Physical appearance is important to everyone's sense of self-esteem. However, for the person with dementia the simple act of putting on clothing can be frustrating. For this reason dressing difficulties need to be managed one-by-one. There are many reasons why the person with dementia might have problems dressing, including physical problems (balance or motor skills); intellectual problems (does the person remember how to dress, recognize his/her clothes or the seasons of the year?); environment (lack of privacy, cold room,lighting, loud noises) or other concerns (pressure to dress quickly, embarrassment).

Following are strategies for coping with dressing problems:

Medical/Physical strategies:

• Have the person undergo a good medical work-up to discover any possible causes or medication reactions contributing to problems with dressing.
• The person may have impaired vision, so have vision or glasses checked.
• Have an evaluation for depression, particularly if the person is frequently unwilling to get up or dressed in the morning.

Environmental strategies:

• Make sure the room is warm enough for the person. Some older people, and especially those with dementia, often have different temperature needs. Sometimes a caregiver may feel that it is oppressively hot inside the house, while the impaired person finds the temperature comfortable.
• Provide adequate bedroom lighting. Also make sure the light in the closet is at the same level of intensity as the light in the room, so that the person won't have to get used to different light levels.
• Close the door and pull down blinds to create a feeling privacy.
• Keep the bedroom free of clutter or of the appearance that things are out of place. Put away rarely worn or out-of-season clothes to make selection easier.
• Choose a suitable spot in the room for the person to dress (to prepare for the day) and a different spot for the person to undress (to get ready for bed). Try to use these same spots every time the person dresses and undresses.

Choose practical clothing and footwear:

• Select clothing that is washable and doesn't need ironing.
• Choose clothes that fit comfortably, possibly purchasing clothes that are one size larger. Stiffness and muscle tension can make dressing very difficult.
• For some people buttons, snaps, hooks, zippers and belt buckles are too difficult to manage. Replace them with velcro tape which can be purchased in a fabric store.
• When buying new clothing, choose clothes with simple patterns. Bright, busy patterns can sometimes be distracting. Also, select solid contrasting colours as these tend to be easier for older people to distinguish.
• To avoid tripping and falling, make sure that the clothing length is appropriate.
• Try using cardigans, and other garments with front openings, rather than pullovers.
• Try jogging suits, which can be easy to get into and out of for the person who has difficulty dressing. They are also warm, good looking and easy to care for.
• Although some caregivers purchase incontinence pads, you might also want to add an extra layer of protection to regular clothing by lining the backs of skirts or pants with towelling material.
• Slip-on shoes are easier to put on than shoes with laces or ties. Make sure the shoes have non-skid soles. Some people prefer tennis shoes with velcro closures; they are also washable.

Clothing specifically for men:

• Encourage person to select his/her own clothes, but make it easier by simplifying the number of choices. For example, offer two outfits to choose between. Ask the person if she/he wants to wear a white blouse or a pink one. For some people with dementia, it may be too difficult to make even these simple decisions.
• Label dresser drawers describing their contents (Shirts, underwear, socks). For some people, it may be helpful to group all the items that are the same colour and that go together (eg. blue shirt, blue sweater and blue socks).
• Hang ties, belts or other accessories on hanger with the matching dress or shirt.
• Lay articles of clothing out in sequence on the bed. That is, they should be stacked or arranged in the order that they are intended to be put on. For example, shoes might be on the bottom with stockings inside, and the dress, slip, bra and underpants on top of each other. Make sure that all articles of clothing are right side out.
• Try putting a poster on the wall above the person's bed and above the laid out clothes. The poster could list the sequence of clothing. For example:
  

- underpants
- bra
- stockings
- dress

If the person is no longer able to read, use pictures of items of clothing to remind the person of what to put on next.

• Try laying out lightly coloured clothing on a dark bedspread. For someone with visual problems, contrasting colours may help the person to distinguish articles of clothing from the background colour of the bedspread.

Choosing clothing (Applies to men and women):

• Select clothing that is washable and doesn't need ironing.
• Choose clothes that fit comfortably. Stiffness and muscle tension can make dressing very difficult. Try purchasing clothes that are one size larger. This may make it easier to get clothes on and off. Tightly fitting blouses, for example, may be very difficult to put on.
• For some people, buttons, snaps, hooks, zippers and belt buckles are too difficult to manage. Replace them with Velcro tape which can be purchased in a fabric store.
• When buying new clothing, choose clothes with simple patterns. Bright, busy patterns can sometimes be distracting. Also, select solid contrasting colours as these tend to be easier for older people to distinguish.
• Slip-on shoes are easier to put on than shoes with laces and ties. Make sure the shoes have non-skid soles. Some people prefer tennis shoes with Velcro closures; they are also washable.
• Make sure that trousers or robes aren't too long. This might cause the person to trip or clothing might get caught in the spokes of a wheelchair.
• Try using cardigans rather than pullovers, and garments with front openings rather han back openings.

