This is a multi-part series to help caregivers learn how to help older adults with their personal care. Activities of Daily Living, or ADLs, are basic self-care tasks. In Part IV, we will focus on how to help adults use the bathroom.
Assist Toileting Elders or Using a Commode
First, assist the older adult to safely get to the bathroom toilet or commode, using any necessary gait devices and proper transferring techniques. Check that there is enough toilet paper and provide privacy. Finally, wash your hands.
Assisting with Bedpan and Urinal
First, get the things you will need (gloves, clean & dry bedpan with cover, bed protector, laundry bag, toilet paper, towel and washcloth, double trash bag). Wash your hands and provide privacy. Put on gloves, then slide bed protector and bedpan under hips, and position the bedpan so it is firmly against the buttocks. Finally, take off your gloves and wash your hands again.
Assisting with Perineal Care
Perineal care refers to the cleaning of external genitalia, surrounding skin, and buttock areas. It is important to protect the older adult’s privacy as much as possible when providing perineal care by covering as much of them as possible. This also helps to keep them warm. It’s an important part when you help adults use the bathroom.
Follow standard precautions whenever you provide perineal care, because your hands will be coming into contact with body fluids. This protects both you and the older adult. Perineal care is generally performed during bathing, but for older adults who are incontinent or have a urinary catheter, you will have to do it more often to keep the skin healthy and free of infection. Before beginning perineal care, raise or lower the bed at a comfortable working height. Position the older adult with their knees bent and legs slightly apart, unless there is some reason not to. Drape the area with a towel.For men, place a towel over his abdomen and cover his legs with a sheet or towel. Once you have organized all supplies and you are ready to begin providing care, fold the blanket or towel back to expose the perineal area. Wash the patient’s upper thighs and inguinal area. Clean the tip of the penis at the urethral meatus in a circular motion from the center outward. Wash the shaft of the penis from the tip to the base in a downward motion. Wash the scrotum including the underlying skin folds. If the male is not circumcised, retract the foreskin and clean the tip of the penis at the urethral meatus in a circular motion from the center outward. Then return the foreskin to its original position. Lastly, wash the outer buttocks then inner buttocks.For women, place a towel over her abdomen so that one corner is pointing in the direction of her head and the other corner is covering the perineal area. Secure the lateral corner of the blanket loosely around her legs. When you are ready to begin, fold the corner covering the perineal area back onto the patient’s abdomen to expose the area you will bathe. Clean the perineal area from front to back, to prevent contamination from the rectal area to the urethra. It is also important to use a separate area of the washcloth for each area or a new washcloth if the one you are using becomes soiled. After you wash and thoroughly rinse each area, pat them dry to prevent skin irritation.If the older adult is continent, once you have completed perineal cleaning and drying, apply a barrier cream (such as Desitin) to the perineum to help protect the skin. When you help adults use the bathroom, or help him or her clean up afterward, remember to provide them with privacy and respect. Be sure to wear gloves for the safety of yourself and the elder you’re working with.
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This is a multi-part series to help caregivers learn how to assist older adults with their personal care. Activities of Daily Living, or ADLs, are basic self-care tasks. In this part, we focus on aiding an elder with personal hygiene.Good personal hygiene is one of best ways to keep an older adult healthy. It can also help make an older adult feel good about themselves; so encourage them to be well groomed. Remember, like everything else, that independence and self-care is the goal, even if it takes longer. For all aspects of personal hygiene, wash your hands before and after any activities, wear gloves, ensure the older adult’s privacy, clearly explain everything you are about to do, and encourage them to perform their own care as much as possible.
