Home Modification Resources

Booklet: Environmental Coping Srategies for Alzheimer's Caregivers

PART VIII. BEHAVIORAL PROBLEMS: Personal Hygiene

The person with Alzheimer's Disease will be able to care for themselves in the early stages of the disease but may gradually begin to neglect themselves and may eventually need total help. Problems may arise in getting person to change clothes, bathe, brush teeth and groom self.

1. DRESSING. INAPPROPRIATE CHOICE OF CLOTHING OR LACK OF INTEREST IN DRESSING:

Possible Underlying Causes:

Confusion resulting from multiple choices; reduced ability to distinguish colors; depression/apathy; embarrassment, loss of independence.

Possible Modifications: IMAGE::Clothing arranged in sequence on bed such that the underware and the socks are near each other, followed by the pants, and lastly the shirt.

Reduce choices in color and style and in matching tops and bottoms.
Remove clothing that is seldom used.
Arrange clothing by color and in a sequence to make decision-making easier.
Provide a mirror in room for person to view self. If the person's reflection is disturbing to him/her, the mirror should be removed.

2. DRESSlNG. DIFFICULTY WITH THE MECHANICS OF DRESSING:

Possible Underlying Causes:

Memory loss; lack of coordination; difficulty remembering the steps; arthritis.

Possible Modifications:

Provide clothing with velcro closings, front closings, large zippers and with few buttons. The use of pull-on, two-piece exercise suits or loose clothing are easy to handle.

3. BATHING. RESISTANCE TO BATHING:

Problems often arise in getting a person to take a bath because of decreased interest in personal hygiene or increased fears or phobia about water and bathing activity.

Possible Underlying Causes:

Resistance to bathing may come from embarrassment; fear of water; fear of getting in and out of bathtub; lack of interest; inability to remember how long it has been since last bathed; apathy; depression or loss of desire.

Possible Modifications: IMAGE::Picture of woman bathing with bubbles.

Arrange implements in order they are to be used: soap, washcloth and towel can be laid out in sequence.
Check water temperature and depth of water in the tub. (Keep lower than normal levels).
Try bathing products like bubble bath, gels.
Remove lock on the bathroom door or deactivate.
Post bathing schedule on calendar of daily events.

4. BATHING. DIFFICULTY WITH MECHANICS OF BATHING:

IMAGE::Picture of a bath tub with hand rails, a small stool, strips on tub floor to prevent slipping, hand held shower, and no enclosure. Possible Underlying Causes:

Reduced strength and balance; fear of falling.

Possible Modifications:

Provide grab bars and skid proof strips on bottom of bathtub or shower.
Provide bath bench if difficulty in sitting or standing.
Provide hand-held shower for ease in washing or long handled bathbrush.
Place towel on edge of bathtub for slippery hands.
Use "soap on a rope" for ease in handling soap.
If bathtub has a glass enclosure, consider removing it for easier access into tub.
Make sure the floor is non-slippery. If a throw rug is being used, it should be firmly secured to the floor.
Consider the use of wall-to-wall carpeting.

5. GROOMING. DIFFICULTY OR RESISTANCE:

Many personal care activities are complex and require a number of steps and therefore should be simplified to support the person's functioning level. Reduced coordination and/or chronic limitations (e.g., arthritis) may also affect the person's ability or interest in grooming. Personal care related to putting on makeup, brushing hair, oral hygiene, nail care and shaving may require the assistance of the caregiver as the person may not have the motor skills or memory to carry out these activities.

Possible Underlying Causes:

Lack of motor skills, confusion as to sequence of task; depression; embarrassment.

Possible Modifications:

Keep bathroom area uncluttered and simple with only necessary items left out.
Lay out all implements in sequence (e.g., brush, comb, mirror).
Place simple instructions next to bathroom mirror outlining steps. You might also put a picture of procedure next to direction (e.g., for brushing hair, a picture of person brushing hair).
Install telescoping magnifying mirror to make viewing easier.
If person has problem gripping or using grooming products because of arthritis or limited strength, there are many aids available that provide a better grip or reduce the need to twist or bend (e.g., comb that bends).

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