Dementia - Dressing and Bathing an Alzheimer's Patient

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Sally Smith: Welcome to Age to Age. I'm Sally Smith. Let's talk. We are fortunate to have Rhonda Weichsel with us today. Rhonda is an Occupational Therapist who specializes in dealing with families who are taking care of loved ones who have Alzhiemer's and Dementia.

One of the things we'd like to talk to you today about is bathing and dressing, ideas for the caregiver, hazzards. Dressing and bathing are just highly personal activities. We are all used to doing them in our own way over our lifetime. These are the things I would like to ask about because I understand this is a sort of a crisis point sometimes in the day is the hygiene, bathing of the patient. Why is this?

Rhonda Weichsel: Oftentimes, patients just don't like it. They fear the water. They fear of getting in and out of the tub that they may fall. Hygiene interest is decreased. But for the caregiver, it is highly increased because they are having to clean nails or having to clean up around the person that is decreased their own hygiene.

Sally Smith: Well, obviously, we need good solutions to that because the person ‘does’ need a good hygiene.

Is this where something like a certain structure where every single day you have the bath? Or you just play around with different times trying to see what works best for you in this particular patient? Or are there certain diversions that work best? Earlier in the interview you said something like, "We'll need to eat before we go to work." Instead of "Get up and come eat." circumventing the direct task in ways that make it easier for them to accept doing it. Is this a strategy that you use?

Rhonda Weichsel: Well often time older individuals don't bathe everyday. They are not going out and mowing the lawn and they're not sweating. So oftentimes they bathe every other day or every third day perhaps. Just depending on what type of activity they've done. But bathing is an issue for individuals because they can become very cold, they can become very hot.

And so, when you start to start a regimen, and again, routine, routine, routine, perhaps, "It's Wednesday mom. It's time for your bath. It's lunch time and we always do it at lunch time. You've asked me to do this every Wednesday at lunch time."

And that gives the individual their autonomy to say, "Oh! I asked to do the bath on Wednesday. It's much worst to do the bath on Saturday. I've always done it that way."

Sally Smith: One thing you mentioned about the getting cold. I guess there's just no way around it except keep the water warm. Somebody told me, in a situation they had, that the best thing that worked for them was some sort of a chair that sat in the tub and a hose that they had. So that instead of sitting down low, which made it difficult to get their mother up and down, out of the tub, she sat up and they could continually have this warm water sort of flowing over her. And it made it easier for the people to bathe her. Is this a strategy that people use?

Rhonda Weichsel: A bath chair is a wonderful thing because it gives you added comfort and security that you're not going to slip and fall and that the caregiver is not going to slip and fall as well. But it does give you an opportunity to have the shower head constantly on the individual. And you certainly want to start from cooler water and work your way up to warmer water rather than turning from hot to cold.

Oftentimes, I actually put a towel on the back of the individuals that I've been bathing. And that keeps their shoulders warm while I'm bathing their legs and feet. But this, oftentimes if the water is not directly on their shoulders, they'd do get chilled.

Sally Smith: One thing I was wondering with older people, decreased oils in the skin, that sort of thing. Are there issues with the bathing of getting very dry skin and how careful do you have to be about those issues with bathing?

Rhonda Weichsel: Well skin is an issue. The flexibility of the skin and skin integrity is oftentimes in jeopardy. So you definitely want to have your skin moisturized with something that does not irritate the skin something very, very mild. Something non-abrasive and you certainly don't want to scrub the skin very, like you would with a luffa pad or anything like that. But you want to keep it moisturized and soft. The same thing for the nails. Once the individuals had a bath, that's the best time to clip the nails because that's another source of hygiene. So that's another option.

Sally Smith: I've had a friend who had difficulty, not so much with bathing of her parent. But bathing, sometimes, in the places where the parent did not want anybody to bathe them but they weren't willing to bathe themselves, their very private, personal areas of the body. Does having a nurse or some sort of a uniformed person that comes across as not a family member bathing does this make it more relaxed for the loved one or does it not really?

Rhonda Weichsel: It really depends on the individual. When I'm bathing someone, I ask would they bathe their private parts now? Don't forget this particular part of the body. And if I feel that they are feeling uncomfortable, I'll turn my head and say. "Okay, let me know when you’ve finished bating your private parts." But there are some individuals that don't want their son or daughter or their loved one to bathe them. And so it might be helpful to have someone not a family member help them bathe.

