Gerontology 130
Working with the Frail Elderly
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Gerontology 130 |
UNIT 8Personal Care |
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The person with Alzheimer's disease can be combative or resistant to care. Making the experience as pleasurable as possible can eliminate fear or embarrassment while maintaining the dignity of the individual is extremely important. It is essential that the person with dementia care for him/herself as much as possible—even though this can take an extremely long period of time. This can sometimes be frustrating for the caregiver who is on a schedule, whose patience is thin, or who is trying to persuade a person who does not understand what he/she is supposed to do. Research substantiates that a person's ability to perform activities of daily living (ADL'S) such as bathing, dressing, grooming, toileting, eating, and ambulation influences a person's quality of life and need for services. As chronic problems persist however, the activities of daily living become difficult to complete without direct assistance from the caregiver.
As the disease progresses, the functional (dressing, bathing, toileting, etc.) abilities of an Alzheimer's patient declines in a predictable order. J. Cohen-Mansfield, J. Werner, and S. Resiburg, (Journal of the American Geriatrics Society, 1996), note "that bathing, dressing, grooming, toileting, walking, and eating often decline in that order." (Management of Challenging Behaviors In Dementia (2000) Mahoney, Ellen; Volicer, Ladislav; Hurley, Ann. Health Professions Press, Baltimore, MD., p. 83). For this reason, it is essential that elderly individuals are encouraged to participate in the activities of daily living for also long as possible.
To find out why individuals are resistant to bathing, dressing or feeding him/herself is like being a detective. There may be physical, medical, emotional, or environmental reasons that individuals with Alzheimer's react negatively. These reasons may include: (Caring for People with Alzheimer's Disease (1995) Andresen, Gayle. Health Professions Press, Baltimore, MD. p. 52)
To cope with these reactions, a caregiver may consider some or all of the following strategies when helping a person bathe:
In addition to suggestions above, a caregiver must be sensitive to the fact that at some level the person's with dementia may realize that they aren't able to perform tasks anymore due to memory problems. This is frustrating and can lead to angry outbursts. Not being able to care for one's own needs is a humiliating experience. In the later stages of dementia, individuals are not able to feed themselves or have difficulty swallowing. They may forget how to use a spoon or fork, or they forget that they have just eaten a sandwich and want to eat again. These create frustrating situations.
Practical suggestions for feeding include:
For individuals that overeat or have insatiable hunger, provide five or six small meals per day and try to distract them with activities, walks or exercise. For individuals who are losing weight, try milk shakes, ice cream or pudding. When feeding an individual, it is important to focus the attention on the him/her rather than socializing with other individuals.
Treating the person with respect by providing limited choices is essential when caring for an elderly person. Some of the strategies below can help when dressing an individual:
In the later stages of Alzheimer's, individuals may lose their bladder and bowel functions. To help monitor these issues, caregivers may want to consider the following:
Not all the strategies will work, and what works one day may not work the next. It is important for individuals to remember the following general principles:
pp. 175-236, It Takes More than Love: A Practical Guide to Taking Care of An Aging Adult (2000), by Anita G. Beckerman, and Ruth M. Tappen. Health Professions Press, Baltimore, Md.
Review the following websites or equivalent resources and read information regarding "Hygiene and Personal Care":
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