Managing Activities of Daily Living

GENERAL TIPS

• As memory and movement disorders advance there is frequently more need to assist with personal care.
• Talk first. When providing care for someone, speak their name and tell them what is about to happen before starting the activity.
• Provide encouragement and be positive about successes.
• Be careful to treat the person as an adult and not speak to them as a child.
• Establish a daily routine, performing activities of daily living (ADLs) at the same time and in the same place each day.
• Provide extra time to accomplish each ADL. Hurrying increases the stress for both the individual and the caregiver.
• Although it may take more time, allow the individual to participate as much as possible to preserve independence as able. It may seem easier to do ADLs for someone but preserving abilities as long as feasible helps to maintain physical strength and emotional health.
• Give simple step-by-step instructions. It may be necessary to give one step at a time.

EATING

• Encourage independence as much as possible. It may be necessary to pre-cut foods and avoid those that are difficult to manage with silverware such as soup and strands of spaghetti.
• Adaptive equipment such as partitioned plates and large handled silverware can help a person maintain independence with eating. Foam tubes can be placed over existing silverware to make gripping easier.
• For the visually impaired, provide color contrasts between the food, dinnerware, and surface.
• Finger foods such as slice of fruit, pieces of bread, and green beans can encourage self feeding while promoting nutrition. Be alert to all the possible foods that can be eaten by hand.
• Squeeze water bottles and accordion straws can make drinking easier.
• Use decorative napkins tucked in the shirt collar to protect clothing from staining. All diners at the table should do the same to promote inclusiveness.
• Do not force feed. Loss of the ability to sequence the steps associated with eating and loss of the swallow reflex may occur. If a person stops eating, call the provider for assistance.

BATHING

• Daily complete baths are rarely necessary and may be done twice or three times a week.
• Use the time during bathing to inspect the skin for any signs or irritation or rashes.
• Be sure the bathing area is warm and well-lit.
• Always check the temperature of the water before allowing the person to enter the bathing area.
• Never leave a confused or physically frail person alone in a shower or tub.
• If the person is able to enter a shower area, be sure there are non-skid pads on the shower floor, a chair and handrails. Very often a caregiver assisting with bathing is not in a position to break a fall or hold the weight of someone who is wet.
• Consider a handheld shower head to reduce the amount of standing and turning needed.
• Liquid pump soap is easier to use than bar soap.
• A long-handled sponge or soft brush can help the person reach calves, ankles and feet.
• Consider an exfoliating scrub with an elastic wrist band for improved cleansing and removal of dead skin cells.
• Allow the person to help as much as possible, remembering to leave lots of extra time to accomplish the ADL. The caregiver may need to place their hand on top of the individual’s hand and guide the washing action.
• Before transferring from the shower area, pat the skin dry; do not rub.
• Remove area rugs to prevent slip and falls when exiting the shower.
• Lotion may be applied to arms and legs.
• Sometimes a person resists bathing. This may be related to being naked in front of another person, especially if dementia is present. It may be necessary to keep body parts covered with towels or washcloths and only expose small areas at a time. Calm, reassuring and distracting conversation may be helpful.
• Each day cleanse the genital areas, folds of skin such as under the breasts, and any problematic areas. Disposable washcloths can help make daily cleansing easier.

HAIR CARE

• Wash hair over a sink especially if baths are preferred over showers.
• Use dry shampoo to reduce the number of actual hair washings. The powders help reduce oils but do not clean the scalp.
• Schedule a weekly trip to a salon or barbershop.
• Consider a short, simple hairstyle.

DRESSING

• Minimize choices with dressing. If the person can assist with deciding what to wear, consider laying out two complete outfits to choose from. As decision-making becomes more challenging, lay out one outfit for the person to wear.
• Choose clothing that is easy to put on and take off including shoes with Velcro fasteners, pants with elastic waistbands, and shirts without button fasteners.

MOUTH CARE

• It may be necessary to put the toothpaste on the brush then clean teeth together so the person can imitate the action they are seeing.
• If the person cannot brush their own teeth, they may clench them and resist the care. It is okay to only clean the outer surfaces if the person will not open their mouth completely. Be patient and calm. Smiling may relax the situation and expose the teeth for brushing.
• Clean dentures daily and check for proper fit. Examine the gums for signs of redness or sores.
• The person should rinse their mouth with water after every meal.
• Consult a dentist for any concerns including additional strategies to maintain dental health.

TOILETING

• Develop a toileting plan to avoid accidents including immediately after a meal for bowel movements and every couple of hours for urination.
• Evaluate the bathroom for safety and consider installing grab bars and an elevated toilet seat. Remove throw rugs.
• A urinal or a bedside commode can provide a safe alternative, especially at night.
• Read the website document Incontinence for more information.