This blog builds on information covered in some other blogs:
- Care refusals based on fear
- Preventing care-resistant/care refusal behavior
- Handling care refusals in real time
In this blog, I will show you how to tailor these general approaches to specific situations where you may have, or have already encountered, care refusals or resistance.
“Let’s Get Dressed” NOT “Do you want to get dressed?
It may be best to introduce the topic of dressing as a stated activity, not as a question. Allow the older adult to dress as independently as possible. As dementia gets worse, it becomes more difficult to select outfits or remember the order in which the clothes should be put on. You can help by laying the clothes out in order or handing them to your family member one at a time. Use prompts, either in the form of short, 1-step requests or by gesturing and pantomiming. If someone is really resistant to getting dressed, it can be helpful to use the “ask for help” technique by asking them to show you how to put on an item of clothing.
Avoid rushing the person living with dementia. Your “vibe” changes when you are in a hurry. If you are feeling impatient, you may cause the person living with dementia to feel upset. Upset feelings often lead to care refusals.
Keep It Simple
Sometimes, we provide too much information. True, adults want to know why they have to do something. It needs to make sense to us. Persons living with dementia may have mixed up and fragmented memories. They may also have problems following a line of reasoning. For example:
“Mom, please get dressed. You are going to the doctor.”
“Why do I need to go to the doctor? I’m fine.”
See where this is going? Now, you are getting into a “hamster wheel” of futile discussion about the doctor’s visit. Instead, shift gears and simplify the situation.
“Mom, it is time to get dressed.”
“Why? I’m fine.”
“I know. But it is time to get dressed. This mango shirt looks great on you! It is one of my favorites.”
It may feel weird, but sometimes simply repeating a very simple fact is all that is needed.
Entering Their Reality
If you are getting refusals, try to think about possible situations from their past that may help trigger memories of getting dressed. For example, what daily routine did the person living with dementia follow? Were they awakened every morning by an alarm? Was the routine getting dressed and then eating breakfast? Sometimes dressing refusals happen because we have changed up the routine due to our needs. We teach children routines to help them make memories. For people living with dementia, we keep routines to help keep the memories.
I lay out my clothes on my bed prior to putting them on. My pants are zipper side up; I flip them around to step into them. If I had moderate dementia, I would not recall this step. Instead, I would pick up the pants (with the zipper facing me) and put them on backward.
If this is something you are noticing, simply lay the clothes out so that the person living with dementia can put them on without turning the item around. This means placing the pants zipper side down on the bed.
It is best to have the person living with dementia do as much dressing as is safely possible. Sometimes, it is tempting to dress the person to save time. Here is the issue: every time a person living with dementia performs an activity, the neurons involved in that activity are exercised. The nerves are used. If you dress the person, you stop the nerves involved in the activity from being used. Over time, the nerves will shrivel up. The person living with dementia may not have enough extra nerves to pick up the activity. The ability is lost forever.
Dr. Rita Jablonski
Rita Jablonski, PhD, CRNP, FAAN, FGSA is a nurse practitioner, researcher, tenured professor, and former family caregiver. Her research and practice involve all aspects of dementia management; she is best known for non-drug strategies to address dementia-related behaviors.