Understanding the Complexities of Dressing with Dementia
For many caregivers, witnessing a loved one with dementia put on multiple layers of clothing can be a baffling and frustrating experience, particularly in warm weather. This action is not willful disobedience but a symptom of the progressive cognitive decline affecting memory, judgment, and sensory perception. By understanding the specific reasons behind this behavior, caregivers can approach the situation with greater empathy and develop effective strategies for assistance.
The Impact of Memory Loss and Cognitive Decline
One of the most significant factors is a lapse in short-term memory. A person with dementia may simply forget that they have already dressed for the day. For them, the internal command to get dressed might be repeated multiple times, resulting in them putting on shirt after shirt or multiple pairs of trousers. This repetition is a classic manifestation of memory impairment and can escalate throughout the day.
Furthermore, the complex, multi-step process of dressing can become overwhelming. Cognitive functions like sequencing, which involve placing items on in the correct order, deteriorate. A patient might grab whatever clothing is nearby and layer it on, regardless of type or appropriateness, because they can no longer remember the standard order of dressing.
Sensory and Physiological Changes
Beyond memory issues, physiological and sensory changes common in dementia play a major role in a patient's perception of temperature and comfort.
Poor Temperature Regulation: The area of the brain responsible for regulating body temperature can be affected by dementia, leading to a reduced ability to feel hot or cold. A patient might feel perpetually cold, even on a summer day, and will try to compensate by adding more layers of clothing. This makes them vulnerable to overheating, which is a serious health risk.
Increased Tactile Sensitivity: Sensory changes can alter how clothing feels against the skin. Some materials may feel uncomfortable or irritating, prompting the person to add another layer of a softer, more familiar fabric over the top. They may seek the comforting weight and feel of multiple layers without consciously understanding why.
Visual and Perception Problems: Visual impairments are common in dementia. A person might not be able to recognize a new, clean piece of clothing as their own, making them resistant to changing. They may also mistake patterned carpets or dark rugs for holes in the floor, but on the other hand, the visual clutter of a full closet can be confusing and overwhelming.
Psychological and Emotional Factors
Psychological and emotional needs also drive dressing behaviors. For a person losing control over many aspects of their life, wearing multiple layers can become a source of comfort and security.
- Familiarity and Routine: Many individuals find comfort in the familiar. If they have a favorite piece of clothing, they may insist on wearing it repeatedly. If a caregiver removes it for washing, they might simply reach for another similar item or add layers over their current outfit to maintain a sense of routine.
- Anxiety and Insecurity: The act of changing clothes can trigger anxiety. It requires vulnerability, especially if assistance is needed, which can feel embarrassing or threatening. Wearing layers can be a way to avoid this perceived threat or to stay covered and feel more secure.
Comparison of Causes for Layered Dressing
| Cause | How it Affects Dressing | Caregiver Intervention | Risks to Monitor |
|---|---|---|---|
| Memory Loss | Forgetfulness leads to repeatedly putting on clothes, even if already dressed. | Offer two simple choices for an outfit. Lay out clothes in the correct order. Reduce the number of clothing options available. | Overheating, dehydration, hygiene issues if clothes are worn for days. |
| Temperature Regulation | Brain changes lead to feeling cold, prompting adding more layers for warmth, even when the environment is warm. | Monitor room and body temperature. Layer thinner clothes that can be easily removed. Offer warm drinks. | Overheating, heatstroke, agitation from being too hot. |
| Sensory Sensitivity | Textures feel irritating or uncomfortable, so the patient adds layers of a preferred, soft material. | Choose soft, comfortable, breathable fabrics like cotton. Look for adaptive clothing with flat seams or no tags. | Skin irritation, pressure sores, and overall discomfort. |
| Need for Routine | Wearing familiar, well-worn clothes provides comfort and stability, leading to resistance to new items. | Buy duplicates of favorite outfits to ensure a clean option is always available. Maintain a consistent morning routine. | Poor hygiene, bacterial infections if soiled clothes are worn repeatedly. |
Managing the Challenge: Practical Steps for Caregivers
Addressing the issue of layered clothing requires patience, flexibility, and a strategic approach. Direct confrontation is likely to cause agitation and distress.
- Simplify and Reduce Choices: An overwhelming number of clothing options can paralyze or confuse someone with dementia. Keep closets and drawers organized and remove seasonal items. Offer a maximum of two pre-selected, coordinated outfit choices. This maintains a sense of autonomy while managing the decision-making process.
- Establish a Calming Routine: Consistency is comforting for dementia patients. Incorporate dressing into a predictable daily routine, perhaps right after breakfast. Approach the task calmly, without rushing, to reduce anxiety. Use simple, clear, step-by-step instructions like, “First, put your arm in the sleeve,” rather than, “Put your shirt on”.
- Use Adaptive Clothing: Look for clothing specifically designed for people with dementia. Features like Velcro or magnetic closures, elastic waistbands, and larger openings can significantly simplify the dressing process. Opt for soft, breathable fabrics that are easy to put on and take off.
- Emphasize Comfort: If a patient is resistant to changing, focus on the benefits of fresh, clean clothes by saying, “You'll feel much more comfortable in these clean clothes”. In warm weather, highlight how lighter clothing will help them stay cool.
- Address the Root Cause: If the issue persists, look for underlying causes. Are they visibly shivering? Is a particular material causing irritation? Have they had a recent urinary tract infection (UTI) that makes them feel cold? Identifying and addressing the root of the problem can lead to more effective solutions.
How to tactfully remove excess layers
For layers that must be removed for safety reasons, a gentle, indirect approach is best. Try saying, “Let’s take off this jacket now so you don’t get too warm,” or, “I think it’s time to change into something more comfortable for lunch.” Distraction can also be effective. You could propose a distracting activity and then suggest a clothing change as part of the transition. In some cases, a favorite item may need to be washed. Removing it while they are sleeping or distracted and replacing it with a duplicate is a common tactic. Learn more about managing dressing difficulties in dementia from the Alzheimer's Association.
Conclusion
Layering clothes is a multi-faceted behavior in dementia patients, stemming from a complex interplay of memory loss, cognitive decline, sensory changes, and emotional needs. Rather than viewing it as a deliberate annoyance, caregivers should approach it with compassion and a strategic understanding of its underlying causes. By simplifying choices, establishing routines, using adaptive clothing, and tactfully addressing resistance, caregivers can transform a stressful daily task into a more manageable and dignified experience for their loved one. Focusing on their comfort and safety, while respecting their remaining independence, is the most effective path forward.
