Dressing

Stage 5: Needs help choosing proper clothing. May need coaxing to change clothes. May layer clothing or refuse to remove at night.

Stage 6: Needs help putting clothing on properly (getting shoes on right foot, tying, etc.). Onset of taking off one shoe at a time and walking about.

Stage 7: Needs total assistance. No longer wears glasses, dentures, hearing aids. May be resistive to wearing bras, slips, etc. Often don't like to wear shoes/socks. May remove belts, wraparound skirts, and clothing which opens in the front. Fiddles with buttons, zippers, etc.

Personal Hygiene

Stage 5: Need assistance in locating bathroom to wash hands, rinse out mouth, clean nails, brush teeth/dentures.

Stage 6: Needs assistance in locating bathroom and with mechanics of personal hygiene. Need tasks broken down. May be resistive to having hair washed during bathing.

Stage 7: Needs total assistance. Best to keep hair short and easily styled. Men may be resistive to shaving.

Bathing

Stage 5: Needs coaxing to bathe; help entering/exiting, washing and drying properly.

Stage 6: Needs assistance to enter/exit; assistance in washing and drying. Independence limited to washing face. May be resistive to bathing due to developing fear of water.

Stage 7: Needs total assistance and often resistive.

Toileting

Stage 5: Continence dependent upon help in locating bathrooms and timely reminders to use.

Stage 6: Needs assistance with mechanics of toileting (wiping, flushing, pulling down underwear, etc.) and continence totally dependent upon being taken to bathroom. Onset of episodic incontinence (both bladder and bowel). Place underwear over incontinent products to reduce non-acceptance of incontinent products.

Stage 7: Needs total assistance. Incontinent of both bowel & bladder. May be resistive to having incontinent product removed or pants pulled down/skirt pulled up. May no longer respond to visual/verbal/nonverbal cuing to use toilet.

Eating

Stage 5: Feeds self with minimal assistance (cutting food, etc.).

Stage 6: Needs meal process very simplified. Can no longer use knife appropriately; needs foods precut. Difficulty with prepackaged condiments. Watch for neglect of 1 side of dish/tray. Needs verbal and visual cuing and hand-overhand demonstrations to get started and keep on task.

Stage 7: Needs very simplified meal process. Feed first as can't wait for food once aware of it and will take food off plates of others. May be resistive to coming to table if don't see food. Feeds self with spoon or fingers. Will pour drinks into meal. Will eat packages of condiments. Generally likes sweets. Spread pureed food on bread and slice into strips to encourage self-feeding.

Hydration

Stage 5: Will use water fountain if has turn handle. Does not use water pitchers at bedside (doesn't think to look there).

Stage 6: Doesn't use water fountains (even with turn handles) or bedside water pitchers (can't pour anymore).

Stage 7: Can't use water fountains (doesn't understand them) or bedside water pitchers (can't pour anymore).

Sources: (1) Reisberg, B.: "Incidence of Behavioral Symptoms in Aging and Alzheimer's". (2) Lucero, M., et al: Phase 1 Final Report, National Institute on Aging Research Project, April 1990, Grant #: 1R43AG07759- OIA1, unpublished.

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