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Living with mid-stage dementia

The middle stage of dementia is a transition time when independent living becomes less and less safe. The person you care for probably doesn’t realize this. Power struggles are common unless you strategize to accommodate your loved one’s needs and simplify the environment.

Avoiding the "War of the Wardrobe"

If your relative has dementia and is wearing mismatched or inappropriate clothing, it’s time to step in. He or she has likely lost awareness of personal appearance. Also gone is awareness of the need for a sweater when it’s cold. Or a lighter shirt when it’s hot.

As much as possible, allow your loved one to continue dressing independently and make clothing choices. It is good brain stimulation and supports a sense of personal dignity.

Here are some tips to avoid conflict about clothes:

  • Simplify choices. Hang favorite outfits together in the closet: shirt, pants, accessories, all on the same hanger. If your loved one has a preferred outfit, buy several! Then he or she can wear that beloved plaid shirt every day and still be clean. (At the end of the day, when your relative isn’t looking, put the soiled clothes in the laundry.)
  • Winnow the wardrobe. When your relative is not around, go through closets and dressers to eliminate excess. Keep only what’s easy for him or her to put on and take off. For example, shirts and dresses that open in the front, pants with elastic waistbands, and shoes that close with Velcro. Remove garments that no longer fit.
  • Stash special occasion clothes. Store them in a separate place. You don’t want Mom putting on her fancy dress to come to breakfast.
  • Consider the weather. Pack away clothing that is not appropriate so your loved one has only choices that match the season.
  • Establish a routine. Set a regular time of day for dressing. If you are laying out your loved one’s clothes, arrange them in the order they should be be put on (undergarments on top, pants and skirts on the bottom). Hide shoes until last.
  • Reduce rushing. Allow extra time. A hurried environment just leads to confusion and potential resistance to getting dressed.
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Mealtime and dementia

The effects of dementia include changes to the way foods taste and smell. A person with Alzheimer’s or another memory disorder may become unable to recognize foods or to know if he or she is hungry or full. Even the seemingly simple mechanics of fork and spoon or chewing and swallowing often become too complicated.

Make the environment supportive. Confusion dulls the appetite, so aim for streamlined and unhurried meals.

  • Eat with your relative. This sets an example that it is time to eat.
  • Simplify the setting. A cluttered table can be confusing. Your relative may not be able to distinguish between a food and a decoration.
  • Reduce unnecessary noise. Turn off the TV/radio. Put the kibosh on emotional or loud conversations.
  • Use contrasting colors. Changes in visual-spatial perception are common with dementia. Avoid mashed potatoes on a white plate on a white tablecloth!

Keep the menu simple.

  • Plan for small, frequent meals. It’s difficult for people with dementia to sit for long.
  • Serve just one food at a time. Pick the most nutritious course and put it on a small plate. If your loved one leaves the table, at least he or she has eaten the most important part of the meal.
  • Check the temperature of the food before serving. Your loved one may no longer know what’s too hot.
  • Stay flexible. What your relative ate eagerly yesterday may not appeal today. Don’t take it personally! Sensitivity to smells and textures can make for picky eating. Offer an alternative. Or wait a half-hour and try again.
  • Support self-feeding. Cut foods to bite size before serving. Provide finger food when possible.
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Bathing and dementia

Bathing brings many discomforts. Bathrooms can feel cold and drafty when a person is wet. And running water can be noisy. Nudity can be distressing when a modest person needs help and may not recognize the helper. Plus, bathing is a complicated process with many steps in a specific order. People with dementia may become confused and frustrated. They also may not understand the need for cleanliness.

Here are some tips to ease bath time:

  • Guard the senses. Sometimes people with dementia are hypersensitive. Heat the bathroom ahead of time. Be gentle and avoid scrubbing. Check the water for temperature—too hot?—and the water pressure from the shower—too hard?
  • Promote independence. Encourage your loved one to do things themselves. If you do need to take over, tell them what you are going to do before you do it. And give them a role so they can participate, such as holding the soap.
  • Preserve modesty. Even if you are helping a spouse, have a towel at the ready for undressing and dressing.
  • Maintain a routine. Most families notice that certain times of day are better than others. Bathing at the same time each day may make it easier. 

Sponge baths work just as well. In terms of hygiene, all that’s needed is a twice a week wash, and even that can be just the highlights: armpits, folds of skin (under the breast, on the belly), groin, genitals, feet. Keep the rest of the body covered with warm towels to minimize any chill.

Get creative

  • Try singing together. Or play music or old radio shows for distraction.
  • Consider using bath wipes. Warm by putting an open package in the microwave for 10 seconds.
  • Call it “spa time.” Use no-rinse soap on moist, warm midsize towels and massage in gently. Wipe off with warm, moist washcloths.

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