EARLY SIGN OF DEMENTIA – GRANDPA WEARS SWEAT SUIT TO HOLIDAY DINNER

Where is grand-pa? All the family were comparing notes, before dinner, on Thanksgiving. “Did you talk to Dad?” “Did he seem to understand where to go and what time?”  And so the conversation went, while the sisters were getting ready to put the dinner on the table. Then right before dinner time, there was the door bell, and the sound of Grandpa letting himself in.

There was Grandpa, smiling, joking and also sporting his old grey sweat suit. On closer inspection he hadn’t shaved, his hair looked greasy, and he was covered in dog hair. When asked by one of his son-in-laws why he was wearing a sweat suit for Thanksgiving, he gave his now customary response. “This is so comfortable,” “This is so warm,” and ” I am afraid of catching cold.”

When asked why he didn’t go to church that morning, it became clear that it was just too hard to get out of that sweat suit, too much trouble. Once again it is just too comfortable, and warm.

Once dressed the confused elder has a sense of security, feeling put together. And more mentally together as well, as the favorite outfit now becomes a security blanket. And what could be more secure than the feel of  fleece, the feel of a sweat suit. So the confused elder then begins to resist bathing, getting into pajamas or even changing that sweat suit for a clean one.

This chosen outfit is then worn everyday, to eat in, sleep in, work in, relax in, for every season, and on every occasion. Grand-pa doesn’t know that he is wearing his confusion out there, for everyone to see.

So for this family as well as for many families during the holidays, the private conversations turn to “how bad is Dad?” “Should we be doing something?” “Is it time for him to go to a nursing home?”

No, its not time yet. Grand-pa drove himself over, seems to only drive with-in a few miles of his home, and has had no accidents. He is able to monitor his gas, and maintain his very old car. He appears well fed, so he must still be able to get his own food.

What can be done now, is to keep in close touch with him. Get in the habit of calling frequently, asking what he has eaten, where he has gone, and what he is doing. Make sure that he is able to use his telephone and that it is user friendly. Go to his house and make sure he has an adequate amount of fire alarms, especially one in the kitchen and by the clothes drier. Get in a schedule of checking the batteries for those alarms. Look at his kitchen items for any signs of burning.

Look carefully around the house for tripping hazards and move furniture to create clear walk ways. If clutter is beginning to be a problem, ask for some of the things instead of suggesting throwing things away.

Get more people involved. Start having food delivered, especially grocery staples. Start having a cleaning service come in  on a regular schedule. The important thing is to start these services, so the confused elder gets used to having these people around. Then, over time, these services can be increased as needed.

As annoying as the Thanksgiving sweat suit can be, it is really just a sign of things to come, and a sign it is time to plan.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

WHEN THE ELDER CAN NO LONGER GET INTO A BATHTUB TRY – A STAND-UP SINK BATH

EQUIPMENT:

  • Elder’s personal soap
  • Incontinent product/underwear
  • Deodorant
  • Comb/brush
  • Electric razor/straight razor
  • Clothes
  • Elder’s personal lotion
  • Shoes
  • Personal items – watch / hair assessories/jewellery

SET-UP:

  • Two wash cloths – one to soap and one to rinse
  • Towels
  • Anti-slip mat

Run water until it is warm, plug sink – continue to run small amount of warm water to rinse

THIS BATH MAY BE CONDUCTED WITH THE ELDER’S UNDERWEAR ON – WHEN BRA BECOMES WET SAY “YOUR BRA IS WET LET’S PUT ON A DRY ONE” AND SO FORTH

PROCEDURE:

  1. Soap and rinse one area of the body at one time.
  2. Start with the neck and shoulders, the wash the arms and hands, moving down the body to the hips, legs and feet.
  3. Make sure to clean well in areas of skin folds – dry those areas very well.
  4. Lift the breasts to wash underneath them.
  5. Wash the privates last. Provide as much privacy as possible – soap the washcloth and encourage resident to do as much as possible themselves.
  6. Do the crotch first – keeping the elder’s privates covered as much as possible.
  7. To do the rear end and if elder able to stand, have the elder hold on to the sink area and bend forward slightly, and do a thorough soap and rinse.

Please see other blogs on this site regarding bathing.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

WHY DO ELDERLY WITH ALZHEIMER’S DISEASE FIGHT TAKING A BATH?

(PART II)

Problems to consider when trying giving an elder with Alzheimer’s disease a bath.

  • Is there a possibility the elderly person is in pain – in any situation when there is aggressive behavior make sure the elder is not in pain.
  • The elder may think they just had a bath and will tell you so.
  • Elderly people get cold easily because of lack of movement and decreased circulation or at times it may be a hypothyroid condition – if the elder does have a diagnosis of hypothyroidism, be prepared they will be cold.
  • Many people with Alzheimer’s disease wear the same clothes all the time – because being dressed makes them feel put together – when they undress they feel vulnerable.
  • The elderly become tired easily – keeping that in mind you may want to approach them when they are at their liveliest or most energetic.
  • Privacy is important to everyone – if several caregivers are meeting in the shower room to chat and only one person there (the elder) is without clothes, they very well may become angry.
  • This generation (the ‘”greatest generation”) didn’t bathe everyday – they were an every Saturday night generation – no wonder they say they just had a bath.

