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10 February, 2010

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Dementia - how carers can help with dressing

Getting dressed can be a complex and overwhelming task for a person with dementia because there are so many steps involved. Helping a person with dementia to get dressed can be time consuming and emotionally exhausting, especially if the person is not cooperating. An approach that suits both the person with dementia and their carer is needed.

There are many reasons why a person with dementia might have problems dressing. These might include:

Physical or medical causes
Forgetting how to dress
Problems with the person’s environment
Lack of privacy
Problems making decisions.

Physical or medical causes
Depression or a physical illness can cause a loss of interest in personal hygiene. Changes may have occurred in gross motor skills, creating problems with balance or walking. The changes may be with fine motor skills, causing problems with fastening buttons or closing a zipper. The person with dementia may have impaired vision. The side effects of some drugs cause dizziness or stiff joints.

Things you can try:

Organise for the person with dementia to have a thorough medical examination to discover any possible causes or medication reactions contributing to problems with dressing.
Arrange to have the person with dementia’s vision or glasses checked.
Organise an evaluation for depression, particularly if the person is frequently unwilling to get up or get dressed in the morning.

Forgetting how to dress
Some people with dementia can’t remember whether they are getting dressed or undressed. In addition, they may forget to change their clothes, put them on in the wrong order or put on many layers of clothes. They may realise they have an item of clothing but have no idea which part of the body it goes on.

Things you can try:

Carefully prompt or remind the person to get dressed independently.
Set out clothes in a pile, with the first item to be put on at the top.
Try using the ‘task breakdown’ technique. This involves breaking the task into simple manageable steps and doing them one step at a time. The carer may have to gently remind the person with each step or may have to do several of the steps themselves. Reassurance and praise for each successful step may make the task more pleasurable for both the person with dementia and the carer.

Problems with the person’s environment
Noise, people, bright lights and clutter in the room can be distracting for the person with dementia when they are trying to get dressed.

Some older people, and especially those with dementia, have different temperature needs. Sometimes a carer may feel that it is oppressively hot inside the house while the person with dementia finds the temperature comfortable.

Things you can try:

Remove distracting items, such as out-of-season clothes.
Make sure the room is warm enough for the person with dementia.
Provide adequate lighting. Ensure the light in the wardrobe is at the same brightness as the light in the room, so that the person with dementia won’t have to get used to different light levels.

Lack of privacy
Getting dressed is a personal and private activity for most of us. Many people have never dressed or undressed in front of another person and this can be an uncomfortable experience.

When a person needs assistance, it also conveys the message that they are no longer able to care for themselves. This loss of independence can be difficult for the person with dementia to accept.

Things you can try:

Close the door and pull down blinds to create a feeling of privacy.
If the person is able to manage most of the tasks, it is far better to leave them to it and assist from a distance, intervening only when necessary.

Problems making decisions
People with dementia may find it difficult to make even simple decisions. However, they should be encouraged to select their own clothing.

Things you can try:

Simplify the number of choices; for example, offer two outfits to choose between or offer a choice between a white shirt or a blue shirt.
Lay out articles of clothing on the bed. They should be arranged in the order that they are put on.
Lay out lightly coloured clothing on a dark bedspread. For someone with vision problems, contrasting colours may help the person to clearly see articles of clothing against the background colour of the bedspread.

Wearing layers of clothing regardless of the weather
Judgement and the sensation of hot and cold can be impaired in some people with dementia. It is not uncommon for a person with dementia to wear layers of clothing regardless of the weather.

If the layers are not causing discomfort, it is easier to let the person wear the extra clothes. Try packing away extra clothing so that it is not visible.

Choosing clothing and footwear
Maintaining a person’s individuality and style of dress is very important. Introducing clothing that is very different from a person’s former style may cause problems. The following hints may help to manage any problems with dressing:

Select clothing that is washable and doesn’t need ironing or dry-cleaning.
Buttons, snaps, hooks, zippers and belt buckles are difficult to manage for some people. These can be replaced with Velcro tape, which can be purchased at any fabric store.
Busy, bright patterns on clothes can be distracting. Choose clothes with simple patterns and with solid contrasting colours, as these tend to be easier for many people to see.
Slip-on shoes are easier to put on than shoes with laces and ties. Make sure shoes have non-skid soles.

Wearing the same outfit day after day
A person with dementia may want to wear the same outfit day after day. Rather than arguing with the person, it is often better to buy a couple of the same outfits.

Note cultural changes
In past times, many people did not change their clothes as often as they do today. It is important that the carer does not impose their own values about how often clothes need to be changed.

Avoid embarrassment
Being reminded to change your clothes can be an embarrassing and humiliating experience. It is important to remember these feelings.

Maintain independence
Any extra time taken to maintain independence is well worth it. Being able to dress one’s self can make a person feel more independent and can also build up feelings of self-esteem.

Be sensitive
Some people with dementia may undress themselves frequently. This can be embarrassing and inconvenient, but it is important to remember that they may no longer understand what is appropriate and are not usually doing this to be provocative. Try to evaluate the situation:

Is the person dressed too warmly?
Do they need to go to the bathroom?
Are they tired and trying to get ready for bed?
Are they bored?

Support for families and carers
Dealing with a range of issues can be difficult for some people with dementia and their families and carers. If you would like further assistance or to speak to someone personally about your particular situation, you can contact Alzheimer’s Australia or the National Dementia Helpline on 1800 100 500.

The Dementia Behaviour Management Advisory Service (DBMAS) is a national telephone advisory service established to support carers and care workers of people with dementia who experience dementia-related behaviours. DBMAS provides 24-hour advice, assessment, intervention, education and specialised
support on 1800 699 799.

Where to get help

Your doctor
Your local community health service
Your local council
National Dementia Helpline Tel. 1800 100 500
Dementia Behaviour Management Advisory Service (DBMAS) Tel. 1800 699 799 – for 24-hour telephone advice for carers and care workers
Carer Respite Centre Tel. 1800 059 059
Carer Resource Centres Tel. 1800 242 636
Aged Care Assessment Services – contact your regional Department of Human Services office
Aged Care Information Line Tel. 1800 500 853

Things to remember

Getting dressed can be a complex task for a person with dementia.
Some people with dementia can’t remember whether they are getting dressed or undressed.
A loss of independence can be difficult to accept.

You might also be interested in:
Dementia - carers and activities.
Dementia - communication issues.
Dementia - early planning will help.
Dementia - how to encourage healthy eating.
Dementia - managing incontinence.
Dementia - safety issues.
Dementia - sexuality and intimacy.
Dementia - support services are available.
Dementia - through all its stages.
Dementia - when driving is dangerous.
Dementia and personal hygiene.
Dementia and sleeping problems.
Dementia and sundowning.
Dementia and travelling.
Dementia and wandering.
Dementia explained.

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