Hands-on care becomes inevitable as your loved one’s Alzheimer’s Disease progresses. People with Alzheimer’s Disease usually need help with home management activities such as meal preparation, budgeting, and traveling in the beginning. Eventually, self-care activities such as bathing, dressing, grooming, toileting, eating, and getting around will also be a challenge.
A cue is a prompt or reminder that assists an individual to begin and/or complete a task. Your loved one may only need a reminder of how to do something and then can take over. Let them do as much as they can on their own, but you can use these techniques to provide a helpful nudge during activities such as self-feeding, brushing hair, or washing a body part. Prompts or cues can help a person initiate, sequence, organize, plan, or do an activity.
This is a list of cues that can be helpful for the task of eating:
- Indirect verbal guidance – “What should you do next?”
- Gestural cue – Point to the fork
- Demonstration – Show them how to use the fork
- Direct verbal cue – iInstruct them to pick up the fork
- Hand over hand – place your hand over their hand and lead them in holding the fork and bringing it to their mouth to complete the motion of self-feeding
- Hand under hand – offer your hand to their dominant hand palm up just like you were going to shake their hand
- Other cues – Place a picture of someone eating with a fork in front of your loved one; put a mouthful of food on the fork
Below is a sample of how to approach a person with Alzheimer’s Disease for bathing. Bathing can be a challenging time and can often cause hostility, crying, arguments, and screaming, all of which should be avoided.
Consider your loved one’s bathing preferences. In the early stages of Alzheimer’s Disease, ask your client about their bathing preferences (a shower versus a bath) to provide them with as much control as possible. In late-stage Alzheimer’s Disease, a sponge bath is usually the least stressful option.
Below are several tips to make bathing easier as the stages progress:
- Make bathing a predictable daily routine by bathing at the same time each day.
- Warm up the bathroom to ensure that bathing is a pleasurable experience. If you are a bit sweaty and hot, then it is probably exactly the right temperature for your client. Lay a towel on the toilet seat for undressing and play soft, soothing music.
- Do not argue with your loved one about how long it has been since their last bath or how poor their hygiene is, since logic does not work. Speak in simple, short sentences and remind them of the positive and fun things to come after the bath or shower.
- When the bathroom is warm enough, approach your loved one, look them in the eye, and smile. Extend your hand so they will take it, get up, and let you walk with them to the bathroom.
- After you have started walking, say something like, “Let’s go shower now and then we’ll have a yummy snack (a vanilla cupcake, juice, etc.) and do something fun.” As you walk with your loved one, keep the conversation light and focused on the snack or fun activity to come. This helps avoid any discussion or argument about the shower. “Those vanilla cupcakes are your favorite, aren’t they? And we can work on that puzzle with the beautiful seashells on it.” A good resource for activities that individuals with Alzheimer’s Disease would like are dedicated Alzheimer’s stores. This way, the snack and/or the puzzle helps them associate showering with something enjoyable and positive.
- Say “we” not “you” in a calming tone as it gives them the feeling this is a relaxing activity both of you can do together, and they are not alone during it.
- Use a hand-held shower head with a valve shut-off so you can control when and where the water goes. The water from a standard shower head may make your client feel like something invisible is attacking their head because they cannot see it. Before turning on the water, get them comfortably seated on the shower chair and turn the shower head toward them while pointing it at foot level.
- At every step, inform your loved one of what is going on and what will happen next so nothing is a surprise. Guide them to do as much as possible so they feel in control and more confident. You could say, “Let’s rub the soap on your back now. That is great. Now we’ll rinse the soap away.”
- Use extra towels for warmth, comfort, and privacy. Cover parts of your loved one that are not being washed for additional warmth. Warm the towels with additional sprays of water.
- After bathing, immediately wrap your loved one front to back in two large, dry towels so they will not get chilled. If warming the towels in the dryer is possible, that would be very pleasurable for your loved one. Drying can be done while they are sitting on the shower chair before moving out of the tub.
Modifications for further stages of AD
Simplifying tasks becomes especially important as a person enters the moderate to severe stages of Alzheimer’s Disease. These modifications make tasks easier to perform by reducing the number of steps involved, making the sequence of steps clearer, or making it not problematic if the steps are completed incorrectly. Gitlin and Piersol suggest the following activities for further engagement in their surroundings and self-care:
- Introduce activities that are repetitive and use the same motion, such as sweeping, raking, and dusting
- Give short instructions with only two or three words
- Use pictures or labels to identify objects in rooms
- Keep talking to your loved one when they are doing something so they know what to do
- Place items out in the order they need to be used
- Provide rest breaks or quiet time
- Take your loved one’s arm to get them to go somewhere with you
- Keep things your loved one likes to use, look at, or touch within reach
- Put items that are needed by your loved one in a place where they will notice them
- Remove visible items that do not pertain to the task in process
- Use pictures to help your loved one remember what to do
- Use bright colors or signs to help your loved one notice an item
- Use clothing that is easy to put on or take off
- Have your loved one do simple chores such as folding laundry, making beds, or drying dishes
- Try to ignore your loved one’s mistakes
- Plan a routine for your loved one and try to stick to it
- Use an intercom or other monitoring device to supervise your loved one when they are in another room
A Caregiver’s Guide to Dementia by Laura N. Gitlin and Catherine Verrier Piersol, 2014