Tips for having a successful bathing experience with an elderly person with Alzheimer’s disease.

  • Try to make this a pleasant experience by not rushing.
  • Using the elder’s personal soap and towels makes it “their” bath – and recognizable.
  • Provide for the elder’s modesty – maybe undressing in steps instead of all at once and covering the elder with towels as they are bathed.
  • Make sure the environment is warm, warm water and warm room air, temperature is so important.
  • Make sure you have all of your supplies handy, but make sure the room is not cluttered.
  • Tell the elder what is happening and what you are doing at all times –  in a low, comforting and reassuring voice.
  • Don’t tell yourself that you need 100% success or nothing – if you do half a bath today and the rest standing at the bathroom sink tomorrow – that is your success

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

WHY DO THE ELDERLY WITH ALZHEIMER’S DISEASE FIGHT TAKING A BATH?

(Part I)

“You’re Mother is getting very combative when we try to bathe her, she fights with everyone we send in there. You are just going to have to come and bathe her yourself.” Sheila knew her Mother could be difficult, but having to bathe her own Mother – she never thought it would come to this.

What could have gone so wrong? – Problems bathing a person with Alzheimer’s disease.

It might have been the way the caregivers approached the elder:

  • Always approach the confused elder from the way they are facing – especially important with a male caregiver – so the elder can see you coming and not be surprised
  • Always approach with a smile – and unrushed attitude
  • Say the elder’s name – so they realize you know them, so they must know you
  • Talk to them for a little while – don’t just start in with “You need a bath.”
  • It is your job to set the tone, pace and mood – this can happen more easily if you offer a snack – enjoy it with the elder – then when you are on a friendly basis with the elder give them a cue that a bath is coming –maybe look at your watch and say “Oh no the time just got away from me, would you like to take your bath now or after breakfast?”

Reasons why the elder would not want to take a bath:

  • Afraid of getting cold – room is too cold or water is too cold
  • Loss of interest in personal hygiene – elder may be depressed and just doesn’t want to bother ( illness can also cause a loss of interest in hygiene)
  • Persons with Alzheimer’s disease may forget what a bath is for and not see the need for one.
  • The elder with Alzheimer’s disease may feel very offended that someone is suggesting that they are dirty – they have always been considered a very clean person.
  • The caregiver picked a bad time – the elder was doing something they enjoyed and didn’t want to leave, just because this person they don’t know says they need to give them a bath.
  • It just took too long for the caregiver to get everything ready and the elder had had enough of waiting

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

THE BED BATH – GOOD FOR THE ELDERLY, THOSE WITH DEMENTIA, THE BED-RIDDEN, THE CONVALESCING ……

I first addressed the issue of bathing a year ago after speaking to Sheila Wilson on the radio in Raleigh, North Carolina. (Sheila is now with Curtis Media Group) Sheila told me of a friend whose mother Mary, had dementia. Mary lived in a nursing home, and due to Mary’s combative behavior the nursing home staff was asking her daughter to come on a regular basis and bathe her mother.

Instead of spending her time visiting with her mother, the staff had given the daughter a” task” and a difficult one at that.  This staff had probably never heard of the benefits of a “Bed Bath.”

The Old Fashion Bed Bath – everything old is new again.

When I was in nursing school, one of the first things they taught you was how to give a bed bath. Times have changed, and while then we were all about being fast and efficient, because everyone was getting a bed bath those days.  Today we are about what is the best thing for the elder and causing less trauma especially to the confused.

THE BED BATH:

  • Assemble all of your supplies, large soft towels, two wash cloths, soap less soap (available on the internet), a wash basin for water, or a pitcher of very warm water (years ago we always used a standard wash basin, but the water became cold very fast and we had to keep changing the water for warm water, the goal here is not to let the elder get cold, and certainly not have to walk away – a better solution is to have a plastic bag large enough to hold the bath towels and wash cloths – pour warm soapy water over the towels in the bag, and take one warm moist towel out at a time)
  • Tell the elder what is going to happen, and explain every step of the way what you will be doing next
  • Make sure the room is warm and lights not shining in the elder’s face, soft music if possible
  • Put a large towel under the elder
  • Start undressing the elder, still covering them with blankets
  • Take one warm moist towel out of the bag with the no-rinse soap, lay it over the elder and gently “wash” using circular motions, from the shoulders working down (change towels as necessary)
  • If the elder is able, hand them a wash cloth to wash their face and hands with, then giving them a dry wash cloth to dry their face
  • The last area to be washed after the legs and feet is the private areas, cleaning well front to back, once again if the person is able to this for themselves, encourage them to do so

Keeping the elder covered at all times is so important for their privacy and dignity.

See also blogs:

Elderly with Alzheimer’s disease don’t want to get undressed, get wet and really don’t want to take a bath.       July 3, 2009

Bathing a senior with Alzheimer’s disease, or when bathing becomes a challenge.

