Caregiver's Handbook--Part 4 of 9
Include: eating, bathing, shaving, caring for the skin, hair and mouth, and
transferring (moving from chairs, toilets or bed). During the course of our
daily lives these activities are taken for granted until weakness or a
disability makes them difficult to accomplish independently or safely. Providing
assistance requires knowledge, patience, skill and physical strength.
- Keep skin clean and dry, especially when people are having problems with
bowel and bladder control. When washing, use a mild soap, rinse well, and dry
- Keep bed linens clean, dry and free of wrinkles. Disposable bed pads can be
purchased at a drug store and can keep sheets dry so that the caregiver does not
have to change sheets so often.
- Massage skin gently using a light, circular motion. Change the position of
older people at least every two hours, particularly for those confined to a bed
or wheelchair. Encourage them to shift their weight between position changes to
redistribute pressure onto other areas.
- Encourage good nutrition and adequate fluid intake. As a supplement to your
family member's diet, give a multi-vitamin every day to ensure proper nutrition.
Check with the physician as to the appropriate supplement.
- Use mattress and chairs that are soft and form-fitting rather than rigid
and hard. (Example: egg crate mattress and sheep skin). This spreads the weight
over a larger skin area, decreasing the pressure under the bones.
- Encourage movement or mild exercise; this helps stimulate circulation which
is good for the skin. Combing hair and helping with bathing and dressing are
good ways for frail people to get exercise and be more independent.
- Watch for possible sources of pressure on anything that would interfere
with good circulation, such as tight shoes, elastic cuffed socks or tight
- Bony prominences are prone to skin breakdown. They are heels, feet, behind
the knees, hips, buttocks, sacrum, elbows and shoulder blades. A special air
mattress may be ordered by the doctor to prevent skin breakdown.
- Watch for any redness or a break in the skin and report it immediately to
the doctor or nurse, and keep the carereceiver off the affected side.
- Safety features in the bathroom, such as grab bars and raised toilet seats,
make using the bathroom safer.
- A commode or urinal may be necessary when flexibility and distance to the
bathroom are a problem. They may be especially helpful at night.
- Lack of control over bowel or bladder functions can be embarrassing and
older people may try to hide it from caregivers and professionals. Be sensitive
to the older person's feelings, and mention this to the doctor. Loss of bowel
and bladder control is not a part of normal aging and often can be controlled.
- For the carereceiver with bowel and/or bladder problems it may help to take
them to the bathroom every 2 hours. Specialized programs exist to retrain a
bladder and bowel function. Check with your doctor or nurse for a program in
Constipation or Irregularity
Many elderly become constipated due to medications and inactivity. If your
carereceiver is experiencing this problem the doctor or nurse can suggest a
stool softener. Other important factors are:
- Eat plenty of fresh fruit, vegetables and foods high in fibers. -- Drink at
least 8 glasses of water a day.
- Avoid constipating foods like cheese, rice, bananas, etc. -- Exercise as
much as is tolerated.
- Be sure your doctor is aware of all the medications being taken.
Eating can be very time-consuming, especially if the older person must be
fed. Encouraging independent eating saves time for caregivers, and promotes the
independence and self-worth of the older person. Try to relax yourself and enjoy
the time spent with your carereceiver. Here are some suggestions for encouraging
- Check gums for areas of redness. Dentures may not fit correctly and cause
the family member pain when chewing.
- Provide adaptive equipment such as plate guards or special silverware with
These can be purchased from medical supply houses (listed under Hospital
Equipment and Supplies in the Yellow Pages). An occupational therapy evaluation
can recommend the best for each individual. -- Prepare finger foods which may be
easier to eat than those requiring utensils.
- Encourage older people to use a straw, cups with 2 handles, or a glass with
ribbed surface for independent drinking.
- If the older adult has limited vision, consistent place setting of food and
utensils helps to know where to find silverware, beverage, etc. Using the
*clock* method to locate food may be helpful; for example, *Your meat is at 9
o'clock, your potato is at 12 o'clock and your carrots are at 3 o'clock.*
- Reminder: Treat older people who are being fed as adults, not children.
Disciplining poor eating habits should be avoided. When they lack interest in
food, try to learn the reason. For example, ask if they are thirsty or not
feeling well, or if the food in not appetizing on this occasion.
Moving people who cannot move safely by themselves requires skill,
knowledge, and some strength. For every type of disability, there is a specific
technique to use. Ask a doctor, therapist or attend caregiver training for
specific techniques. In all cases, remember:
- When lifting, do not add your own weight to whatever you are lifting-get
close and keep balance centered.
- Do not use weak back muscles to lift - use your leg muscles because they
are much stronger.
- Do not twist when you are lifting - instead, change the position of your
feet so that you face the older person, keeping your spine straight. -- Balance
is vital - spread your feet to serve as a base for support. -- Your doctor can
refer you to a physical therapist who can teach you to transfer safely.
As we age, our sleep patterns change. The elderly require less sleep time.
It takes longer for them to fall asleep. Also, awakenings during the night
increase. Scheduled rest times are important. A few naps during the day can
refresh and revitalize the carereceiver. However, if you notice that your
carereceiver is sleeping for brief periods during the night, it could indicate a
problem. Notify your doctor and discuss your concerns.
- Allow the carereceiver to do as much as possible; provide only as much help
When older people do all or part of their own personal care, it is a form of
exercise that will help maintain strength as well as promote independence. No
matter how small the activity (holding the soap, combing the front of the hair,
etc.) it is important that the person be able to participate.
- Adapt the home to allow the carereceiver to do more things. Install
equipment such as grab rails in the bathroom, wheelchair-accessible sinks and
mirrors, bath bench for the shower or tub, and lights with switches that can be
- Seek the aid of therapists or nurses to teach you how to perform personal
care tasks safely and effectively.
- Learn about the carereceiver's disability and what you and others can do to
help him/her function as independently as possible. If the older person cannot
perform a certain activity, see if there is a part that can be done. For
example, one might be able to independently dress the upper body if sitting, but
require help dressing the lower body.
- Whenever possible, include the carereceiver in making plans for his/her
care. Take suggestions and feelings into consideration and encourage involvement
in his/her own care. Sometimes, slowing the pace of an activity allows older
people to do more for themselves.
Be aware of changes in the carereceiver's health and abilities. Your plans
for care will change as the carereceiver changes.
End of part 4