Clothing specifically for men:

• Try using suspenders or pants with elastic waistbands.
• Try tube socks, which are easier to put on because they don't have heels.
• Consider buying T-shirts. They tend to look okay even if worn backwards.

Clothing specifically for women:

• Try slip-on blouses, wrap-around or elastic waistband skirts or slacks.
• Consider using a cotton vest if person has a lot of difficulty with putting on a bra.
• Try short cotton socks, knee high or thigh high stockings. Panty hose are difficult to put on. However, stockings with garters and knee highs with wide elastic bands may be bad for people with circulation problems.
• Avoid using a slip unless person feels uncomfortable without it.
• For a lady who is used to wearing pearls or beads each day, a simple choice of long beads of pearls which can be twisted to double with no clasps can really preserve self-esteem.

Preparation:

• Lay articles of clothing out (with right side out) in sequence on the bed (preferably on a solid -coloured background). Shoes might be on the bottom with stockings inside, and the dress, slip, bra and underpants on top of each other.
• Try putting a poster on the wall above the person's bed and above the laid out clothes. The poster could list the sequence of clothing. For example:

-underpants
-bra
-stockings
-dress

If the person is no longer able to read, use pictures of items of clothing.

Label dresser drawers describing their contents (shirts, underwear, socks). For some people, it may be helpful to group all the items that are the same colour and that go together (eg. blue shirt, blue sweater and blue socks).

• Hang ties, belts and other accessories on hanger with the matching dress or shirt.

Routine and selection

• Keep the morning routine as familiar to the person as possible and avoid delays or interruptions. Help the person to eat breakfast, wash and dress in the same order that the person has done these activities throughout his/her life.
• Show the person the dress or shirt he/she is going to wear when introducing the idea of dressing.
• Encourage the person to select his/her own clothes, but make it easier by simplifying the number of choices. For example, offer two outfits to choose between. Ask the person if he/she wants to wear a white blouse or a blue one. For some people with dementia, it may be too difficult to make even these simple decisions.

One Step at a Time:

Make sure you are only doing one step at a time. Sometimes carers have a tendency to group or combine several small steps together, not realising that the impaired person may no longer be able to do two or three steps at one time.

For example, a carer might hand the person a pair of underpants to put on, not realising the complexity involved in this particular sequence of steps. It may be that the person is no longer able to distinguish the front from the back of the underpants; or he/she may not be able to pull the underpants up to his/her waist without some assistance. In this situation, the carer may have to gently remind or prompt the person with each step. In some cases, the carer may have to do several of the steps him/herself.

These communication techniques may be of help:

• Speak in a calm, friendly tone of voice.
• Use short words and short, simple sentences. Avoid complicated phrases.
• Use, when needed, very specific concrete verbal and visual cues. For example: "Here are your blue trousers," while pointing to the trousers on the bed.
• Give praise and encouragement as the person completes the steps of the task. A warm "good" or "you are doing well" conveys the message that the person is being successful.
• In trying to communicate clearly, be careful not to talk down to people with dementia or treat them like children. After all, they are adults, entitled to be treated with dignity and respect.

Other Considerations:

• A generation ago many people did not change their clothes as often as they do today. It is important not to impose our values about how often we change our clothes on those for whom we are caring. For example, is it vital to change into noght clothes when going to bed? Does it really matter if mother goes to bed in her dress.
• Being reminded to change your clothes can be a very embarrassing and humiliating experience. It is important for carers to recognise these feeling if there is some resistance to getting dressed.
• Sometimes it takes more time to assist the person with getting dressed, rather than doing it yourself, but the extra time is well worth it. Being able to dress one's self can make a person feel less dependent and can also enhance feelings of pride and self-esteem.
• Sometimes people with dementia want to continue wearing the same outfit day after day and refuse to consider any variation. Don't argue with the person (even though this may be irritating). Instead, buy a couple of outfits just like it.
• Some people with dementia tend to undress themselves frequently. This can be embarrassing and inconvenient, but it is important to remember that they no longer understand what is appropriate, and usually are not doing this to be provocative. Again, evaluate each situation:
  

- Is this person dressed too warmly?
- Does he/she need to go to the bathroom?
- Is he/she tired and trying to get ready for bed?
- Is he/she bored?

If this is a problem, try putting clothes on backwards, or purchasing clothing that is difficult to remove, such as jump suits that fasten at the back.



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