PERSONAL CARE HINTS

Personal care


Introduction


Personal care is important to all of us. It affects how we feel about ourselves and how other people react to us. Good personal hygiene is important for health. The impact of dementia on a person’s ability to look after themselves will vary from one individual to another. Washing, dressing and attention to personal care all need to be approached in a fairly ordered way. They involve skills which people with dementia sometimes find difficult. Lack of motivation, forgetfulness and inappropriate behaviour all have a serious effect on a person’s ability to attend to their personal appearance and care.


Difficulties


Difficulties which may be encountered include:


• A loss in personal appearance. This may take the form of inattention to cleanliness, grooming or to the appropriateness and state of dress. Even a previously tidy person may neglect appearances and look unkempt.


• Wearing the same clothes day after day. The person with dementia may refuse to change clothing and of challenged about this become irritable and unco-operative.


• Forgetting to wash, shave, comb hair, brush teeth and so on, or performing certain activities repeatedly but neglecting others.


• Forgetting how to carry out personal care activities or when they were last undertaken.


• A lack of awareness of personal safety when using hot water, electrical appliances, razors, wet floors and so on.


• Confusion over the order in which clothes should be put on.


• Being unable to cope with fastenings such as zips and buttons.


• Dressing or undressing at odd times or in inappropriate places.


How you can help


The very personal nature of these activities can make it hard both to offer and to accept assistance. People with dementia often experience considerable frustration and anxiety when they try to carry out personal care tasks. They may react badly to being reminded or hurried. Tackling these difficulties requires patience, tact, understanding and a positive approach.


You should try to maintain the highest possible degree of independence, while being aware of the need to consider safety. Think about how much help is required. Consider ways in which you could encourage or help the person to carry out tasks. We all have our own way of going about things and it is helpful if the person’s own routine can be kept to as closely as possible.


The following suggestions may help:


• Allow time for activities such as washing and dressing. Make sure the room is warm and comfortable. Try to make things as relaxed as possible.


• Provide the maximum degree of privacy which safety will allow.


• Try giving prompts before assisting more actively, and provide the necessary prompt one step at a time. If assistance is required, give it tactfully and explain what you are doing.


• Avoid discussions and arguments and approach tasks positively.


• Limit choice of clothing but continue to offer a choice if possible.


• Lay items of clothing out in the order to be worn (preferably the same way the person would usually do it.) Lay toiletries out in order of use.


• When the person is trying to do things, give encouragement. Give compliments and generally take an interest in the person’s appearance.


The person’s general level of co-operation with you regarding personal care tasks may fluctuate considerably. Remember it is pointless to argue. It is likely that in a short time the person with dementia will forget the dispute but you may be left tense, angry and exhausted! If certain areas prove difficult, try again later, try different approaches or choose a time of day when the person is usually most co-operative.


Some hints on care


Hands and feet


Trim nails when softened, either following a bath or after soaking feet or hands in a basin. Use round tipped scissors and cut toe nails fairly straight. Providing a manicure can be a relaxing experience. Nails generally become harder with age and you should not trim them if they do not cut fairly easily.


People with circulatory problems, especially diabetics, have to take special care of their feet and regular chiropody may be essential. Comfortable, well-fitting shoes are important and preferable to slippers indoors.


Hair


It is best to keep to a routine familiar to the person, while providing as much assistance as necessary. If the person has been a regular visitor to the hairdressers, try to maintain this. Simple, easily cared for styles are best. Perhaps you could arrange for a visitor to call at the person’s home. (Choose a comb or brush which is easy for the person to grasp).


Mouth


Mouth care is important to everyone’s general health. A person with dementia may neglect teeth cleaning, and dentures can become ill fitting due to weight loss. Other problems include oral infections, inflammation and difficulties with chewing food.


You can help by giving prompts, one step at a time throughout the process of cleaning teeth or dentures, to maintain independence as much as possible. If you have to provide care yourself, clean teeth or dentures thoroughly at least once a day. Regular check-ups are important and a home service is available.


Dressing


Choose clothing which is easy to wear and care for. Clothing can be made more manageable by replacing hooks, buttons and zips with Velcro fastenings. Dressing aids, such as long handled shoe horns, elastic shoelaces, sock or stocking holders, may help to maintain independence and make it easier to help.


Take away clothes which need washing to avoid them being worn again. If the person requires complete assistance with dressing, dress him or her in stages, dressing just the top or bottom half of the body at one time. If a person has a weakness on one side, it is easiest to put clothing on this side first and remove it last.


Washing and bathing


When you help someone to bathe, check the water temperature and depth. Less water in the bath is not only safer but may help to reduce fears about getting into a bath. A shower unit is easier to use but some people may be unused to showers or afraid of them. In a shower use a stable seat in the cabinet. A number of aids to safety are available, including non-slip mats, support rails and bath seats. Ask the Occupational Therapist (OT) at your local hospital or social work department about these aids.


Having a fairly regular routine in relation to bathing can be helpful. Although bath oils and foams can make bathing more enjoyable, they must be used with extreme care as they can make the bath or shower tray very slippery. It may be best to use a favourite body oil or lotion after the bath.


When you supervise, prompt or assist someone with washing, be aware of the importance of carefully washing and drying skin folds. These areas are particularly vulnerable to soreness. Check for areas of redness, dryness, rashes or sores. If you use talcum powder at all, apply it very sparingly as it can be an irritant and cause inflammation, especially on moist skin.


Shaving


Changing over from the use of a blade razor to an electric shaver will be safer and can enable someone to shave himself for longer. It is probably best to encourage this change at an early stage, before it becomes essential.



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