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When Getting Dressed Takes A LOOONNNNGGG Time

Buttoning

I know I should be more patient, but it takes her so long to get dressed that I end up just doing everything for her.”

I hear complaints like this all the time.  Although a person with dementia may be physically capable of getting dressed with a little extra time (or just a few verbal reminders), the caregiver finds him or herself helping more than is necessary.

Is this ok?  Does the extra help lead to learned dependency?  Should the caregiver just let the person take as long as she needs to get dressed?

Relax, there is no right or wrong answer.  It’s all relative.

First, identify if there really is a problem.  Are you (caregiver) just a “get-it-done” kind of person?  Does the length of time the activity takes make you late for work or other appointments?  Or is your urge to help more related to the sense of normalcy and efficiency that comes with completing tasks in a timely fashion?  Does it frustrate you that it takes her so long to get dressed?  Ask yourself, is it just that the time required seems excessive, or do we have an actual problem?

If the answer is, “Yes, Houston, we have a problem.  Mom can’t complete the task without multiple errors.  She gets distracted. She takes forever to put her stockings on.  She can’t decide what to wear, or chooses the wackiest outfits.  She just sits there and stares.  She layers her clothes.  She wears yesterday’s clothes.  She wears no clothes…”

…then we have an identifiable problem.  We can implement some strategies that may help.  Remember that although there might be some personality challenges and resistance as you try to suggest alternatives or time management strategies, there is a degenerative process going on in the brain that is causing difficulty in organizing and attending to information.

You probably wouldn’t be frustrated if Mom took longer due to an amputated leg or a paralyzed arm, so you need to view the damaged brain through the same lens.  You don’t need to be patient, you just need to be informed.

Brain Degeneration

Dementia is usually due to a disease process (Alzheimer’s, Parkinson’s…).  There is a loss of brain cells and neural connections causing slower brain function.  Problems with dressing can be related to:

  • memory loss “I forget what I am doing.”
  • language deficits “What is this item called?
  • sequencing errors “Which item to put on first?”
  • initiation problems “I don’t know how to begin.”
  • problem solving difficulties “How do I get this over my head?”
  • repetitive behaviors “I don’t know when I’m done.”

Strategies

  • Organize the environment.
  • Eliminate clutter.
  • Weed through and discard old clothes.
  • Give only one article of clothing at a time.
  • Keep verbal cues to short phrases- avoid chatter.
  • Label drawers
  • Lay out clothing in a left to right sequence.
  • Choose your battles- or in this case, choose your body part.  You can physically assist if the task is difficult or painful.  But if she can get her shirt and bra on, let her.  If she can pull her pants up, let her.  Let him try to button his shirt and do a few of the easier ones- help with the buttons up by the neck. The physical benefits of dressing are like exercise, and carries the same “use it or lose it” potential.
  • Parkinson’s- folks with Parkinson’s disease tend to move more slowly (bradykinesia) and have problems with initiation.  This has nothing to do with behavior.  Sometimes music with a strong beat (marching or symphonic rhythms) provide the external cues needed to move.
  • Safe seating surface- make sure there is a firm seating surface for dressing.  A solid chair with arms is ideal, as sitting on the edge of the bed or a low bench makes balancing and coming to stand more difficult.

What strategies have worked for you?

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24 comments

  1. I love the article! Helps understand why and how we can help make it easier on both people.

  2. This article made me see red. Hallucinations in the early stages were enough to send us searching for answers and the ultimate diagnosis. But I’d almost prefer them (the benign ones anyway) to the sad, sad phenomenon I refer to as “inside out, upside down, and backwards.” In fact, I even googled it to find out if anyone else had ever remarked on it. The scary hallucination phase seemed to pass only to be replaced by this bizarre inability to get dressed. Like you said–it’s the sequencing that’s off, or she gets into a continuous loop and goes back to wash the body part she just washed, rinsed, and toweled off. (She has to take sponge baths not tub baths now. We have a shower bench but she hates showers.)

