As Alzheimer’s disease progresses, your loved one will need more and more help with the seemingly simple activities of daily living (ADLs). Eating, dressing, basic hygiene, shaving, and eventually toileting will likely be neglected as routines are forgotten, and abilities deteriorate.
ADLs are those things we all need to do on a regular basis to ensure our health and well-being. ADLs are those need-to-do things that take up so much of our day and that we all take for granted–until we cannot do them anymore. Activities involving health and hygiene are called basic activities of daily living. By contrast, instrumental activities of daily living are those abilities that allow a person to live independently. Some examples:
Basic Activities of Daily Living
- Ability to get out of bed or a chair
- Walking (can be with the aid of a cane or walker)
Instrumental Activities of Daily Living
- Food Preparation
- Housekeeping and Laundry
- Managing Financial Matters
- Use Telephone
- Take Medication
- Responsible for Transportation (public transit, auto, etc.)
Doctors and nurses, psychologists, social workers, and other healthcare professionals measure one’s ability to perform these activities to ascertain his or her functional ability. Tools such as the Katz ADL Scale and the Lawton IADL Scale are often used to determine the level of care an injured or disabled person needs. Ultimately this may include a recommendation for long-term institutional care.
ADLs and Alzheimer’s Disease
Activities of Daily Living for Alzheimer’s Disease and Dementia
As Alzheimer’s disease and other non-curable cognitive disorders progress there is a steady deterioration of abilities including the capacity to perform those activities necessary to live independently. There is a physical aspect to Alzheimer’s disease. As the plaques and tangles that affect memory and cognition take hold, motor control also deteriorates. It is very frustrating and depressing to realize that this is happening.
Anxiety, irritability, anger, aggression, and apathy and withdrawal are often listed as symptoms of Alzheimer’s disease. It is likely that these behaviors are to some extent the result of the cognitive recognition that one’s basic abilities are deteriorating, and along with those abilities, one’s independence.
Unfortunately, this trend cannot be reversed; that is the nature of the disease. We can, however, provide therapies that delay the motor and cognitive effects of dementia. We can also help to make these daily activities easier, or at least more do-able. We improve a person’s quality of life by prolonging that person’s independence, and by making her feel that she is being productive.
Create a Safe Environment
Safety is the first concern of anyone caring for a person with a disability, but stay aware of that person’s innate desire for independence while creating a safe place for her or him to live. Many of the things we take for granted can be dangerous for someone who has trouble maintaining focus; remembering that a knife, for example, can cut fingers as well as vegetables. Alzheimer’s-proofing a house is very similar to child-proofing it.
Establish and Maintain a Routine
A manageable routine is probably the most significant step you can take to extend the independence of the person with Alzheimer’s. The basic activities of daily living should be part of a routine, done at the same time and in the same order each day.
Put Her to Work
OK, I don’t mean that you should send her out to get a job so she can earn her keep, but losing the feeling that one is a productive member of the family or society is as big a blow to someone as is her loss of independence. Give her chores around the house. Let her help with the dishes, even if you have to re-wash them later. Allow her to vacuum, even if you have to go over the floor again to get some of the dirt and dust she missed. Let her chop vegetables (keeping in mind the safety imperative), even if…. Well, you get the idea. She could sort and fold laundry, clip coupons, dry silverware, dust tables; most any of those pesky household chores will provide a sense of accomplishment for the person with dementia.
Provide Physical and Mental Exercise
Stretching, dancing, and walking, anything that is physically stimulating, will extend the time that a person with Alzheimer’s can remain physically independent. Game, puzzles, reading, anything that is cognitively and sensorially stimulating will increase the time he will remain mentally independent. Tailor or select each activity according to the abilities and interests of the individual. The more enjoyable it is, the more beneficial it will be. And it should be a little challenging; anything too easy will be a bore. Even Sudoku can be enjoyed by someone in the early stages of dementia, especially if she liked that sort of thing when she was younger.
Don’t forget to exercise the hands. Keeping them strong and limber will make it easier to do many of the activities listed above.
“Special” doesn’t necessarily mean “funny looking” or “odd.” For someone in the earlier stages of Alzheimer’s, shoes with Velcro fasteners, tube socks, pull-over or zipper front shirts and sweaters, all make it easier for him to dress and undress himself. In later stages you may need clothing that is designed for someone who needs help dressing. Eventually, clothing that he cannot remove may be necessary, as
inappropriate undressing can be a problem in the middle and later stages of dementia.
Something as simple as a cane can make it possible for him to get around. Specially designed forks and spoons make it easier to eat by himself. Sturdy grab bars that are securely fastened to the wall make getting in and out of the tub easier and safer. Raised toilet seats extend his independence by making toileting easier. Begin by defining the problem. It is very likely that someone has found a solution that fits. If you would like help, contact us, describe the issue, and we will do our best to help or point you in the right direction.
When dementia begins to effect memory, just dialing the phone can become an insurmountable task. With this Photo Phone, all one needs to do is press the picture of the person he needs to call, and the programmable phone dials the right number.