Dementia Effects on Activities of Daily Living (ADLs)

Activities of Daily Living (ADLs) are tasks that need to be accomplished on a regular basis to function.1 Examples of ADLs include bathing, dressing, grooming, eating, mouth care, and toileting.

What Impact Does Dementia Have on ADLs?

Alzheimer’s disease and other kinds of dementia often make performing ADLs difficult. Tasks may be done halfway, poorly, or not at all. For example, while some people with dementia appear as if there’s nothing wrong with them, others look disheveled and may wear dirty, mismatched clothes. 

A person’s ability to perform ADLs is often evaluated when assessing their cognitive functioning. Since dementia is typically a progressive condition, the ability to perform ADLs declines over time.

Assistance required increases over time. Persons with dementia need help with various activities for many reasons. They may not remember how to do them, they may have movement disorders and poor coordination, they may have lost interest in doing things, or may not understand why something needs to be done. They may not be able to understand instructions when someone tries to help them. As dementia is a progressive disorder, they need more assistance as their condition worsens.

Dementia Makes ADLs Difficult

Several of the brain functions required to perform ADLs are impacted by dementia.

Persons with dementia face several problems while trying to do a task. For example, they may not understand what they have to do. They may not understand instructions or forget them midway of the task. Their ability to stay focused or interested may be poorer. They often stop recognizing objects or knowing how to handle them. Balance and coordination may be poor, and movement may not be controlled. When they struggle to do something, they may get frustrated. When trying to help them, you may try to explain to them what needs to be done and why it is important. Then, when the person looks blankly at you, you get disheartened.

Executive Functioning

It can be difficult to correctly order the multiple steps required to wash hair, for example, or to get dressed.2 It’s not uncommon to see people put clothing on in the wrong order, such as trying to put a bra on over their shirt. Sequencing, planning, and organizing a multiple-step activity can be very difficult.

Memory

Sometimes, the person with dementia just forgets to do the task or how to perform it. They might not remember to put clean clothes on in the morning or comb their hair.

Judgment

Poor decision-making skills can also impact ADLs.2 In the middle of winter, someone with dementia might decide he doesn’t need long pants or a jacket.

Attention

The ability to focus on completing an activity such as a bath might be challenging if the environment is noisy or if the person is feeling tired or experiencing pain.

Behavioral and Psychological Symptoms of Dementia

Sometimes, dementia can affect personality and behavior so that a loved one resists assistance with ADLs, further complicating things. She might become fearful or angry at your “meddling” because she doesn’t understand that she needs assistance with a bath or brushing her teeth.

Visual-Spatial Changes

The visual perception of where the toothbrush is on the bathroom counter or uncertainty as to which container is the toilet can make completing ADLs difficult.

How to Help Someone Who Has Dementia With Their ADLs

General tips

• Establish a routine. Schedule grooming activities for the same time and same place each day. For example, brush teeth after meals, or schedule baths for the mornings or evenings. Choose the most relaxed time of the day for bathing and grooming.
• Respect privacy. Close doors and blinds. Cover the person with a towel or bathrobe.
• Encourage independence as much as possible. This will help to promote a sense of accomplishment.
• Keep in mind the person’s abilities. Allow enough time to complete each task; for example, brushing his or her hair or teeth.
• Give encouragement and support as he or she completes tasks. Acknowledge his or her efforts when completed. “You did a nice job brushing your hair today.”
• Tell the person what you are doing. “I am going to wash your hair now.”
• Keep fingernails and toenails clean and trimmed.
• Break down all grooming tasks into simple, step-by-step instructions.