February 12, 2009

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Caregiver Tips: Bathing the Elderly, Confused Patient

What could be more personal than bathing another adult?

This healthcare worker consistently receives high praise for the shower or bed bath she gives. Patients have said:

“You have an angel working here, and she gives showers.”

“I never feel embarrassed when she gives me a shower.”

“I just had the best shower of my life, it made me feel so good.” This from a cancer patient.

Actual praise for getting another adult totally undressed and bathing them?

What is so special about this healthcare worker’s showers?

She uses the same shower products; soap, towels, shower chair and shower stall. The equipment is the same as everyone else’s.  The patients are usually straight from the hospital after recent surgery, and are still hurting. They may be confused due to their recent hospital stay and the aftermaths of medication or suffer from ongoing cognitive decline.

Whatever the situation, when it comes to the most intimate area of caregiving, the shower, this healthcare worker not only is competent but provides a special experience.

Here are the princiles she follows:

  • Talk to the patient, get to know them before you suggest undressing and bathing them.
  • Get all of the supplies ready before you bring the patient to the shower. At least four towels and four washcloths, soap, shampoo and clean clothes.
  • Get the area warm, turn on warming light and start running warm water.
  • When the patient is undressed and in the shower, ask them if they would like to wash their face. Give resident wash cloth with just plain water and let them wipe their face.
  • Starting with the top of the body, ask the patient if they would like to wash their arms and offer a wash cloth with soap on it. Or would they like you to “help” them? There is a difference between doing somthing to someone or asking if they would like your “help.”
  • Take your time and let the patient know that their shower is important to you. This is not just a chore you want done quickly, and out of the way. For this time you are totally with them and attending only to them.
  • For every body part ask the patient if they would like to do it themselves.
  • When the caregiver does the washing, she folds the soapy washcloth into a envelope she puts over her hand. She never just splashes around with a flying loose washcloth. But she carefully and slowly soaps the body part with her folded cloth.
  • She keeps the patients private areas covered with small towels throughout the shower time. And only washes the patients private areas when they are unable to do this themselves.

The big four principles of a great shower

1. Keep the patient warm.

2.  Take your time. You might give four showers today, but this is the only one this patient is having.

3.  Provide privacy for the patients private areas, as well as the shower area.

4.  Use the word “help” often.

5.  Most important, spend some time getting to know the person, before you do something so sensitive as undressing and bathing them.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance

www.pleasegettoknowme.com

Caregiver Tips: Elderly with Alzheimer’s disease don’t want to get undressed, get wet and really don’t want to take a bath

Alzheimer's bathing

For elderly, poor personal hygiene may be sign of Alzheimer’s disease.

 
One of the first things a family member might notice, is that their loved one starts bathing less and less. However they will become highly insulted if someone suggests that they need to bathe. They will say they just had a bath, or they will just “wash up at the sink.” I have heard many families say when their elder moves into the nursing home that they haven’t taken a bath or shower for years.

Washing up at the sink in their later years is very common. The elderly may refer to that as “taking a spitz bath.” The elderly population, that are in their 80’s or older, grew up in a time of tub baths not showers. So taking a shower, especially, is not “normal” for them.

The confused elderly don’t want to get undressed.


Many times an elder with Alzheimer’s disease will not want to undress. Being dressed makes a person feel put together, even when they have been wearing the same clothes for days. So when a person is unsure of so many things, they can at least feel more competent if they are dressed.

Elder can’t get undressed the bathroom is too cold, water is too cold.


Many times a elder with Alzheimer’s disease has a changed perception of temperature. Their internal body thermostat no longer functions normally causing them to over dress or under dress. So they say they don’t want to get wet and chance a cold.

When the reason for bathing is forgotten, and seems like way too much trouble. And you add to that the fear of getting cold or catching a cold, and the insecurity of getting undressed. No wonder, bathing is often the most stressful task of caregiving.

Caregiver Tips: Bathing a senior with Alzheimer’s Disease, or when bathing becomes a challenge .

Bathing a confused senior can be a big challenge.


If there is anything I know we are all the same and facing the same challenges everyday. I was on the radio this morning in Raleigh, North Carolina, station WCLY-AM, talking to Sheila Wilson. While talking about the aging population and all of the people now caregiving at home. Sheila told me of a friend and the friend’s mother who has dementia.

It seems her friend, we will call her Mary, has her mother in a long-term facility. The staff there, due to her mother’s combative behavior need Mary to come and bathe her Mom for them. The first thing that came to my mind was that now instead of having the opportunity to visit with her Mom, Mary has been given a task. A very difficult task.

Getting rid of misconceptions about bathing.


The rest of this week I am going to concentrate the blog on bathing, especially bathing the combative elderly person. And hopefully get rid of some misconceptions about bathing.

Do you think the whole person has to be bathed at one time?
If it doesn’t happen in a tub or shower is it really a bath?
When a person suffers from a dementing illness, how can you use distraction in a positive way to accomplish a bath?

My thanks to the great people at WCLY in Raleigh, and their friends.