5 WAYS TO KEEP YOUR CONFUSED ELDER WARM OUTSIDE IN THE COLD

When winter is upon us it is so important to protect our confused elderly from the the effects of cold and even frostbite. The elder who is confused may no longer know how to dress for the season or temperature.  Helping someone confused, dress for the cold, can be as simple as knowing how to put together those items the elder already owns. And often, more effective than buying something new. There is comfort in the familiar, even a familiar piece of clothing.

Dressing for the cold:

  • Every one recommends wearing layers of clothes in the cold but equally important is what kind of layers those are.
    • The layer closest to the body should be a fabric that can wick away moisture due to possible perspiration
    • The middle layer is where your insulation comes in – wool only if the elder has no allergy to wool, a quilted fabric or something with synthetic pile to it.
    • The outer layer is there as a wind breaker, and needs to be water repellent as well.
  • Keep the elder’s head covered as well as hands and in some cases the face as well. Mittens are warmer than gloves but don’t allow for the free use of your fingers as well as gloves. So depending on the activity, you may want gloves or to even put mittens over a pair of gloves.
  • Keep your elder’s feet dry, it is hard to feel warm if your feet are wet and cold. Use the same system of layering to keep warm, by putting on two pairs of socks. Boots or rubber covers for shoes also provide for better traction on slippery surfaces.
  • An empty stomach will make anyone feel colder, eat before you go out. If you know the elder will be out in the cold for awhile, bring along a snack, trail mix or an energy bar with some protein.
  • Stay hydrated with soup, tea, water but avoid alcohol and caffeine.

Every winter season brings stories on the news of the elder who made a bad decision and was found out in the cold. Close monitoring of a confused elder’s activities and where bouts during bad weather can be a simple as a routine “good night”phone call.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

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

 

DEMENTIA CARE – DRESSING FOR CAREGIVING, USING COLOR

The traditional color for healthcare workers has been white. There are good reasons for this. Many times when I have walked into a bedroom of an elderly confused person to check on them, if the elder wakes they immediately say “nurse”. I would reassure them that everything was alright, but that white uniform said much more.

White of course reflects and stands out in a dark room making the caregiver easier to see. White is connected in everyone’s brain with good, pure, heavenly, and clean. This perception doesn’t change when a person gets old or confused.

On the other hand when an athletic team wants to intimidate their opponent they will wear black. A team dressed in all black will look larger and more dangerous. Add a little red to that athletic uniform and red adds the message stay away, danger.

Any clothing in very dark, almost black, colors might be difficult for a confused elder to see, and they may only see black. Happy colors are in the yellow family. Also light green is considered a color that improves mental functioning. Green has been shown to improve test results with students, and light blue is shown to be a stay-awake color. The combination of white with yellow, light green or light blue is the perfect combination for caregiving.

Archive pictures show Florence Nightingale in her familiar uniform of long black dress. But that dress was softened by her white lace collar and lacy cap. Even pictures in her old age showed her in the same combination with the addition of a white lace shawl. However, for many years the color of healthcare has been white.

Every time research is conducted on what profession people think is the most trustworthy, nursing rises to the top. So dress the part, especially if you provide care at night, wear white and you will hear your elder say “nurse.”

Virginia Garberding RN
Certified in Gerontology and Restorative Nursing

KNOW THE CONFUSED ELDER’S ROUTINE BEFORE YOU HELP THEM GET DRESSED

Know the elders routine.
Do you drink your coffee first thing in the morning or with breakfast? Do you get dressed before breakfast or after? There is so much comfort in having your own routine, doing things the same way at the same time. Everyone has an established routine. You like to do things in a certain order, so does your elder. Confused elders can become upset when they are unsure of what is happening next. The caregiver may be unaware of why the elder is getting upset.  Knowing what the elder’s routine is and keeping to it can reduce agitation and provide the cues the elder needs to be successful in their day.

When assisting a confused elder – this is not the time to do it your way
If you are a family member, spend some time remembering the little things that meant so much to your loved one. Special music that you remember she always loved to hear. How she liked the environment – was she always cold, or complained about being hot? Maybe you are always warm, but she always said she was cold. These are the many things the confused elder may no longer be able to verbally communicate.

Be prepared
The confused elder is in the moment. When you are assisting the elder getting dressed you can’t be too prepared. Think about how you get dressed. Do you put a shirt on before pants or the other way around?

Have all of the clothes laid out before you start. If you have to stop what you are doing to look for something, the person you care for is in the moment – once you walk away the moment might be over for that elder.

