Friday, August 01, 2014

Wednesday, October 31, 2012 Yvette, Community Member, asks

Q: Good Morning My father-n-law lives with us has dementia and we are having such a hard time getting him to bath and not eat so much. Does anyone have any advise or tricks we can try?

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Answers (3)
Christine Kennard, Health Pro
11/ 1/12 9:57am

Hi Yvette

 

Thank you for your question. The problems you have are common ones. That does not necessarily make them any easier to deal with. You know you are trying to get your father in law to bath or eat because he needs to to keep him as fit and healthy, but he may well not be able to make a judgement on that.

 

I wrote this sharepost on 5 causes of difficult to manage behavior in people with Alzheimer's that I hope give you some ideas to work with.

 

A recent 'Question and answers' on how to get people with Alzheimer's to cooperate with issues of care such as personal hygeine and bathing will also point you in the right direction.

 

Each person who has Alzheimer's is an individual so solutions need to be geared towards their personality type and the degree of impaiment that the disease has inflicted on them. Routine, love and kindness, humour and adapting your caregiver approach will all help.

 

Seeking help through your local Alzheimer's Association who can provide information on local facilities, education and support groups may also be worth checking out.

 

All my best wishes

Christine

 

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NC, Community Member
11/ 4/12 2:53pm

This is common that the Alzheimer's patient with moderate stage would not want to bathe and also want to eat a lot of sweet cookies and etc. The person has lost his ability to understand what is the right thing to do for his health. He would be afraid of water temp. not knowing how to adjust it so he would not get burned. He also forgets the steps to take the shower/bath. You need to be in the bathroom to help him step by step. Set up the clothes in order first and make him sit on the bath bench at the bath tub, and then you will need to use a small towel to wash him with soap. Adjust the water so he can rinse with it. You need to do it for him.

It would be easier to tell him to get up and go to the bathroom for a shower before he gets dressed in the morning. This way you don't have to take his clothes off again and he would be upset about that. After the shower, you also need to help him to put his shirts/pants back on. Then put on his socks and shoes... He now needs help for daily activities.

About eating too much, first you make sure he eats his own portion for meals, and then hide the cookies or snacks away so he cannot find them. Give him enough and put away the rest. Sometimes he could go to the fridge to get some. Put them high up in the cabinets.

Don't argue with him because you cannot reason with him. You can only gently tell him that he needs to be washed and he eats enough now.

It is a lot of work. I would suggest that you hire part-time caregiver to help you out. Also home health nurse may be able to come to dress/bathe him once a week if he has medicare A/B.

 

Regards,
NC

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Carol Bradley Bursack, Health Guide
11/ 5/12 6:31am

Fantastic tips, as always, Nina. I really liked the idea of trying to get him to shower or bathe before he gets dressed in the morning. If a person can do that, it saves a lot of steps for both the caregiver and care receiver. And the person with dementia may not have had time to start obsessing about the bath process.

 

Take care,

Carol

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NC, Community Member
11/ 5/12 12:52pm

Thanks. Actually when my late FIL moved to the nursing home for dementia patients, they had the showers in the evening before or after early supper at 5pm.

He didn't like that but they were able to ask him to do so. I think one reason is that he was more polite to the outsiders and he was more demanding to home care crew or family members thinking he can be casual with family/home care people. It is sad that he had to behave differently this way but this way he was able to take a shower once a week. At least it worked. In late stage, some staff couldn't give him more showers each week. This thing was declining with the stage unfortunately - dehydration can make the patient smell bad as well. Sponge bath will do wonders too.

 

Regards,
NC

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Carol Bradley Bursack, Health Guide
11/ 5/12 12:59pm

You were flexible and learned as you went, Nina. We really value your input and tips. Thanks so much,

Carol

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NC, Community Member
11/ 5/12 12:54pm

Sometimes in end stage, sedative helps so the person would not be combative for toileting business.


Regards,

NC

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AFA Social Services, Health Guide
11/ 9/12 12:04pm

Like other activities of daily living, bathing can be difficult for individuals with Alzheimer's disease. Your father-in-law could be having difficulty with bathing due to several issues.  He may have forgotten how to undress, wash or dry.  He may be frightened about the bathtub surface or become disoriented to the people or place he is in. 

 

But there are ways to make the process easier for both caregivers and the person with the disease. My suggestions apply to bathing, but can be used to assist with other activities of daily living. Recognizing your loved one’s  abilities and preparing ahead of time can help simplify the process.  Try to follow the same bathing schedule you father-in-law had prior to the onset of the disease. For example, if he used to take a shower, not a bath, head for the shower. If he used to bathe in the morning, follow that routine. This is the rule of thumb unless he has specific hygiene needs or behavioral changes arise.  For example, adjustments may be necessary if he is severely agitated, wakes up soiled in the morning, or experiences behavioral problems, or "sundowning" as evening approaches. Also, you can try to utilizing a male caregiver to provide assistance, as he might feel more comfortable with the same gender.

 

It is also important to “set up the scene” in advance to make bathing seem less intimidating. For example, if your father-in-law thinks that another person might be in the room while seeing his own reflection, you should consider covering up the mirror. You can also dim the lights, play soft music, and turn on the hot water in advance to warm up the room. You also must consider privacy issues, as it is possible he feels uncomfortable being exposed. When in the shower, it can be helpful to wash one body part at a time, while keeping the rest covered to preserve his dignity. It is a good idea to use a handheld shower head as this can also prevent water from splashing directly into his face (which can be very frightening to a person with this illness). Allow him to take part in the process by encouraging him to wash himself. You can use his favorite scents in the tub that could help spark memories from the past. , try engaging her with activities and discussion throughout the process. Here is an example of a conversation you can have

 

Just remember to always be positive, patient and go at his pace. If you have exhausted all these options, and he continues to refuse to bathe, you may have to consider giving him sponge baths as an alternative.

 

Here are a few other helpful tips:

1-Give one-step instructions in short, simple terms, and go slowly

2-Make sure to communicate with non-verbal cues to help the individual understand

3-Remember to provide privacy, and ensure dignity for your mother throughout the whole process

4-Provide reassurance

5-Always approach from the front whenever possible

6-Make sure the room temperature is appropriate for disrobing

7-Keep your father-in-law in a bathrobe until in the bathing area

8-Lay out clothing in advance to proceed quickly from drying to dressing

 

Another concern you are having is his over-eating. Since your father-in-law is eating too much, it is imperative to consult his primary care physician to discuss this matter. It is important that he receives adequate nutrition and is maintaining a healthy, sufficient diet. The physician can run tests to determine if there are underlying medical reasons for his increased appetite, and possibly prescribe a treatment that can decrease his appetite. When he goes to his physician for an evaluation, ask his doctor if the medications he is on causes an increase in appetite. The doctor also might refer him to be seen by a dietician, to evaluate his caloric intake.

 

Your father-in-law has Alzheimer’s disease which has impaired his cognition. Your father-in-law might have forgotten when he ate last. He can also be eating out of boredom. He might not realize how much he is eating, and perhaps requires supervision to maintain a diet appropriate to his plan of care. Here are some helpful tips:

 

1-Control access to sweets by placing theme where he cannot reach or find them.

2-Give him healthy snacks in small portions throughout the day

3-Make sure he is hydrated, by giving him water

4-Plan activities to help to prevent boredom-related overeating.

 

For other ways to cope with activities of daily living, please check out http://carecrossroads.org/cms/index.php?option=com_content&view=article&id=8&Itemid=12

 

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By Yvette, Community Member— Last Modified: 11/09/12, First Published: 10/31/12