Dressing

Getting dressed can be a very complex and overwhelming task because there are so many steps involved. Helping a person with dementia to get dressed can be extremely time consuming and emotionally exhausting, especially if the person is not co-operating. Each person with dementia will react in an individual way and therefore an approach is needed that works best for both you and the person with dementia.

Possible causes
There are many reasons why a person with dementia might have problems dressing:-

• Physical or medical causes

• Depression, or a physical illness can cause a loss of interest in personal hygiene

• Changes may have occurred in gross motor skills, creating problems with balance or walking

• The changes may be with fine motor skills, causing problems fastening buttons or closing a zipper

• The person with dementia may have impaired vision

• The side effects of some drugs can cause dizziness or stiff joints

What to try
Organise for the person with dementia to have:-

• A thorough medical examination to discover any possible causes or medication reactions contributing to problems with dressing
• Their vision or glasses checked
• An evaluation for depression, particularly if the person is frequently unwilling to get up or get dressed in the morning

Forgetting how to dress
Some people with dementia can't remember whether they are getting dressed or undressed. In addition, they may forget to change their clothes, put them on in the wrong order or put on many layers of clothes. They may realise they have an item of clothing but have no idea which part of the body it goes on.

What to try
• Gentle prompting or reminders may help the person get dressed independently
• Try using the task breakdown technique. This involves breaking the task into simple, manageable steps and doing them one step at a time. You may have to gently remind the person with each step, or do several of the steps yourself. Reassurance and praise for each successful step will make the task more pleasurable for both of you

Problems with the environment
Noise, people, bright lights and clutter in the room can be distracting for a person with dementia trying to get dressed. Some older people, and especially those with dementia, have different temperature needs. Sometimes you will feel that it is oppressively hot inside the house, while the person with dementia finds the temperature quite comfortable.

What to try
• Remove other distracting items such as out-of season clothes
• Make sure the room is warm enough for the person with dementia
• Provide adequate lighting. Also make sure that the light in the wardrobe is at the same brightness as the light in the room, so that the person won't have to get used to different light levels

Lack of privacy
Getting dressed is a very personal and private activity for most of us. Many people have never dressed or undressed in front of another person and this can be an uncomfortable experience. When a person needs assistance it also conveys the message that they are no longer able to care for themselves. This loss of independence can be very difficult to accept.

What to try
• Close the door and pull curtains or blinds to create a feeling of privacy
• If the person is able to manage most of the tasks, it is far better to leave them to it and assist from a distance, intervening only when necessary

Problems making decisions about what to wear
It is important to encourage a person with dementia to select their own clothing, although for many it may be difficult to make even simple decisions.

What to try
• Simplify the number of choices. For example, offer two outfits to choose between, or offer a choice between a white shirt and a blue shirt
• Lay out articles of clothing in sequence on the bed. They should be arranged in the order that they are meant to be put on
• Try laying out lightly coloured clothing on a dark bedspread. For someone with visual problems, contrasting colours may help a person with dementia see articles of clothing from the background colour of the bedspread

Some other suggestions:-

Putting on many layers of clothing regardless of the weather
Judgment and the sensation of hot and cold can be impaired in some people with dementia. If the extra clothes are not causing any discomfort it is easier to leave well alone. It may be worth packing away extra clothing so that it is not visible.

Choosing clothing and footwear
Maintaining a person's individuality and style of dress is very important. Introducing clothing that is very different from a former style may cause more problems than it is worth. However, the following hints may help to manage any problems with dressing:-

• Select clothing that is washable and doesn't need ironing
• For some people, buttons, snaps, hooks, zippers and belt buckles are too difficult to manage. These can be replaced with Velcro tape which can be purchased at any fabric store
• Busy, bright patterns on clothes can be distracting. Choose clothes with simple patterns and with solid contrasting colours as these tend to be easier for many people to see
• Slip on shoes are easier to put on than shoes with laces and ties. Make sure shoes have nonskid soles

Wearing the same outfit day after day
Rather than arguing with a person who wants to wear the same outfit day after day, it is often better to buy a couple of the same outfits.

Other considerations
• In past times many people did not change their clothes as often as they do today. It is important that you do not impose your own values about how often clothes need to be changed
• Being reminded to change your clothes can be an embarrassing and humiliating experience. It is important to remember these feelings
• Any extra time taken to maintain independence is well worth it. Being able to dress yourself can make a person feel more independent and can build up feelings of pride and self esteem
• Some people with dementia may undress themselves frequently. This can be embarrassing and inconvenient, but they may no longer understand what is appropriate, and are not usually doing this to be provocative.

Remember that people with dementia do not always recognise new clothes as belonging to them. When replacements are needed, try to buy the same style or colour as the old familiar ones.

Evaluate the situation:-

• Is the person too warmly dressed?
• Do they need to go to the bathroom?
• Are they tired and trying to get ready for bed?
• Are they bored?

Did you know?

More than 60 per cent of all care home residents, aged over 65, have a form of dementia.