Aiding an Elder with Personal Hygiene
Assist with bath or shower
A bath can help the older adult to relax. Older adults have sensitive skin that is prone to dryness, so they often may not need bathing more than once or twice a week. As always, listen and try to accommodate what the older adult wants in terms of the routine. Before you start, make sure the bathroom is a comfortable temperature and get the items needed (eg. gloves, soap, washcloths, bath towels, clean clothing and any required safety equipment such as grab bars). Make sure there is a non-slip mat on the bottom of the shower or tub and on the floor as they step out to prevent falls. Place a shower bench or seat in the shower so the older adult can sit down while he/she showers. Next, turn on warm, not hot, water. Check the water temperature and water pressure and make adjustments before the older adult gets into the tub or shower. Never turn on hot water once the older adult is in the tub or shower. Assist the older adult to remove clothing and to step into bath or shower, using assistive devices and hand rails if required. Use a gentle non-irritating soap, such as Dove. Wash face first to feet; perineal (or genital/buttocks) care is last.
Assisting with sponge baths
If an older adult is not able to use a tub or shower but can still wash themselves to some degree, you can provide a washbowl or help them with using the sink, either while sitting or standing. These alternatives help the older adult move at their own pace while giving them independence. Get the items needed (eg. gloves, washbasin, soap, washcloths, face towel, bath towels, clean clothing). As always, ensure the older adult has both respect and privacy. Put on gloves and fill basin with warm water. Wash face without soap, starting with each eye from the inside corner. Pat dry. Wash shoulders to feet; then wash back, buttocks, and thighs. Finally, wash perineal area. Towel dry, remove gloves and wash hands.
Assisting with shampooing hair
Like bathing or showering, washing hair daily is not necessary, but should be done at least once a week. Make sure to use a mild shampoo. Since washing hair can be time consuming and tiring for the older adult, you might consider doing it on a non-bath day. A dry shampoo can work well if the older adult wants to wash their hair without taking a bath or shower. Before brushing or washing hair, check the scalp and hair to see if you need to make changes in anything, like the type of shampoo. Brush or comb hair every day to help distribute natural oils to the ends of the hair shafts.
Assisting with oral hygiene
Good oral hygiene is important for older adults, particularly because they are more prone to problems with the teeth, gums, and lips, and at the same time, they are less able to detect pain than younger adults. Older adults produce less saliva, which helps to clean the teeth. Poor mouth care can result in mouth sores, bad breath, and poor appetite, which can lead to weight loss and malnutrition. It is extremely important that you encourage the older adult to brush their teeth at least once a day. Make sure the older adult sees a dentist regularly and any dentures should be checked regularly to ensure proper fit.
When assisting with brushing teeth, wash your hands and get items needed (eg. toothbrush, toothpaste, glass of cool water, small basin or plastic bowl, face towel, paper towels, gloves).
Put on gloves and ensure that the older adult is sitting upright. Place a towel over older adult’s chest. Assist older adult to brush teeth and clean tongue, encouraging self-care. Provide water for the older adult to rinse their mouth. Hold basin or cup to their chin to allow older adult to spit.Make sure to examine the older adult’s mouth for any signs of redness, swelling, bleeding, sores, or loose teeth. Dentures should be cleaned at least once a day to prevent staining, bad breath, and gum irritation. Finally, remove gloves and wash your hands.Aiding an elder with personal hygiene is key to their health and self confidence. Continue to let them do as much as possible on their own.
This is a multi-part series to help professional eldercare givers learn how to assist adults with their personal care. Activities of Daily Living, or ADLs, are basic eldercare self-care tasks. In Part II, we will focus on assisting an older adult with grooming and dressing.
Assisting with Personal Eldercare: Grooming
Helping with nail care
Nail care should be performed every week. The nails of an older adult are often thick but also brittle, and grow more slowly than those of younger adults. After washing the older adult’s hands, clean under the nails using the pointed end of an orangewood stick. An orangewood stick is preferred to a metal stick. Then either rinse the stick or dispose of it. Massage the nails and cuticles with a moisturizing lotion. This helps to prevent hangnails. Soak the nails in warm, soapy water for 3-5 minutes. This will make the cuticles and nails softer. Push cuticles back gently. Too rough may lead to skin breakdown and infection.Cut nails with a nailcutter; or, if nails are brittle, file them down instead. Move the emery board in one direction and don’t file too close to the sides of the fingers.
