Dementia Effects on Activities of Daily Living (ADLs)

Activities of Daily Living (ADLs) are tasks that need to be accomplished on a regular basis to function. Examples of ADLs include bathing, dressing, grooming, eating, mouth care and toileting.

What Impact Does Dementia Have on ADLs?

Alzheimer's disease and other kinds of dementia often make performing ADLs difficult. Tasks may be done halfway, poorly or not at all. For example, while some people with dementia appear as if there's nothing wrong with them, others look disheveled and may wear dirty, mismatching clothes. 

A person's ability to perform ADLs is often evaluated when assessing their cognitive functioning. Since dementia is typically a progressive condition, the ability to perform ADLs declines over time.

Why Dementia Makes ADLs Difficult

Several of the brain functions required to perform ADLs are impacted by dementia.

Executive Functioning

It can be difficult to correctly order the multiple steps required to wash hair, for example, or to get dressed. It's not uncommon to see people put clothing on in the wrong order, such as trying to put a bra on over their shirt. Sequencing, planning and organizing a multiple-step activity can be very difficult.

Memory

Sometimes, the person with dementia just forgets to do the task or how to perform it. They might not remember to put clean clothes on in the morning or comb their hair.

Judgment

Poor decision-making skills can also impact ADLs. In the middle of winter, someone with dementia might decide he doesn't need long pants or a jacket.

Attention

The ability to focus on completing an activity such as a bath might be challenging if the environment is noisy or if the person is feeling tired or experiencing pain.

Behavioral and Psychological Symptoms of Dementia

Sometimes, dementia can affect personality and behavior so that a loved one resists assistance with ADLs, further complicating things. She might become fearful or angry at your "meddling" because she doesn't understand that she needs assistance with a bath or brushing her teeth.

Visual-Spatial Changes

The visual perception of where the toothbrush is on the bathroom counter or uncertainty as to which container is the toilet can make completing ADLs difficult.

How to Help Someone Who Has Dementia With Their ADLs

• Remain calm​
• Provide one direction at a time
• Model the behavior alongside the person
• Decide what's really important and let the rest go
• Allow extra time to decrease stress
• Use humor appropriately
• Choose the caregiver or family member who has a good rapport
• Take a break if it's not going well and try again later
• Hire home health care to assist
• Practice the activity in the same routine every day

If other conditions such as arthritis or a significant decline in function exist, ask your physician if Medicare will pay for Occupational Therapy for a period of ADL assistance or training.​