Introduction

People with Alzheimer’s disease may need help with routine activities related to grooming and hygiene. This reliance on others can be very difficult for them because it signifies a loss of independence and privacy.

It is also difficult for caregivers, especially when they assist with activities that interfere with the individual’s privacy.

The following are tips for assisting with personal care that you can download and pass along to caregivers.

Bathing

Bathing is often the most difficult personal care activity that caregivers face. Because it is such an intimate experience, the person with Alzheimer’s may perceive it as unpleasant, threatening or painful and, in turn, exhibit disruptive behaviors such as screaming, resisting and hitting. These behaviors often occur because the person doesn’t know what bathing is for or doesn’t have the patience to endure such unpleasant aspects as lack of modesty, being cold or experiencing discomfort. Try the following:

• Do everything you can in advance to make the process easier, such as increasing the room temperature and having bath towels nearby.

• Make the person feel in control. Involve and coach him or her through each step of the process. You may need to experiment to determine if the individual prefers showers or tub baths and what time of day is best.

• Create a safe and pleasing atmosphere. Place nonslip adhesives on the floor surface and grab bars in the bathtub to prevent falls. Test water temperatures in advance to prevent burns.

• Respect the person’s dignity. Some individuals may be self-conscious about their nakedness. Allowing the person to hold a towel in front of the body, both in and out of the shower, may ease anxiety.

• Don’t worry about the frequency of bathing. It may not be necessary to bathe every day. Sponge baths can be effective between showers or baths.

• Be gentle. The person’s skin may be very sensitive, so avoid scrubbing and pat skin dry instead of rubbing.

• Be flexible. You may experience the most difficulty when attempting to wash the person’s hair. Use a washcloth to soap and rinse hair in the sink to reduce the amount of water on the person’s face.

Toileting

It is common for persons with Alzheimer’s disease to experience loss of bladder and/or bowel control. This can be caused by many factors, including medications, stress, a physical condition, the environment and the person’s clothing. If incontinence is a new problem, consult your doctor to rule out potential causes such as a urinary tract infection, weak pelvic muscles or medications. If the problem continues, try to:

• Provide visual cues. Signs may assist an individual in finding the bathroom. Placing colored rugs on the bathroom floor and lid covers on the toilet may help the bathroom stand out. Avoid having items nearby that can be mistaken for a toilet, such as a trash can.

• Monitor incontinence. Identify when accidents occur and plan accordingly. For example, if they happen every two hours, get the person to the bathroom before that time. To help control incontinence at night, limit the intake of liquids after dinner and in the evening.

• Remove obstacles. Make sure clothing is easy for the individual to remove.

• Provide reminders. People with Alzheimer’s often forget they need to use the bathroom periodically. Watch for visible cues such as restlessness or facial expressions that may indicate the person needs to use the bathroom.

• Be supportive. Help the person with Alzheimer’s retain a sense of dignity despite incontinence problems. A reassuring attitude will help lessen feelings of embarrassment.

Dental care

Good oral hygiene can be a challenge for individuals with Alzheimer’s. Brushing is sometimes difficult due to the individual’s inability to understand and accept assistance from others. To help the individual:

• Provide short, simple instructions. “Brush your teeth” may be too difficult. Instead, try: “hold your toothbrush,” “put paste on the brush,” and “brush your top teeth,” etc.

• Use a mirroring technique. Hold a brush and show the individual how to brush his or her teeth.

• Monitor daily oral care. Brush teeth or dentures after each meal, and floss daily. Remove and clean dentures every night, and brush the person’s gums and roof of the mouth. If the person refuses to open his or her mouth, try using oral hygiene aids available from your dentist to prop the mouth open. Strained facial expressions during dinner or refusal to eat may indicate oral discomfort.

Caregivers are essential in helping the person maintain oral hygiene, noticing any problems and seeking help from a dentist. Notify the dentist in advance that the person has Alzheimer’s, so that an oral care routine can be developed.

Dressing

Physical appearance contributes to everyone’s sense of self-esteem. Clothing can be a form of self-expression, so it’s important to consider the person’s tastes and dislikes. To help the person with dressing:

• Simplify choices. Each morning, offer two choices of shirts and pants for the individual. Keep the closet free of excess clothing.

• Organize the process. Lay out clothing in the order it needs to be put on, or hand the person each piece while giving short, simple instructions. Don’t rush the individual; it will only create anxiety.

• Be flexible. If the individual wants to wear the same outfit repeatedly, try getting a duplicate of the outfit or have similar options available.

• Choose comfortable and simple clothing. Cardigans or shirts that button in front are sometimes easier to work than pullover tops. Substitute Velcro™ for buttons, snaps or zippers that may be too difficult to handle. Make sure the individual has comfortable shoes that are not slippery.

With all personal care activities, it is important to incorporate the individual’s past routine whenever possible into the current one.

As you assist the person, be patient and creative. An approach that worked one day may not work the next, so be flexible.