    We first became aware of it when my mother started wearing tops inside out or backwards or both. Then it started taking her two or three hours to get bathed and dressed–she had been functioning more or less independently, with minimal help, up to that point. (She lives in our home, in the in-law suite downstairs.) I would hear the bath water running at 4 a.m. and go go down to tell her it was time to go to church, or to a funeral, or to some other function 2 or 3 hours later, and the entire surface of the bed would be covered with clothes. She would be standing there in her bra and underwear, crying. She just could not figure out how to do it. Everything goes on inside out and backwards. She hangs the clothes up sideways (the neck of the hanger through an armhole). She kept blaming her eyesight. But it didn’t help, no matter how “helpful” I was in pointing out where the seams or labels were situated. I thought maybe she’d had a stroke and did google that, too–and actually the doctor thinks it’s possible, as the MRI shows damage to the occipital area of the brain. She mixes up left and right–often switches shoes onto the wrong feet, turns left when I say go to the right, misses the food on the left side of the plate (“left neglect”).

    The most helpful article I found on dressing was for stroke patients. One tip was to have the stroke victim button shirts from the bottom up. I’ve tried this to no avail–she insists on buttoning from the top down. In fact, she takes forever buttoning and always buttons crooked, so when I can get her to comply I will button everything first while she’s doing something else and then slip it over her head and she will put her arms in the armholes and pull the shirt down quite easily.

    Another tip was that the caregiver should lay out the clothes in reverse order, with the underclothes on top. Well, that makes perfect sense, and I was grateful for it–only my mother still manages to turn the garment sideways and backwards and put it on incorrectly, just like she does if I put the right shoe by her right foot and the left shoe by her left foot. Something is just hopelessly scrambled up there now–whatever neural pathways there were that traced the steps you use to put on and take off garments–and even with prompting she takes forever. So what I have to do is lay everything out, then cue her. “Now, take the slippers off so you can get your PJ bottoms off. … OK, now take the PJ bottoms off. Now take the underwear off and I will hand you clean undies.” And I do–facing the correct way, so all she has to do is step into them. And yet she will turn them around and try to put them on backwards unless I stop her and turn them right way around again. And so it goes–for each and every article of clothing, until we are done. I’ve had to put her stockings on her for about 18 months now… she has forgotten how to do it. Can’t even figure out how to get them back up if she has to use the toilet–keeps pulling on the waistband, and I have to intervene or she would put runs in them. It’s gotten worse, to the point where I now don’t have the patience for her to put on ankle socks because the heel can end up on the top, on the side, or on correctly–she is oblivious to where the heel is, except sometimes to say as she jams her foot into the shoe that the sock “feels all rumpled up.” Well yes, I can imagine–the heel is sticking up on the instep of your foot so it’s a wonder you can even get the shoe on. The shoes are the killer as far as I’m concerned–how anyone can put a left shoe on a right foot and a right shoe on a left foot and not realize that something is wrong, not sense that the balance and “feel” is funny, totally baffles me. I will set the shoes out in the right position and even tell her that I have done so, and I’ll turn my back and she will have switched them anyway.

    So sorry if I sound like a heartless harridan but I am done with helpful tips on “letting them do as much as they can.” If I did that, I would be getting to work even later than the hour late I already am standing there for 20-30 minutes cuing her on bathing and dressing. We already get up at 5 a.m. … should we start getting up at 4 so she can do it herself? Enough is enough. I even tried bringing my clothing down to her room to get dressed at the same time as her–if not for modeling the behavior, at least I could get dressed simultaneously and not have to wait till she was done. But I gave up that idea the day that I accidentally handed her MY underwear to put on in my flustered state and then couldn’t find them, which meant I had to go back upstairs after she was done to get dressed. (Darn, and that was a really comfortable nice pair of panties, too!)

    • What a fantastic comment! Although the purpose of this site is to offer some measure of support, I am not of the belief that all of this rhetoric really makes much of an impact. I know you’ve heard all the platitudes and advice from the “experts”. But nobody lives your journey. Thank you for speaking the truth- that this is awful, and confusing, and hard to watch, and frequently hopeless. There’s actually a term for “dressing apraxia” where people don’t know what to do with their clothes. The proper orientation of the item (front, back, up, down, in and out) is sometimes a whole different issue depending on where the brain damage is. You are absolutely right that enough is enough and you can only do the best you can do. Thanks so much for your honesty and candidness… and humor! All the best to you and your mom.

      • Thank you for giving a name to the condition. The two different occupational therapists we engaged apparently had no idea of what it was or how to treat it. How sad. I will do further research on “dressing apraxia.”

    • Re: sox getting bunched. You might want to try tube sox. They have no heel; although the toe has to go on right. Not pretty but you have a better chance ( 50-50!) of getting it right.