• Remain calm​
• Provide one direction at a time
• Model the behavior alongside the person
• Decide what’s really important and let the rest go
• Allow extra time to decrease stress
• Use humor appropriately
• Choose the caregiver or family member who has a good rapport
• Take a break if it’s not going well and try again later
• Hire home health care to assist
• Practice the activity in the same routine every day

If other conditions such as arthritis or a significant decline in function exist, ask your physician if Medicare will pay for Occupational Therapy for a period of ADL assistance or training.​

Eating

• Be sure to provide your loved one with a nutritious diet and plenty of healthy fluids, such as water or juice.
• Encourage independent eating if your loved one is able. Consider serving finger foods that are easier for the person to handle and eat.
• Adaptive equipment, such as plate guards or silverware with specially designed handles, is available for individuals who have difficulty holding or using utensils.
• Do not force feed. Try to encourage the person to eat, and try to find out why they do not want to eat. Remember to treat the person as an adult, not as a child.

Bathing

• Remove or secure throw rugs to prevent falls.
• If the person is heavy or can offer little help, special equipment may be needed. Your doctor or therapist can give you advice on how to safely bathe your loved one.
• A complete bath may not be needed every day. A sponge bath may be enough.
• Always check the temperature of the water in the bath or shower. You may want to consider setting your hot water thermostat to 120 Fahrenheit.
• If giving a bath in the tub, try using a bath chair with handrails. Also, place rubber mats in the tub to prevent slipping.
• Use a hand-held showerhead.
• Make sure the bathroom is warm and well-lit.
• Let the person wash him/herself (if able). If needed, help guide them through each step with simple instructions. Another idea is to place your hand on top of theirs to assist with the washing action.
• Be sure that the genital areas, the area underneath any folds of skin and difficult-to-reach areas are cleaned and dried well after the shower.
• Pat the skin dry; do not rub. Apply lotion to keep the skin soft and supple.
• Never leave a frail or confused person unattended in the shower or tub.

Hair care and shaving

• Try washing the person’s hair in the sink, especially if baths are preferred to showers.
• If your loved one is able, a trip to the salon or barbershop may be a fun and positive experience.
• Try using a dry shampoo if the person is bed-bound or fearful of having his or her hair washed.
• To reduce the risk of cuts, use an electric razor for shaving, especially if the person is taking blood-thinning medicines (such as Coumadin®).

Dressing

• If the person can dress themselves, lay out the clothes in the order they are to be put on.
• Buy loose-fitting, comfortable clothes.
• Buy clothing that is easy to put on and take off. Garments and shoes that use Velcro closures and large zippers are preferred to belts, buckles, buttons, and shoelaces.

Dental care

• If the person brushes his or her own teeth, help by putting the toothpaste on the brush.
• If the person does not brush his or her own teeth, assist them.
• If the person refuses to open his or her mouth, try brushing only the outside of the teeth.
• If the person wears dentures, clean them every day. Check that the dentures fit properly, and examine the gums for sores or areas of redness.
• Have the person rinse their mouth with water after each meal.
• Ask your dentist for advice on providing good dental care.

Using the toilet

• Install safety features in the bathroom, such as grab bars and raised toilet seats.
• A bedside commode or urinal may be helpful if getting to the bathroom is a problem, especially at night.
• Schedule routine bathroom visits to prevent accidents.
• Tell the doctor about any loss of bowel or bladder control. These problems may be symptoms of conditions that can be treated with medication.

Some useful external links.

One particularly good site for a variety of daily care tips is the Daily living section of the Alzheimer’s Society which has pages for a wide variety of daily activities, including many discussed on this page. Also, check our pages on handling changed behavior: Handling Behavior Challenges and Special tips for wandering, incontinence, repetitions, sundowning, and other specific behavior changes.

Read more at Dementia Care Notes: Page title: Helping with Activities of Daily Living, Link: https://dementiacarenotes.in/caregivers/toolkit/adl/

1. Alzheimer’s Association. Glossary. 
2. Marshall GA, Amariglio RE, Sperling RA, Rentz DM. Activities of daily living: where do they fit in the diagnosis of Alzheimer’s disease?. Neurodegener Dis Manag. 2012;2(5):483–491. doi:10.2217/nmt.12.55

Additional Reading

• Alzheimer’s Association. Dressing and Grooming.