Don’t be in a rush. Confused elders can tell when you are impatient. Elders with Alzheimer’s disease who no longer speak can tell by tone of voice or body language that someone is impatient with them.

If it takes two hours for the elder to dress themselves, it is two hours well spent, because:
The elder will feel successful if they dress themselves
The elder will maintain the ability to dress themselves
This is an important activity of the day and everyone needs something to do

See also blogs:
When the Elder with Alzheimer’s Disease Stops Moving, February 23, 2010
Other blogs on Dressing

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

Eldercare Tips: It continues to be Important to Nursing Home Residents to Dress Nicely and Look Good

Ask your self “Are these clothes right for this Nursing Home resident?”

Every Sunday I visit my Mother. And sometime during the visit I straighten out her closet and organize her clothes. This Sunday I found two new pieces of clothes with Mom’s name on them. The problem was that they were both sweatshirts, a piece of clothing that would be terribly difficult for a caregiver to assist my Mom to put on.

Since Mom’s stroke her left arm has become rigidly extended and fixed in place. Thus making it very difficult to assist her in dressing. Mom also has a history of eczema which can be triggered by being too warm. A sweatshirt is much more difficult to change if she gets too warm than just removing a cardigan sweater.

Clothes continue to be important for the Nursing Home resident

Whether the resident is confused or not a person’s appearance has much to do with how they are perceived. A person who continues to have coordinated clothes, their hair always done, looks and smells clean will be perceived in a more positive way.

(The following is an excerpt from: Please Get To Know Me – Aging with Dignity and Relevance)

Even the small day-today things can mean so much. Mother likes to wear colored beads everyday with her outfits. We couldn’t expect the nursing assistants to keep track of her jewelry, so we installed removable adhesive hooks to the inside or her closet door within easy reach, to hang the beads on.

Mother has a standard outfit of black pants and a white or black cardigan sweater that she wears with a bright colored top and a string of beads every day. The system has proved successful because staff members no longer had to try to coordinate her clothes. Mother is happy. The staff is happy because we haven’t tried to add any additional duties for them. They can easily help her put an outfit together and it creates less stress for everyone involved.

A standing appointment in the beauty parlor every Friday helps Mother keep track of the days in the week and provides an additional opportunity to visit with other people and make more acquaintances. Mother has a simple, short, and curly hairdo. Each Sunday afternoon, I reorganize Mother’s closet as well as straighten up her room as part of her care team.

Changing Mother’s clothes seasonally and taking them home to store, as well as bringing in special seasonal outfits like her black velvet pants suit, keeps her and the staff interested in her appearance. When Mother needs new clothes I bring in catalogs and we make an occasion out of shopping.

See other blogs from this site on dressing.

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: Confused elder with Alzheimer’s Disease, wants to wear the same clothes all the time.

Can’t get confused elder to change clothes.

 
Many times I have heard family caregivers say that one of the hardest tasks is to get the individual who is confused to change clothes. Sometimes the favorite outfit is also used to sleep in. Recently a man was telling me about his wife’s favorite outfit and how he had tried to get her to change for a holiday dinner in a restaurant they were invited to. He turned and said “Here she is now.” To my surprise came a very cheerful woman in her woman in her late 70’s with dyed red hair in a purple sweat suit. This was the favorite outfit that was worn every day, every season.

Clothing helps confused elder feel put together.

 
Our clothing has many meanings for us socially. Many confused elderly have a sense of security when they are dressed. As though if they are dressed they may feel more put together and in control mentally as well. And so they resist changing, bathing, getting in pajamas, anything that might not let them feel as put together.

9 Things to  do when dressing is an issue for confused elder:

 
• Remove all out of season clothes and store.
• Have limited selection of outfits, so closet doesn’t seem overwhelming.
• Have clothes that reflect the individual’s life long choices in style and color, but are now in fabrics that are wrinkle free and easy to maintain.
• Everything needs to be washable and mainly cotton, which doesn’t hold on to odors like other man made fabrics.
• When there is a favorite coat – outfit it helps to have a matching one to substitute while the other is being cleaned.
• Simplify dressing whenever possible with Velcro closures when a person can no longer manage buttons – if dressing is just too hard and too much trouble why bother anymore, the person might think.
• Brassieres that open in front may be easier to manage.
• Elastic shoe laces can assist in allowing shoes to remain tied and yet be slipped on.
• Front opening clothing is easier than over the head styles. Likewise short sleeves are easier to get on than long sleeves.

Dressing can be an opportunity for success for confused elder.

