The Dementia Queen Exploring the evidence, the anecdotes, & the hunches- a rehabilitation perspective
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.
Memory Impairment
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
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?
- Pain?
- Medication side effect?
- UTI?
- Depression?
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.
Dressing 95 times is a real challenge for caregivers to be sure. Writing from experience, I have considered that this behaviour, along with a myriad of others, is always a behaviour which the vast majority of human animals exhibit. The difference is that, in someone without dementia, undressing and dressing is just not nearly to the extent. How many of us have changed two or three times for an occasion…not every day, or even once a month perhaps. (Although I bet when we were 3 or had a date or a big presentation, or gained a few winter pounds, etc. we dressed and undressed – and still do excessively – although perhaps not 95 times.) And so it would simply “make sense” that in someone with memory loss and/or executive function issues – this behaviour – (which we have excited and may very well still experience) – is simply just magnified. There is an awareness there, It is just that the sense of follow through to completion is lost, which you mention.
Another issue is that those with dementia and/or executive function issues often mix up their “senses” as in sight, smell, hearing, etc. This includes touch – or tactile response. They sometimes do not feel like they have clothes on or off…and if their sense of sight (or lack of vision centre connection) may not reveal this to them in the mirror. I have observed the “mixing up” their senses…eg. They taste something they do not like and “swat” or hit with their hand after the mouthful has been chewed and swallowed and another mouthful taken. Unfortunately, too often, the aides determine it is “agression” or violence towards the health worker…when really the Caree is just mixing up the senses and getting the signals crossed…instead of making a face or spitting out the food…a/he swats at it…
Elizabeth, thank you for your comments! Your insight into the sensory processing component is spot on. The truth is, behaviors like this can have multiple, compounding, interconnected reasons that are far more complicated than a battle of wills. Thank you so much for mentioning yet another piece of the puzzle.
Help! He Changes His Clothes Multiple Times A Day! People may change clothes multiple times due to either their culture or generation. It seems like the caregiver is lazy and does not want to do laundry.
My mom had a stoke last April, she has a friend that my husband and I have known for years. Suddenly out of nowhere we started seeing this type of behavior. She has always been a recluse and always stayed in her room. She has always been anti social and quiet so when my mom has a stroke her being this quiet was something we really noticed.
Is it possible that Alzheimer’s could have gone this long without us knowing and suddenly this odd behavior start?
I am stumped by this.
Thank you.