Helping with shaving
Make sure you are working in a well lit area and sit the older adult upright if possible. Place a towel under his chin to protect his clothes. Spread a warm (not hot), damp towel over the lower face and chin to soften the hairs, or have him take a shower before the shave. This makes shaving much easier. Using a circular motion, apply a thin, even layer of shaving cream on the lower face and chin, and leave it on for a minute to soften the hairs. Warm a razor with a sharp blade in a tub of warm water. Stretch the older adult’s skin as taut as possible while shaving. Shave in the direction of hair growth. Usually the beard hairs grow downward toward the neck, but neck hair usually grows toward the chin. Use short strokes, starting with sideburns, cheeks and neck. Finish with the upper lip and chin. Wipe the razor on a clean towel or tissue, and rinse it in a tub of warm water frequently. When you are done, rinse the person’s face thoroughly with cool water and pat dry with a towel. Do not rub. Finally, apply non-sting after-shaving moisturizer.
Helping with routine skin care
Skin changes with increasing age: it begins to thin, dry and becomes easier to damage. The normal fat layer under the skin begins to disappear, making it easier for pressure sores to develop. For proper dermatology and eldercare, keep the person’s skin clean and moisturize it regularly. Use a moisturizer that is free of fragrance and unnecessary ingredients that may cause skin irritation or allergy. Eucerin is often a good choice. Even the massaging motion of applying moisturizer can help keep an older adult’s skin healthy.
Assisting with Personal Care: Dressing
Assisting with clothing – including adaptive clothing
First, gather necessary items; for example, towel/blanket, older adult’s choice of clothes, gloves. Start dressing the older adult’s weaker side. Pull the shirt over the head or around the back. Finally, assist older adult with stronger sideThe goal is for the older adult to do as much of the dressing as possible themselves. One way to encourage this is to use adaptive clothing, which is widely available. Adaptive clothing, or ‘easy access clothing’ is easier to change and remove than regular clothing, and is specially made for older adults or people with disabilities. It has simple closures, helps an older adult retain dignity and provide some level of self-care. Some examples of adaptive clothing include Velcro shoe closures, Velcro or snap closures rather than buttons, front closing bras, and designs which allow a person to get dressed from a seated position.
Assisting with support stockings
Support stockings by definition are snug-fitting and can be difficult for an older adult to apply themselves. They can even be difficult for caregivers to apply, but a few simple strategies can make their application much easier.First, have the older adult sit while applying stockings. Make sure there is no skin breakdown. Apply the stockings before the older adult gets out of bed in the morning (before any swelling starts), and take them off after they get in bed at night. This can make application much easier. There are various devices that can make the application of compression stockings much easier, such as an E-Z slide applicator. Ask at the medical supply store where the stocking was purchased for what they have available and for any instruction on using their applicators. If the stockings are open-toed, place a plastic bag over the foot, and put support stocking over. Then remove plastic bag by pulling it through the open toe area. Do not fold the top edge of support stocking, this can cause tourniquet effect.If the older adult won’t wear the stockings because they feel too tight, speak to the doctor or therapist who prescribed them. Stockings are available in very light strengths, and often some compression is better than no compression at all. Support stockings usually only need to be knee high, any higher and they are more difficult to pull on. Put any creams or moisturizers on the legs at night and then stockings on in the daytime. Moisturizers can damage the elastic in stockings. Always remember to apply footwear with a rubber sole, as support stockings are slippery and have no traction when walked on.Assisting with personal care is important, but remember to let the older adult do as much as possible themselves. Professional eldercare is about helping someone enjoy their lives
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This is a multi-part series to help caregivers learn how to assist older adults with their personal care. Activities of Daily Living, or ADLs, are basic self-care tasks. Here, we will focus on how and why we help by using ADLs. We’ll also discuss how to assist adults with eating and drinking.
Personal Care: Why is helping older adults with everyday activities so important?
