Resistance to Activities of Dailing Living (ADLs)

Preventing and managing resistance when attending to activities of daily living

The following scenario describes the recommended approach and responses to preventing and managing resistance when attending to ADLs. Below the flow chart you will find specific strategies to manage resistance to care.

Always use clear communication before attempting to attend to the person’s self care. Make sure that you have:

  1. Introduced yourself.
  2. Explained what you are about to do BEFORE you start.
  3. Given the person enough time to comprehend what you are telling them.
  4. Not put yourself directly in front of them.

(Please refer to: the Ten Top Tips for dealing with people who have dementia and Communication strategies)

Bathing

  • Ensure the bathroom is warm and private for security
  • Encourage the person to hold onto grab rails or other solid object for security
  • Use a shower chair or bath seat
  • Ensure personal preference for bathing times and methods are respected
  • Encourage independent bathing by offering simple, one-step instructions and actions
  • Talk to the person about pleasant and non-threatening topics while providing care
  • Use appropriate furnishings to encourage a welcoming look rather than a sterile/austere look.

Dressing and grooming

  • Eliminate choices - show one object of clothing at a time
  • Provide simple, practical clothing that is durable and washable
  • Solid coloured clothing is less confusing than 'busy' patterns
  • As a last resort, eliminate unnecessary clothing such as bras, slips, panty hose & undershirts
  • Lessen any frightening aspect of the bathroom, ie; cover the mirror

Toileting

  • Identify and treat any physical cause of discomfort, ie; UTI
  • Promote easy identification of the bathroom with clear signs and pictures
  • Substitute pull-on pants or skirts for those with complicated closures
  • Be aware of and respond promptly to non-verbal cues of toileting needs
  • Promote privacy

Eating

  • Assess for any physical or psychological causes such as dirty eye glasses, ill-fitting dentures, or a full bladder and address these appropriately.
  • Provide foods according to assessed personal preference
  • Provide a calm dining environment with minimal distractions & background noise
  • Reduce confusion by serving one item of food at a time & providing one utensil at a time
  • Allow plenty of time for eating

References and recommended reading

Alzheimer's Association Australia (2000). Help Sheets for people with dementia and their families and carers. Alzheimer's Association Australia. [available online] http://www.alzheimers.org.au.

Potts, H.W. Richie, M.F. & Kaas, M.J. (1996). Resistance to Care. Journal of Gerontological Nursing, Vol.22: No.11, pp.11-16.

Robinson, A. Spencer, B. & White, L. (1991). Understanding Difficult Behaviours: Some practical suggestions for coping with Alzheimer's Disease and related illnesses. Eastern Michigan University, USA.