I prepare the morning ritual with notes and signs. I prepare by helping him brush his teeth and comb his hair, and by organizing his clothes so selecting is easy. I prepare and prepare, and because I’ve prepared, he can feel like himself. The ritual is preserved.
Our appearance helps express who we are, and self-maintenance is unfortunately something else that slips away for someone with Alzheimer’s or related dementia. As dementia progresses through stages, dressing and grooming (tasks including brushing teeth, shaving, and combing hair) become harder. Someone with dementia can look at a nail clipper, comb, or toothbrush and not have any idea what it’s for.
Which problems pop up while grooming depends on which parts of the brain are affected by the disease. If the part of the brain that can follow a sequence of steps is affected, you may have to remind your loved one at each step of a grooming task. If there is a moment of faltering (these moments increase as the disease advances), demonstrate how to do it yourself, and cue your loved on along to get as much participation as possible.
If you’re caregiving for a loved one with dementia, you must pay attention to how they dress. Someone with Alzheimer’s might wear inappropriate clothing, like a sweater in summer, or might wear clothes backwards or otherwise incorrectly. Eventually, your loved one may not know when or how to dress. Expect questions like “Which drawer are my sock in?” or “Where are my shoes?” Finding clothing becomes hard.
You can help.
As with so much else in caregiving, routine makes tasks easier. Cleaning, shaving, dressing, brushing, etc. should all happen around the same time daily. The more you stick to routine, the less your help will be necessary.
Continue to allow the use of favorite products, though you may need to replace grooming tools with something simpler and safer.
When help inevitably becomes necessary, offer reminders of what to do next. You could demonstrate the grooming task and encourage your loved one to do the same thing. If you need to physically step up and help, try the hand-under-hand technique.
With all these grooming tasks that follow, your loved one may simply need reminders in the early dementia stages and be able to act alone. As the disease progresses, you’ll have to help more and more.
Keep hairstyles short and simple. Remind how to do something like comb, and if necessary, guide the hand. You may be able to let go, to see if your loved can take over the action.
Use minimal to no makeup for women.
Trips to the barber or salon can be fun and empowering, if your loved one can handle a change in scenery. When dementia worsens, there are barbers who will pay house calls. Memory care and assisted living residences will often have a hairdresser in house.
Cuts indicate that you may need to take over shaving. If you use a safety razor, place a towel under the chin to catch water. Wet the whole beard with a wet towel, and apply shaving cream. Shave with the grain, in the direction the hair grows. Short strokes. Be gentle over sensitive spots. Rinse with a fresh wet cloth and dry the skin. After-shave is optional.
If your loved one likes an electric razor, he can probably continue shaving himself longer before you step in. Consider pre-shave lotion for electric razors. Use firm circular motions. A good way to reduce anxiety about using an electric razor is to put a second electric razor in your loved one’s hand and turn it on. He may connect with what you’re doing through the vibration.
People with dementia often misplace eyeglasses, so always keep them in the same place when not in use. You’ll probably need to remind your loved one to put on glasses, then need to help, and ultimately put them on that person yourself. Use eyeglass holders / cords such as Croakies that allow their glasses to fall around their necks when not in use.
Don’t skip glasses; better vision makes mobility safer and delivers important stimulation to the brain and of course, reduces disorientation.
Glaucoma and cataracts are common problems that need to be detected and treated to prevent blindness. Regular eye doctor checkups are important for as long as possible.
In the early stage of dementia, mouth care is usually no problem. Brush your teeth at the same time, to help by showing.
Brush in the morning and at night, and rinse with water after every meal.
Eventually, reminders to brush teeth may be necessary, until you’re helping with the brushing yourself. Use a moistened gauze pad to clean the gums. This is probably easiest from behind (see video link above). Long, angled toothbrushes are best for this. Also look for redness, sores, loose teeth, or swelling. Alert a doctor or dentist if you find anything concerning.
Unexplained irritability or refusal to eat may indicate a dental or medical issue.
Help clean dentures, and don’t lose them. Like glasses, people with dementia frequently misplace dentures. Put them in the same place when they’re not in use. Keep them in when your loved one’s awake, because dentures are important for proper digestion. Reminders eventually may not be enough, and you’ll need to help insert dentures.
If brushing your loved one’s teeth, consider an assisted brushing toothbrush, a brush specifically designed with a grip and angles to optimize cleaning.
In addition to forgetting how to do it, elderly people can have a difficult time reaching or seeing their own feet, and balance and dexterity become a problem. Establish a regular routine for trimming nails and help as needed. While helping, watch for swollen spots or discolorations that might indicate a problem like bunions or calluses. It is important to catch and treat foot problems early, before they worsen.
Don’t let your loved one stay in their pajamas all day.
Encouragement and compliments can help your loved one continue with the daily ritual of dressing. Your job, at first, is to be like a cheerleader, so this task can boost self-esteem and mood. Be sure to allot plenty of time, to avoid creating anxiety and frustration.
Organize for success. Tape pictures on closets and drawers. Pictures showing what’s inside closets and drawers provide a visual reminder of what’s inside, helping your loved one find the right item.
Clean out closets and dressers, to avoid having too many choices of jackets, shoes, pants, and other clothes items. With less clutter and clothing, the dressing routine becomes easier. Completely remove out-of-season clothes that aren’t appropriate for the weather.
Give your loved one a couple options to choose from, because choice equals control.
Lay out clothes for each day, in the order they should be put on (underwear first, then pants, etc.).
Labeling can also help; for instance, you can put a note on top of pajamas that says “Pajamas to put on after dinner when it gets dark outside.” Eventually, you may need to hand each clothing item one at a time, and prompt each step. Be specific about where arms, head and legs go.
With advanced dementia, you may have to physically dress your loved one. Remember to describe what you are doing, and ask for help so there’s as much cooperation as possible. It is still worthwhile to present a couple options for tops and pants.
If your loved one wants to wear the same outfit all the time, consider buying more of those items.