Activities of Daily Living: Personal Hygiene and Toileting

Activities of daily living (ADL) describe the fundamental skills an individual needs to care for himself independently. Those who cannot perform ADL become dependent on others or mechanical devices. Assessing an older adult’s ADL capabilities allows caregivers to know areas where they need support. 

There are six basic activities of daily living, namely, bathing, dressing, eating, transferring, continence, and toileting. In this first article, the means and ways of personal hygiene, toileting, and continence are discussed.

PERSONAL HYGIENE

Before the Shower

The bathroom can be slippery and dangerous, especially for older adults who need assistance. You can place non-slip rugs or non-slip mats to keep the floor dry, install grab bars for support in stabilizing themselves, and keep the bathroom organized.

Prepare the items needed for the shower such as shampoo and conditioner, soap, wash clothes, towels, body lotion, shower tool, and a clean set of clothes. Set up these materials beforehand and check the temperature of the water in case it is too cold or too hot. Communicate with the older adult and ensure that they are covered until it is time for the bath or shower. 

Playing their favorite music or preparing their usual shower products can make it a more relaxing activity. You can also ask for their preference to cater to their needs. It is important to respect their privacy by only assisting in tasks that they need help with. 

For dementia care, it is essential to explain what is happening while helping them shower or bath. You can also consider strip wash throughout the week such as washing a different part of the body every wash day. 

If they can wash by themselves, you should close the door until they are done. However, you can give them a sponge or washcloth if they need assistance in areas of their body that they cannot reach. These areas can be their back or their feet. Move from the cleanest area to the dirtiest when using a washcloth or sponge.

After the Shower

Help them in getting out of the shower and avoid wet surfaces to not slip. Hand them a robe or towel to dry off. If they need assistance, do not rub harshly and pat the towel gently to avoid irritating the skin. You can also ask them if they want to apply lotion in the dry areas of the body.

While assisting the older adult after the shower or bath, you can check if they have skin irritations such as sores, rashes, or dry patches. 

Everyday Hygiene Practices

Daily routines should include a bath or shower twice a week as a minimum. This reduces the risk of rashes or other skin problems, removes bacteria, and keeps them clean. Brushing teeth should be done in the morning and evening to maintain oral hygiene. Make sure that the fingernails and toenails are also kept clean by trimming them often to avoid infections. 

Aside from these, older adults should be encouraged to wash their hands after using the toilet or the bathroom. Adults with dementia can forget due to memory loss thus needing a prompt to wash their hands. Hands should be washed with soap and water. If this is difficult, you can try giving them a soapy face cloth to clean their hands.

TOILETING AND CONTINENCE

Evaluate the bathroom for potential safety hazards and take into consideration what needs to be changed to ensure safety. This can be installing grab bars near the toilet, raised toilet seats, non-slip mats, well-lit pathways, and bathroom supplies within their reach. 

Aside from these precautionary measures, it is helpful to utilize equipment that makes toileting easier. Some helpful equipment are bidets to assist with cleanliness, safety frames that provide additional support, toilet seat risers to make sitting easier, disposable bed or adult diapers for added protection, and bedside commodes for those with limited mobility. 

To help an older adult get to the bathroom, stand at their side and walk at their pace. Take small steps until the toilet is directly behind and help them slowly lower themselves to the seat. You can put your hands on their torso and bend your knees to steadily lower down to the toilet seat. Once they are done using the toilet, do not lift them outright. Encourage them to use a grab bar or support from you to slowly stand up. 

If they are incontinent, personal hygiene should be prioritized to avoid infections or skin problems. Make sure that they are not left in a wet pad or underclothes and that they have the correct continence aids. Encourage the older adult to drink enough water to maintain bowel and bladder health. If continence continues to persist, consult a healthcare provider.

Activities of daily living maintain older adult’s sense of autonomy, self-worth, and dignity. On the other hand, caregivers need to be equipped with adaptability, patience, and empathy. Support and encouragement are vital to seniors with ADL but it should not become too overbearing. Through conducting assessments, you can identify specific target areas to personally cater to their needs.