure can help overall grooming and also be a source
of pleasant touching and stimulation.
And
for men
- Use
an electric razor.
- Consider
the time of day. It may be best to shave at a regular
time, or at a time when he seems most willing. These
may vary from day to day.
- Try
going to a barber for a shave, or find one who will
come into the home.
- Let
the beard grow, if shaving becomes difficult.
Day
to day
We
all want to look good and feel good. Some days grooming
routines can be accomplished with little or no effort.
Other days, every task may seem like a challenge. On
those days, a caregiver has a choice: which task is worth
the effort and which is not? You may choose to do only
the essentials -- sufficient clothing to keep warm, enough
cleaning to ensure basic hygiene. Just do what is possible.
A little untidiness -- or dirt -- never hurt anyone.
It is important to remember that you are doing the best
you can.
In
addition
We
are learning more about Alzheimer's disease and its care
everyday -- much of it from caregivers like yourself
who find solutions to problems and share them with others.
You can call your local
Alzheimer Society to find resources in your community.
You can also exchange ideas by visiting the Forums.
There is information. There is help. You are not alone.
Resources:
- The
Alzheimer Journey, Module 4, Understanding Alzheimer Disease: The link between brain and behaviour,
video and workbook series, the Alzheimer Society of
Canada, 2002.
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