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Introduction

The brain is extraordinarily complex. It is made up of several distinct parts, each with its own function. While these parts are separate, they must work together to complete the simplest task. As Alzheimer’s disease affects each area of the brain, certain functions or abilities can be lost. One link in the chain of events may be missing and the person will need help or a coping mechanism to complete the task. It is important for caregivers to remember that changes in a person’s behaviour may be related to the disease process.

Grooming

Each person develops particular routines of grooming and most of what we do to improve our appearance is done in private or, at least, independently. As Alzheimer’s disease changes all aspects of a person’s life, it also changes a person’s approach to his/her appearance and habits of grooming.

Where to begin

As a caregiver, you need to become a problem solver as you deal day to day with the effects of Alzheimer’s disease. Understanding the disease can also lead to possible solutions. For example, when the part of the brain that controls sequencing is damaged, the person with the disease has difficulty putting clothing on in the right order. Or when the part of the brain that initiates an activity is damaged, the person needs assistance in starting a task. Other times a person can look at an item, such as a hairbrush, and not recognize it. The following suggestions may help you to find a way to assist the person with Alzheimer’s disease:

Consider the person

Are there medical problems that contribute to a lack of interest that could be treated (e.g., depression)?
Does the person know what to do with a brush or a face cloth?
Does memory loss cause the person to forget what he/she is doing before completing the task?
Is there resistance to being helped?
Is vision impaired? Can the person see how he/she looks or if there is dirt somewhere?
Are decisions difficult to make, for example, too many choices about what to wear?
Does the person feel rushed?

Consider the environment

Is the lighting adequate?
Are there distractions in the room, for example, noise, people, clutter?
Is there privacy?

And yourself, the caregiver

Does your presence cause embarrassment?
Are you rushed?
Are your instructions clear?
Are you being too fussy? Are you trying to maintain a standard of appearance that is adding unnecessary stress to both you and the person you are caring for?

What to try

Whether you figure out a specific reason for the problem or not, there are a number of things you can try to make grooming activities easier and more pleasant.

In general

Make sure the setting is quiet and private with adequate lighting.
Examine the task and break it down into simple steps. Allow the person to do as many of the steps as possible.
Prepare. Have everything that is needed at hand: soap, towels, brush, etc.
Give instructions one at a time.
Do not rush the task, allow plenty of time.
Whenever possible, give visual cues as well as verbal instructions. For example, when saying, “It is now time to brush your teeth”, hand the toothbrush to the person.
Demonstrate. It can sometimes prompt the individual to begin the task him/herself. For example, the person may begin to comb his own hair by watching you comb yours.
Consider your own attitude to appearance. What is important?

Oral care

Proper oral care is important to prevent tooth decay and gum disease. Poor dental health will also affect an individual’s ability and willingness to eat. It is wise to have a complete dental examination early in the disease. Ask the dentist to schedule appointments at times when there will be no delay at the office. At home, the following tips might be helpful:

Remind the person to brush twice a day with a soft-bristled toothbrush and fluoridated toothpaste. Give step-by-step instructions, or try “hands-on” guidance or gestures.
Try fluoride swabs if the toothbrush is refused.
Remove partial dentures before cleaning natural teeth.
Remove dentures at bedtime and clean with a firm brush. Place them in water overnight.
Make sure dentures are well identified to prevent misplacement. To prevent damage when cleaning, make sure the sink is filled or the drain is closed and the toilet lid is shut.
If the person develops “dry mouth”, try sugarless candies or gum to increase the flow of saliva.

Hair care

Clean, well-groomed hair will make a person with Alzheimer’s disease look and feel better. It will likely help his/her caregiver feel better too.

Choose a hairstyle that is easy to care for.
Encourage the person to comb his/her own hair, if necessary give step-by-step instruct-ions, or a cue, for example, place comb in person’s hand or start combing your own hair.
Try a dry shampoo if washing hair is difficult.
Try a scalp massage when washing - it may be soothing.
A salon or barbershop can be a familiar and relaxed setting. Make the stylist aware that the person has Alzheimer’s disease. If the person feels insecure, you may want to stay with him/her; or try to find a stylist to come into the home to cut or style hair.

Skin care

As a person ages, skin becomes more delicate and needs a little extra care beyond a wash. Creams or lotions can help the skin and may be necessary in the prevention of skin breakdown for those who are inactive. The application itself can also have a pleasantly soothing effect.

Use a damp cloth or a “hasti-wipe” for cleaning hands and face. This may be easier than a basin-soap routine.
Use a favourite scent for soap or lotion.
Massage or stroke when applying cream or lotion.
If applying lotion is soothing, try it at a time of day when the person is more likely to be restless.

Foot care

As people age, foot care is often neglected because people can no longer reach their feet comfortably, and they often can’t see to provide proper nail care. This task can be more of a challenge if the person has Alzheimer’s disease. The following suggestions may assist you.

Check the person’s feet on a regular basis. Look for discoloration that might be a sign of circulatory problems. Check for callouses or bunions or nail problems that might cause foot pain. Report any findings to the doctor.
Check nail length. Be careful with nail clippers and scissors. If you are uncomfortable trimming nails,arrange to have this done at a foot clinic or have a professional come to the house.
After bathing, make sure skin between the toes is clean and dry.
While checking the person’s feet, take the opportunity to provide comfort by giving a foot massage with scented lotions.

Dressing

Whenever possible, allow the person to choose the clothing to be worn that day. Limit the number of choices to make the decision easier.
Lay out clothing in the order that it should be put on.
Remove extra clothing from the closet. Seeing a lot of clothing can be confusing.
If the person insists on wearing the same clothes every day, try to launder these clothes often or get duplicates of favourite outfits.
Choose clothing that is easy to wear and care for. Zippers and velcro are easier to fasten than buttons. Skirts and pants with elastic bands are easier to put on.
Label (or use pictures from magazines) to describe the contents of dresser drawers. For some people it may be helpful to group items of the same colour or ones that are worn together.
Hang ties, belts or other accessories on a hanger with the matching shirt, dress or pants.

Especially for women

The application of make-up may be a regular and important part of the grooming routine. Once again, try to simplify and allow the person to do as much as possible for herself. For some women, beauty treatments give particular pleasure.
A manicure can help overall grooming and also be a source of pleasant touching and stimulation.

And for men

Use an electric razor.
Consider the time of day. It may be best to shave at a regular time, or at a time when he seems most willing. These may vary from day to day.
Try going to a barber for a shave, or find one who will come into the home.
Let the beard grow, if shaving becomes difficult.

Day to day

We all want to look good and feel good. Some days grooming routines can be accomplished with little or no effort. Other days, every task may seem like a challenge. On those days, a caregiver has a choice: which task is worth the effort and which is not? You may choose to do only the essentials - sufficient clothing to keep warm, enough cleaning to ensure basic hygiene. Just do what is possible. A little untidiness - or dirt - never hurt anyone. It is important to remember that you are doing the best you can.

In addition …

We are learning more about Alzheimer’s disease and its care everyday – much of it from caregivers like yourself who find solutions to problems and share them with others. You can call your local Alzheimer Society to find resources in your community. You can also exchange ideas by visiting The Care Exchange and Caregiver Forum on the Alzheimer Society of Canada Web site, www.alzheimer.ca. There is information. There is help. You are not alone.

Resources:
The Alzheimer Journey, Module 4, “Understanding Alzheimer’s disease: The link between brain and behaviour”, video and workbook series, the Alzheimer Society of Canada, 2002.

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