A common complaint
A person with dementia dresses and undresses multiple times a day. Wardrobe changes are a relatively harmless behavior challenge, although they are certainly a time-consuming frustration for the caregiver.
Let’s analyze the behavior and break it down into manageable chunks.
The act of dressing and undressing is really a repetitive behavior enhanced by a few factors: impaired memory, decreased executive function, and psychomotor agitation.
The memory part is obvious; he just doesn’t remember that he recently changed his clothes. Or, she mistakenly believes she has somewhere to go and needs to get dressed for the occasion. It’s a short term memory issue. Period.
Executive Function Impairment
The executive function part is also related to memory issues, but is part of the disease process where a thought cannot be fully executed into action. It’s like losing the thread of story or leaving the water running… the task is initiated with cogent intention, but the sense of “Ok, I’m done now” is impaired. We see this a lot in folks who layer their clothes, wear a ton of make-up, over-eat, and wash their hands for an extended period of time. This person probably repeats themselves a lot too- the action gets stuck in a repetitive loop. It is a memory problem, but it is also an impairment in task completion. He just never “feels done”.
Psychomotor agitation is the way a person physically demonstrates anxiety. It’s an action, usually repetitive, that serves as an outlet for some nagging concern. It’s akin to wringing your hands or going on a compulsive cleaning binge when you’re upset- you just need to do something to alleviate the anxiety. For some people, changing their clothes is a way to relieve tension. It’s like pacing and wandering, a motor action that the person hopes will clear the cobwebs.
Strategies for Repetitive Dressing/Undressing
- Limit access
- Group outfits
- Limit quantity- does he really need 22 pairs of pants and 7 winter coats?
- Provide a place to perform the action safely where you can control the volume of clothing but still allow the behavior to occur- set up a “dressing corner” if you will
- Use verbal reminders or check lists or calendars for feedback (may not be effective for later stages)
- Provide some other outlet for the need to be repetitive- go for a walk, put music on, dust the furniture, rock, swing, rummage
- Is the anxiety a sign of something else?
- Medication side effect?
8. What is he getting dressed for? Determine the core desire. Is he getting ready to go:
- To work (to be productive)?
- To meet family (for love)?
- Just to look nice (to be desired, or appreciated)?
Take comfort in the fact that lots of people experience this caregiver challenge. Also remember that actions like these are the result of a disease process, and have no conscious, malicious intent to drive you crazy.