Sally Smith: One thing I've learned, I just in dealing with my mother-in-law and my mother, is that as things progress, different solutions that are important, maybe you get the person to come in, the nurse to come in and bathe for, maybe, 2 months.

And then after 2 months maybe they don't know who's bathing them and it doesn't really matter anymore. So none of these things I learned are usually forever solutions. It's always sort of a moving target and you do different strategies at different levels of the disease. Well, of course, once you dressed and cleaned, you've got to get dressed. And I know the bath is a lot of confusion sometimes buttons, zippers, things that would have been easy before. What are the recommended, sort of, clothing issues?

Rhonda Weichsel: Actually lose clothing is not as recommended as clothing that is comfortable. You certainly don't want to have hanging sleeves that could get caught on something. The best approach is to have easy, non-slip, skid proof shoes. Something easy to put on. Pull over clothes are a little more difficult for individuals that have forgotten how to dress. For instance, buttons are much easier. Oftentimes, people will start to take off their clothes when they’ve become uninhibited.

And if that's the case, maybe turning the clothes inside out. Where the buttons are on the front of the blouse but on the inside. It's much more convenient if you lay out the clothes. Not have the closet clutter but lay out the clothes. This is the shirt that you'll wear with these pants and tell them basic instructions. "Now put on your shirt. Now put on your slacks. Now put on your socks." So one task directions.

Sally Smith: I know that you were saying that you had experience with families that did have uninhibited parents who suddenly want to undress. And that you had some of these strategies from ways to put on clothes that make it harder. Like wearing them bottle side out and buttoning them on the inside. I thought that was ingenious.

One person told me they used tube socks because there's no heel. It's just a tube. So there's no right or wrong. That you get it just a certain way which made it less frustrating for their parent as well with the dressing.  Unfortunately, part of what happen sometimes as this disease progresses is that being able to know when you need to make a trip to the bathroom does change and you lose that ability.

How does the dressing issue change if someone has to be in a depend or something like that? There are special pants that make it easier to deal with people that have to have these things changed out regularly or is it just the same type of clothing?

Rhonda Weichsel: They can pretty much wear the same type of clothing. It is easier if they wear clothing that is pull up. It's elastic waist band rather than built in snaps and buttons and buckles. In so far as when you're changing your loved one, putting their depends on. There are two different types. There's the pull up method of depends which means that you have to take off their pants their pants and, perhaps, their shoes or then there's a tapped depend type underwear where you can place it on their waist.

Pull down their slacks and pull it through like you're standing and diapering. That's not exactly the right terminology because you're not diapering.  But it is that type of method that you would use. Standing and placing the taps on the waist and pulling the front through and tapping. One at a time.

Sally Smith: Maybe you were saying that one of the things that was wonderful about your job was that some of the tips that you've learned over time save caregivers such a lawn of frustration and extra added 5 or 6 minutes every time they do that particular task. And something like this is a good example. That you've got to stand up and take everything off and work it through. So it sounds like they've adapted our product.

But notice because also you're dealing with somebody who's not totally rational. Maybe that's something allowed there like put them up, bathe in, have everything done to them. You've got to be Johnny on the spot quick.

Rhonda Weichsel: That's true. There is actually a technique that OT's use and many caregivers in nursing homes and assisted livings where you can only take off one side of the pant, the pant leg. Put the depends on and so you're taking off one shoe and one pant leg rather than both pant legs and both shoes and it really saves you about four minutes. And with an agitated individual, four minutes is a very long time.

Sally Smith: That's the perfect example of something that is a seemingly small thing that can really help on the frustration level and literally make you a better caregiver and that you're not completely frazzled with every single thing that comes along. You save your frazzle for when you really need it type. Yes.

Rhonda Weichsel: You can choose your battles.

Sally Smith: You can choose your battles. I hope you will come back and speak with us again sometime Rhonda because you have such hands on experience with things like this and something like that tip is invaluable to people that are trying to make it work in a new world that haven't really learned that much about and because they've never had to before. Thank you so much for coming and I hope we can get you come again?

I'd also like to thank my producer Betsy Reeves, web administrator Sujit Kara. Thank you to all of our listeners too for joining us today. We welcome your suggestions and invite your comments on our website. This is Sally Smith, Age to Age, saying goodbye and wishing you courage and joy on your journey. We are all connected.

Announcer: If you have any questions about the services or programs offered at the Medical University of South Carolina or you'd like to schedule an appointment with one of our physicians, please call MUSC Health Connection at 1-843-792-1414.

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