Physical appearance contributes to everyone's sense of self-esteem. Dressing ourselves is a very personal and private experience, and a statement of our independence from the time we are very young.

For people with Alzheimer's disease, the act of dressing becomes that much more important: It allows them to maintain a sense of dignity, self-esteem, independence, autonomy and privacy. That's why it is imperative for every caregiver to encourage and enable them to dress themselves for as long as they possibly can.

However, for the cognitively impaired, choosing and putting on clothes can be confusing and frustrating. People with dementia may not remember how to dress, or they may be overwhelmed with the choices or the task. As dressing becomes at once more difficult and significant in the person's routine, seek to simplify the number of decisions involved without compromising the individual's independence.

The following sections offer tips to make dressing easier for patients and caregivers alike.

Simplify choices

Limit the number of choices so as not to confuse the cognitively impaired person. A person with dementia may panic if clothing choices become overwhelming. Each morning, offer two choices of shirts and pants for the individual. For example, you might offer a choice of wearing either a blue shirt or a white shirt. If even that choice seems too confusing, then simply lay out just the blue shirt and say, "Would you like to wear this shirt today?"

Organize the process

Lay out clothing in the order it needs to be put on, or hand the person one item at a time while giving short, simple instructions. One step at a time, tell the person what to do or what you are doing. Make sure your instructions are specific. For example, instead of saying something like "Get dressed," you should say things like "Put on your shirt."

Set a dressing routine

Don't overlook established habits. If the person is used to changing clothes once every other day, twice a day, or more or less often, the switch in routine can be upsetting. Try to incorporate the individual's past routine into the current routine, as much as possible. Bear in mind that cognitively impaired people may be losing the ability to remember how much time has passed since they last changed.

Don't rush the person

Allow extra time for dressing so that you never have to rush people with dementia. Your haste in rushing the individual will only create anxiety.

Be flexible

If the individual wants to wear the same outfit repeatedly, try getting a duplicate of it or have similar options available. The person also may want to wear several layers of clothing. As long as the clothes are sensible for the climate, the individual's sense of independence and accomplishment outweighs fashion sense. Offer praise, not criticism, if clothing is mismatched.

Don't argue

If people with dementia become upset while you're helping them dress, don't fight or wrestle with them. Instead, try calming them, reassuring them, changing the subject and giving them a few moments to calm down before trying again. Similarly, if they refuse to change clothes, avoid getting in an argument. Instead, redirect their focus and make the suggestion again later.

Keep the closets free of excess clothing

A lot of choices will confuse the cognitively impaired individual and can become overwhelming. Put away in storage any clothes that are out of season or rarely worn. Also remove from the closets any unnecessary accessories that can exacerbate confusion.

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Choose comfortable and simple clothing

Select fabrics that are lightweight and flexible, and that feel soft and comfortable on the person's skin. Select loose-fitting clothes, which are easier to manage.

Select practical and sensible clothing.

Shirts and cardigans that button or fasten in front are easier to work than tops that have to be pulled over the head. For the same reason, look for pants and skirts with elastic waistbands. Consider using athletic sweatsuits that are comfortable, washable and have few fasteners

Adapt to the person's deteriorating skills.

As the disease progresses, cognitively impaired individuals will find it increasingly difficult and frustrating to manage buttons and zippers. Substitute Velcro tape for buttons, snaps, zippers, belt buckles and shoelaces that are becoming too difficult to handle. Also look for reversible shirts and jackets, so that it doesn't matter if the person puts them on inside-out. Try tube socks, which take less skill to put on because they don't have heels.

Chose comfortable shoes that are not slippery.

Slip-on styles with elasticized inserts on top or Velcro closures are easy to put on and remove. Sneakers or shoes with crepe soles can help prevent falls. So can low heels and flared soles. Make sure slippers are not slick-soled or floppy. Be constantly sensitive to how the progression of Alzheimer's often changes the person's gait into a shuffle, creating increased risk for falling.

Buy adaptive clothes specially designed for impaired adults.

Specialized or adaptive clothes can provide ease of care that is not always available in standard clothing. Adaptive clothing can make it easier to dress someone who has limited mobility and cognitive function. Moreover, adaptive clothing can provide easier access to diapers. More and more catalogs are offering adaptive clothes specially designed for impaired adults.

Select clothes that the person likes.

Because clothing can be a form of self-expression, it's important to consider the person's likes and dislikes. At the same time, if the clothing is mismatched, consider the person's sense of independence in dressing themselves over fashion sense. In choosing function over fashion as the disease progresses, continue to consider the person's lifelong tastes and dignity.

Simplify color schemes.

Be aware that busy patterns may confuse the cognitively impaired. Try buying the same color socks so that the confused person doesn't become frustrated trying to match them.

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Use adult briefs and protective pads as needed

Adult briefs are specially designed for older people with incontinence problems. They are disposable and are available for daytime use or overnight use depending on absorbency. You can also use protective pads inside non-disposable briefs or underwear. However, in deciding to use disposable adult briefs, take into account how that might affect the person's self-esteem as well as health, especially in the earlier stages of the disease.

Choose clothing that is easy to remove and care for

If incontinence is a problem, use clothing that is more easily accessible. For example, use pants with elastic waistbands for men as well as women and dresses rather than slacks for women. In addition to protective pads and padded underwear, consider adding an extra layer of protection to regular clothing by lining the backs of skirts or pants with terrycloth material.

Buy adaptive clothes designed for incontinence

Specialized adaptive clothing offers protection as well as ease of care unavailable in standard clothing. Adaptive clothing can provide easier access to disposable adult briefs. Several products consist of an outer washable pant that holds a disposable pad; the ideal is a soft, cool material in which the absorbent pad draws urine away from the skin.

Sleep clothes should be comfortable as well as functional

Nightgowns and nightshirts are easier to work than pajamas. If there is a problem with confused Alzheimer's patients trying to remove disposable adult briefs at night, consider getting them in a one-piece outfit at night.

Click here to access our caregiving tips on Incontinence and Toileting.

Sources: the Alzheimer's Disease and Related Disorders Association website (www.alz.org ) and Action Series brochure "Steps to Assisting with Personal Care"; Nancy L. Mace and Peter V. Rabins's book The 36-Hour Day: A Family Guide to Caring for Persons with Alzheimer Disease, Related Dementing Illnesses, and Memory Loss in Later Life (1999, Third Edition, Johns Hopkins University Press).

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