Think about all of the little things you need to do each day. Just to start your day you must get out of bed, take care of your personal hygiene (bathe, shampoo hair and brush your teeth), pick out clothes, get dressed and eat. Many little steps are required to do each of these things. For example, getting out of bed requires that you are able to roll to the side of the bed, swing your legs over the edge of the bed, place your feet on the floor and stand. The important, personal care you provide helps to keep the older adult as independent as possible, safe, healthy and improve their quality of life.
Honor individual preferences and independence
We all have preferences about when and how we like to do things and it is important to honor others’ preferences whenever possible. The older adult you are caring for has had some loss in their ability to fully care for themselves. It is, therefore, important to help them feel that they still have some control in their daily lives. Involve them in choosing when and how you will do certain activities and encourage them to do as much as they can on their own without being overly dependent on your help. Although it may take longer for an older adult to do a particular task, it is best for them to do as much as they can for him/herself. Be patient. When you are unsure if your help is needed, just ask.
Helping adults with drinking
An older adult needs about 8 glasses of water per day. Having enough water helps prevent urinary tract infection and constipation.Dehydration occurs when a person does not get enough water. An older person may not feel thirsty, even when they needs fluids, because ability to detect thirst decreases with older age. Many older people also don’t want to drink too much because they are afraid they may have to go to the bathroom too frequently or have an accident. Drinking water should be available to older adults at all times. If an older adult has an impairment that affects their ability to drink, you may need to offer a straw or small sips and assist them to drink throughout the day. Avoid soda and juice as much as possible because they are high in sugar. Coffee, tea and soda also contain caffeine, which actually dehydrates, or draws water out of, the body even more. Alcohol also dehydrates.
Helping adults with eating
Mealtime is an important social time. Use a calm, friendly and encouraging tone when helping with mealtimes. This will go a long way toward making it special.
Serve the meal by placing it within easy reach.
Make sure the older adult has all the utensils they will need.
Check frequently to see if they need help.
Offer to cut food for an older adult who is having difficulty. When cutting food, always make sure the pieces are small enough to help prevent choking. An older adult with arthritis may also need help with things such as opening milk containers.
Offer different food if an older adult refuses what was offered.
Allow them time to complete one course before starting another.
If needed, help the older adult check their personal appearance before moving away from the table. For example, check to see if there are any food spills or crumbs that need to be cleaned. Help an older adult to wipe his/her face, if necessary. Make sure they feel presentable.
You need to be aware of the possibility of choking on certain foods. Some helpful hints for alternative food choices or preparation methods might include:
Cutting, grinding food, or turning it into a cream sauce – If you are family caregiver, make sure this is ok with the older adult’s healthcare provider, and if you are a professional caregiver, make sure this is on the care plan.
Serving a rich soup or blended meats and vegetables to increase calories.
Using mashed or pureed fruits and vegetables or their own juices to make dry foods more edible
Using gelatins, ice creams, puddings, custards or milk shakes to replace hard-to-chew or hard-to-eat foods.
Offering liquid or soft supplements (if appropriate) such as health shakes, Ensure or fortified cookies.
If you see any of the following, tell your supervisor or health care provider depending on whether you are a professional caregiver or family caregiver:
A change in the amount of assistance an older adult needs while eating.
A change in general behaviors during mealtime such as playing with food, taking food from others, throwing food or falling asleep.
A change in attitude such as withdrawing, showing anger or frustration.
Choking while eating or drinking.
Eating less or more food than usual.
A refusal to eat.
Personal care assistance is so important with older adults. Keep in mind the fine line between being helpful and inhibiting their independence. If you would like to learn more about offering Personal Care and healthy eating habits for an older adult in your life, please check out CareAcademy’s newest eldercare class. The Personal Care Class will be available soon. If you would like to be the first to know when it’s live on our site, please email us at firstname.lastname@example.org to let us know you’re interested. Thank you!
Madhuri ReddyHow to Assist Adults with Eating and Drinking