What to Expect in ADL Care with Dementia Stages

Grace Hau

27 Jul 2024

What are ADLs?

Activities of Daily Living (ADLs) are essential tasks that individuals perform throughout the day to maintain their independence. These activities are crucial for keeping people safe, healthy, clean, and feeling good.

ADLs include eating, dressing, bathing or showering, getting in and out of a chair or bed, grooming, brushing teeth, and using the bathroom. In the early stages of dementia, most people can independently perform basic ADLs. However, as dementia advances, individuals may require assistance with all basic ADLs.

Understanding how dementia affects the ability to perform ADLs at different stages is crucial and empowering. As dementia progresses, caregivers may need to assist with the individual’s diminishing abilities to perform these tasks.

How does dementia at different stages impact ADLs?

Dementia can impact activities of daily living (ADLs) at different stages of the disease:

Mild cognitive impairment (MCI)

Instrumental ADLs, like shopping, driving, and household chores, may decline.

Mild dementia

Mood and personality changes may be noticeable, such as increased anxiety and aggression.

Moderate dementia

Supervision may become necessary, and basic and instrumental ADLs may require more assistance. Behavioral and psychological symptoms, like anger, frustration, and difficulty communicating, may also disrupt basic ADLs.

Later stages

People may need help with personal care tasks like washing, brushing their teeth, and taking care of their hair, hands, and fingernails. In some cases, a carer or loved one may need to complete these tasks for them.

Other impacts include:

Spatial memory

People may forget where they placed objects or have difficulty retracing their steps when looking for them.

Attention

People may become easily distracted, have trouble concentrating, or have a short attention span, making it difficult to start and complete tasks.

Using the toilet

People may have problems with coordination and movement, forget where the bathroom is, or lose bowel or bladder control.

Here are common patterns in different dementia stages that affect ADLs:

Early Stage

Middle Stage

Late Stage

Memory

Frequent forgetfulness of recent events or information.

Difficulty in remembering appointments or names of new acquaintances.

Worsening Memory.

Increased difficulty with short-term memory and some long-term memories.

Forgetting personal history, such as their address or phone number.

Severe Memory Loss.

Inability to recognize close family members and familiar faces.

Significant loss of verbal communication skills.

Cognition

Struggles with planning or organizing tasks.

Difficulty with problem-solving and decision-making.

Problems with complex tasks like managing finances or cooking.

Difficulty understanding time, dates, and the sequence of events.

Inability to perform any complex tasks.

Complete disorientation to time, place, and person.

Language & Communication

Trouble in finding the right words during conversations.

Frequent repetition while speaking.

Significant trouble with language, including understanding others and expressing thoughts.

Frequent pauses or substitutions of words.

Inability to express thoughts and words.

Difficult in understanding logic.

Behavior

Getting lost in familiar places.

Difficulty with spatial orientation, such as misplacing items.

Increased confusion and agitation.

Potential for wandering and getting lost.

Severe mood swings, aggression, and hallucinations.

Loss of mobility and coordination.

Performance

Able to manage tasks.

Quite independent in taking care of oneself.

Need for help with dressing, grooming, and bathing.

Development of incontinence.

Need assistance with all ADLs, including eating, dressing, and toileting.

Increased risk of infections and other health complications.

Often bedridden or in a wheelchair.

Mood

Increased anxiety, depression, or irritability.

Lost interest in activities or social events.

Withdrawal from previously enjoyed activities.

Complete withdrawal from social interactions.

What could caregivers expect to support ADLs across each stage?

Early Stage: Minor help with ADLs, primarily for organizational tasks and reminders.

Middle Stage: Moderate help with ADLs, including personal care and supervision.

Late Stage: Full assistance with all ADLs, often requiring professional care.

CAREGIVER’S KEY – Supporting your loved one is not just a role. It’s a vital part of their care. It means accepting their unusual behavior, adjusting the environment to their needs, and being aware of their body language.

If you are unsure about a person’s stage or signs of dementia, there are online tests—try the Clock Test or SAGE Test—that can help pinpoint symptoms and provide a general idea of their stage. However, it’s important to note that these tests are not a substitute for a professional diagnosis, which provides more accurate and comprehensive guidance.