    • Thanks for sharing this, my husband does the same things as your mom, and I haven’t found anyone else from my support group that their loved one did this.
      Sometimes I need I’m going nuts, everything is inside out, upside down, and backwards.
      My husband has early onset Alzheimer’s at the age 60, and he is in the middle stage now.

      • Lynne, thanks for your kind words. Yes, it feels sometimes like we are going crazy, doesn’t it? We are living in this bizarre alternate reality with them. So sad for all concerned.

  3. Great Post very resourcefull information

  4. My husband 5 years into Alzheimers diagnosis- I lay out his underwear , jeans and shirt. He knows where his socks and shoes are and does fine with that. He sometimes doesn’t see the underwear and will ask me for help locating them. He sometimes goes back into his closet for a shirt he wore yesterday- no big deal unless we’re going somewhere /having company or something. I started laying out his underwear after the morning he came into the living room dressed but saying something’s not right. I asked him what is it? He unzipped his pants and no underwear! We both laughed about that.

  5. 4/15/2016
    Good Day Sue,
    Helping my Mom who has Dementia and Parkinson’s get dressed and other activities can sometimes be a chore and challenging at times. But I seem to reflect back when I needed assistance with dressing and other activities when I broke my leg. Mom was there to help me without complaining and with the greatest of patience and tenderness. So I now am there for her without complaining, with patience and tenderness, with these thoughts everything goes more smoothly, then if a person were to be aggressive and in a hurry things never go right in this state of mind. Mom is counting on me to understand she doesn’t remember how to do these things, I am more than happy to help her no matter how long it takes.

  6. My mother-in-law has difficulties knowing where to start when getting dressed. If left on her own to dress, she will put a shirt over her nightgown or put on a hoodie jacket with nothing underneath it, or add a clean pair of underwear over her dirty ones. I normally get out her clothes, ask her to take off her gown, take off her undies, put on clean undies, etc. I hand her a shirt in the correct direction and she just slides her arms in and can put it over her head. Shoes are a little confusing. We don’t even bother with a bra unless we’re going out somewhere. Plus, we only have pull-on slacks and no buttons on any clothing. Her clothing choices are more limited now, also. Now if we could convince her to not take the sheets and comforter off her bed 10 times each day. 🙂

    • So, here are some fun facts: 1. People tend to sequence things from left to right (even in cultures that don’t read in that direction). So setting up clothing in order, and oriented so that repositioning is not needed, increases the chances for success. 2. And for the bed… it sounds like she’s wanting to be useful and helpful, and is “deconstructing” as a way to produce a meaningful outcome. So if you can provide other opportunities for her to deconstruct something (tear up paper, break something apart, unmake the bed :)) you might be able to scratch that itch on a smaller scale. See if this helps… http://thedementiaqueen.com/2014/03/productive-activities-the-art-of-deconstruction/

      • Thanks so much for the advice! That’s exactly what she is doing. She likes to fold clothes, so that has been our usual task. But that’s constructing rather than deconstructing. She was a teacher … we’ll find something on that line for her to deconstruct. 🙂

  7. Vikki Rodriguez

    I am a caregiver and your article is right on time, Thank you.

    I will continue to assist as needed, we are not in a hurry. As my patient says “I am retired I don’t need to hurry, I don’t need to go to work”..ha ha

  8. As a Caregiver for seniors in their homes, I specialize in caring for dementia and Alzhiemers clients. Every one is unique. With few basics, talk slowly, 3 word sentences, give time for it to connect. It takes anywhere from 5 to 60 seconds for client to react to directions. Only give one directive at a time. I.e. take off shirt. Not take off shirt and put on a clean one. Last 3 to 4 words is what sticks.

    Alzhiemers is a heart breaking disease for victim and fam8ly as they lose their loved one twice, to the disease then in death. And so many family caregivers get no respite care. They suffer from burnout and guilt because of their frustration.

    I pray every day for cure! And strength to continue to care for my charges. And I pray you all on this site find peace.

  9. I work at a facility where we have to stick to time limits, and we’re told to help the patient do everything or do it for them even if they can do it themselves because if we let the patient do everything themselves we’re not giving good care to them.

    • Yes I know that frustration very well. Sometimes you can make the argument to the administration that preserving skills ultimately leads to less caregiver time. The more the person can do for himself the less care (and time) is required. I think it’s all about compromise. Let the person perform one or two self care functions while you do something else- put their sweater on or comb their hair- and the caregivers can do the rest. I would aim to preserve something that they are already pretty good at, and go ahead and do for them the things that are too challenging or time consuming.

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