Which action would the nurse take for an older client with alzheimer disease who has laid out

At some point, people with Alzheimer’s disease will need help bathing, combing their hair, brushing their teeth, and getting dressed. Because these are private activities, people may not want help. They may feel embarrassed about being naked in front of caregivers. They also may feel angry about not being able to care for themselves. These suggestions may help with everyday care.

Bathing

Helping someone with Alzheimer’s disease take a bath or shower can be one of the hardest things you do. Planning can help make bath time better for both of you. If the person is afraid of bathing, follow his or her lifelong bathing habits, such as doing the bath or shower in the morning or before going to bed.

Safety Tips

To keep the person with Alzheimer’s safe during bath time:

• Never leave a confused or frail person alone in the tub or shower.
• Always check the water temperature before he or she gets in the tub or shower.
• Use a hand-held showerhead.
• Use a rubber bath mat and safety bars in the tub.
• Use a sturdy shower chair to support a person who is unsteady and to prevent falls. You can buy shower chairs at drug stores and medical supply stores.

Before Bathing

Before starting a bath or shower:

• Get the soap, washcloth, towels, and shampoo ready.
• Make sure the bathroom is warm and well lighted.
• Play soft music if it helps to relax the person.
• Be matter-of-fact about bathing. Say, “It’s time for a bath now.” Don’t argue about the need for a bath or shower.
• Be gentle and respectful. Tell the person what you are going to do, step by step.
• Make sure the water temperature is comfortable.
• Don’t use bath oil. It can make the tub slippery and may cause urinary tract infections.

During a Bath or Shower

Allow the person with Alzheimer’s to do as much as possible. This protects his or her dignity and helps the person feel more in control. Here are other tips:

• Put a towel over the person’s shoulders or lap. This helps him or her feel less exposed. Then use a sponge or washcloth to clean under the towel.
• Distract the person by talking about something else if he or she becomes upset.
• Give the person a washcloth to hold. This makes it less likely that he or she will try to hit you.

After Bathing

Try these suggestions:

• Prevent rashes or infections by patting the person’s skin with a towel. Make sure the person is completely dry. Be sure to dry between folds of skin.
• If the person is incontinent, use a protective ointment, such as petroleum jelly, around the rectum, vagina, or penis.
• If the person has trouble getting in and out of the bathtub, do a sponge bath instead.

Other Bathing Tips

For most people, a full bath or shower two or three times a week is enough. Between full baths, a sponge bath to clean the face, hands, feet, underarms, and genitals is all you need to do every day. Also:

• Washing the person’s hair in the sink with a hose attachment may be easier than doing it in the shower or bathtub.
• Get professional help with bathing if it becomes too hard for you to do on your own.

Dressing

People with Alzheimer’s disease often need more time to dress. It can be hard for them to choose their clothes. They might wear the wrong clothing for the season. They also might wear colors that don’t go together or forget to put on a piece of clothing. Allow the person to dress on his or her own for as long as possible.

Other tips for dressing:

• Lay out clothes in the order the person should put them on, such as underwear first, then pants, then a shirt, and then a sweater.
• Hand the person one thing at a time, or give step-by-step dressing instructions.
• Put away some clothes in another room to reduce the number of choices. Keep only one or two outfits in the closet or dresser.
• Keep the closet locked if needed.
• Buy three or four sets of the same clothes if the person wants to wear the same clothing every day.
• Buy loose-fitting, comfortable clothing, such as sports bras, cotton socks and underwear, and sweat pants and shorts with elastic waistbands.
• Avoid girdles, control-top pantyhose, knee-high nylons, high heels, and tight socks.
• Use Velcro® tape or large zipper pulls for clothing instead of shoelaces, buttons, or buckles.
• Try slip-on shoes that won’t slide off or shoes with Velcro® straps.

Grooming

When people feel good about how they look, they often feel better. Helping people with Alzheimer’s disease brush their teeth, shave, put on makeup, and get dressed can help them feel more like themselves.

Mouth Care

Here are some tips to help the person with Alzheimer’s care for his or her teeth and mouth.

• Show the person how to brush his or her teeth. Go step by step. Remember to let the person do as much as possible.
• Brush your teeth at the same time.
• Help the person clean his or her dentures.
• Ask the person to rinse his or her mouth with water after each meal and use mouthwash once a day.
• Try a long-handled, angled, or electric toothbrush if you need to brush the person’s teeth.
• Take the person to see a dentist. Some dentists specialize in treating people with Alzheimer’s. Ask the dentist how often the person should be seen.

Other Grooming

Here are some other suggestions for grooming:

• Encourage a woman to wear makeup if she has always used it. If needed, help her put on powder and lipstick. Don’t use eye makeup.
• Encourage a man to shave, and help him as needed. Use an electric razor for safety.
• Take the person to the barber or beauty shop. Some barbers or hairstylists may come to your home.
• Keep the person’s nails clean and trimmed.

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For More Information About Caregiving and Activities of Daily Living

NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center 800-438-4380

Working with patients who are cognitively impaired presents an ongoing communication challenge. For instance, they likely will have trouble following any instructions about their care, including how and when to take prescriptions. Make sure someone can closely monitor care management, and try to involve a care partner whenever possible.

1. Try to address the patient directly, even if his or her cognitive capacity is diminished.
2. Gain the person's attention. Sit in front of and at the same level as him or her and maintain eye contact.
3. Speak distinctly and at a natural rate of speed. Resist the temptation to speak loudly.
4. Help orient the patient. Explain (or re-explain) who you are and what you will be doing.
5. If possible, meet in surroundings familiar to the patient. Consider having a family member or other familiar person present at first.
6. Support and reassure the patient. Acknowledge when responses are correct.
7. If the patient gropes for a word, gently provide assistance.
8. Make it clear that the encounter is not a "test" but rather a search for information to help the patient.
9. Use simple, direct wording. Present one question, instruction, or statement at a time.
10. If the patient hears you but does not understand you, rephrase your statement.
11. Although open-ended questions are advisable in most interview situations, patients with cognitive impairments often have difficulty coping with them. Consider using a yes-or-no or multiple-choice format.
12. Remember that many older people have hearing or vision problems, which can add to their confusion.
13. Consider having someone call the patient to follow up on instructions after outpatient visits.
14. If the patient can read, provide written instructions and other background information about the problem and options for solutions.
15. Address potential issues of driving, getting lost, and home safety each time you see the patient. And, encourage regular physical activity, social activity, hobbies, and intellectual stimulation, as well as a healthy diet. Some studies link these approaches to the maintenance of cognitive function.

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

Content reviewed: May 17, 2017