 
Be aware that every activity – especially dressing is made up of many small steps. Completing every step is an opportunity for success and a feeling of accomplishment. Keep in mind that less is more when it comes to talking and instruction. Patience, being in the moment, praise and acceptance go a long way.
See: Caregiver Tips: Working with Elders with Alzheimer’s disease using their Body Memory

CAREGIVER TIPS: How to help the confused elder with Alzheimer’s get dressed.

Please Get to Know Me

Know the elder’s routine.

 
What was their routine? Keeping to persons routine is so important. If someone was used to – for many years- getting up in the morning and eating breakfast in their robe, and then getting dressed, you want to continue to do that. There is much comfort in doing things in a familiar routine. Confused people can get upset when they are unsure of what happens next. The caregiver may never know why the person is upset.
See web site: www.pleasegettoknowme.com

This is not the time to do it your way – dressing is about their way.


Have everything ready. When helping someone who is confused, with any activity of daily living, the first thing to do is be prepared. If you are dressing, have a routine. If you are family and lived with this person try to remember how they did things. If you are a caretaker who didn’t know this person, see if anyone in the family does know how they did things. This is not the time to do things your way. Think about how you dress – do you put a shirt on before pants or the pants on first? You like to do things in the same way, so do they. Have all of the clothes laid out ready before you start. If you have to stop dressing to look for something – remember a person who is confused is IN THE MOMENT and the moment for dressing can be over for them when you walk away.

Take the time – the confused elder still knows impatience.


Don’t be in a rush. Confused elders can tell when you are impatient. Even elders with Alzheimer’s who no longer speak can tell by tone of voice or body language that someone is impatient with them. Let the person do as much for themselves as they are able. If it takes 2 hours for a confused elder to dress themselves with a little assistance, they need to still do this for themselves, so that:
• they can feel successful.
• they can maintain the ability to dress.
• this is their activity – everyone needs something to do.

Remember to use elder’s body memory when dressing.


Use their BODY MEMORY. Children start to dress themselves when they are very little, before they start school. So an elderly person has dressed themselves for many years – every day. The body remembers. (see: Caregiver Tips: Working with Elders with Alzheimer’s disease using their Body Memory.) If a person has forgotten how to put a shirt on. When the caregiver helps with one sleeve and then drapes the shirt around the person, the feel of the one sleeve on and the shirt on the neck, can trigger the person to put their other arm in the sleeve. The caregiver wants the person to have the time to feel what they are doing. Have clothes one size to large – to make things easier to get on.

Dressing is great exercise.


 If a person is still able to dress themselves with a little assistance, practicing this ability will make sure they will be able to continue to dress themselves longer. And dressing is great exercise. Everyone knows how tiring it is to go shopping and try on clothes. Putting your arm through a sleeve, bending the elbow and then extending the arm are all exercise. Say something like “Oh, I forgot Mary, your sister is coming for lunch today, and you know how she likes your pink sweater, let’s change and put that on for her.” Dressing and then re-dressing helps a person with their body memory and is great exercise.

Caregiver Tips: Alzheimer’s Disease/Stroke When The Elderly Start Undressing In Public.

Alzheimer's Disease

When confused elderly always want to take their clothes off.

 
What could possibly be harder than caring for your parent, and now not only are they incontinent – but they want to get those clothes off – and are undressing. Trying to preserve the dignity of your parent and respect their privacy, while keeping them clean and dry can be a challenge.

Is there a reason the elder wants to undress?


Sometimes finding out why the elder is undressing will lead to the solution. Do they need to go to the bathroom? Are the just anxious and fiddling with their clothes? Have they had a stroke and since then have this behavior?

My grandfather moved into a nursing home because my grandmother needed the care due to her Alzheimer’s disease. After Grandma died, Grandpa stayed because over the years he began to need assistance also. However Grandpa was always upset with his roommate who was constantly undressing. Then Grandpa had a major stroke and had the exact behavior that he had always hated in his roommate – he started taking his clothes off.

4 Things to consider when the confused elder is always taking off their clothes.


• For a man, having him wear suspenders on his pants with shirt and sweater over to reduce the ability to be able to remove the pants.
• If the undressing is due to trying to get to the bathroom – have the elder on a toileting schedule; immediately when you get up in the morning, right after meals (especially breakfast, many people have a bowel movement right after drinking their coffee in the morning) and every two hours when awake.
• If the elder is undressing due to anxiety and just kind of playing with their clothing – provide a distraction, keep the elder engaged in folding laundry (even if it is the same laundry over and over) whatever active activity they enjoy.
• Look for adaptive clothing that have categories for the person who undresses. A company I have used is: www.buckandbuck.com