How Teens and Kids Can Deal with Fear of Humiliating Themselves
It’s completely normal for kids and teens like you to get nervous and feel anxious. But when your anxiety feels bigger than just shyness or the normal nervousness—and you find yourself avoiding situations or activities because of these bigger feelings—this is called Social Anxiety. The good news is, no matter how painfully shy you may be and no matter how bad the butterflies are in your stomach, you can learn to be comfortable and enjoy yourself around others.
What you can do
Talk about what you feel face-to-face with someone you trust
Challenge your negative thoughts
In the moment, focus on your senses—sight, sound, taste, smell, touch, or movement
Learn how to control your breathing
Move—short bursts of movement, several times a day, can reduce anxiety
Get enough quality sleep at night
Face your smallest anxieties and move your way up to bigger ones
What is Social Anxiety?
Social Anxiety is the phrase used to describe the overwhelming fear of being judged or embarrassed in public. This fear isn’t just tied to the fear of speaking in front of a large class or going to a big birthday party where you only know one other person; you can have Social Anxiety in very small groups, or just one-on-one with someone you’re unfamiliar with.
When you have Social Anxiety, some places or situations may be so scary to you that you get upset just thinking about them. You may find yourself going out of your way to avoid these situations all together, which ends up isolating you from others and making your life lonely and scary.
Signs and symptoms of Social Anxiety
Just because you sometimes get nervous at a party or in a crowded theater, it doesn’t necessarily mean you have Social Anxiety. Many kids feel shy or self-conscious at times, yet it doesn’t get in the way of their lives and their everyday routines. Social Anxiety, on the other hand, does interfere with your normal routines and can disrupt things and activities that make you happy.
How do you know if you have Social Anxiety? There are many different symptoms to help you figure it out.
Symptoms of Social Anxiety
Extreme shyness and anxiety in everyday social situations, like eating at the cafeteria table or working on a group project
Intense worry for days, weeks, or even months before an upcoming party or event
Extreme fear of being watched or judged by others, especially by people you don’t know
Fear that you’ll act in ways that that will embarrass or humiliate yourself, like saying the wrong thing or falling down in front of others
Fear that others will notice that you’re nervous
Red face, or blushing
Shortness of breath
Upset stomach, nausea (i.e. butterflies)
Trembling or shaking (including shaky voice)
Fast-beating heart or tightness in chest
Sweating or hot flashes
Avoiding social situations so much that you can’t join in activities that normally make you happy
Staying quiet or hiding in the background so that no one will notice you
A need to always bring a friend along with you wherever you go
Social Anxiety and your body
While many of us have thoughts about our body that we’re not happy with—a nose that’s too big, for example, or legs that are too thin—our physical imperfections don’t get in the way of our daily lives. Some of us, however, may obsess over these real or imagined “flaws” to such a degree that we avoid other people and social situations. This isolation can sometimes lead to suicidal thoughts and behavior. There are plenty of things you can do to overcome the negative thoughts associated with your body and regain control of your life.
Common Social Anxiety triggers
Most kids experience some type of anxiety in social and performance situations, but for others, anxiety is connected with specific situations that trigger Social Anxiety, such as speaking to strangers or performing in front of an audience.
Social anxiety triggers
At school: Being called on in class, taking a test, being bullied or made fun of
In public: Using public bathrooms, eating or drinking in a restaurant, going to parties or other events, meeting new kids, performing on stage
In other situations: Making phone calls, being watched while doing something, being the center of attention, going on a date
Dealing with the feelings triggered by Social Anxiety
Feeling helpless in certain situations has always been part of life. Over time, our bodies have evolved to give us ways to quickly relieve the stress and anxiety generated by this feeling of helplessness.
Dealing with social anxiety
Talking face-to-face: a rapid anxiety reliever
The most effective way to calm your nerves is to talk to someone you trust, face-to-face. This can be your best friend, a parent, teacher, sibling, or coach. Talking to someone who is kind and supportive will help you get rid of your butterflies and insecurities quicker than anything else. Yes, you may not always have a friend to lean on the exact moment when your anxieties flare up, especially face-to-face, so if you can make a phone call, send a text, or get online to reach out to a supportive person, it will also help keep your stress and anxieties in check.
Using your senses to relieve stress and anxiety
Another way to quickly lower your feelings of Social Anxiety is to focus on one or more of your senses—sight, sound, taste, smell, touch, or movement. By looking at a favorite photo, smelling a specific scent, listening to a favorite song, tasting a piece of gum, dancing alone in your room, or hugging a pet, for example, you can quickly relax.
Controlling your breathing
Many times, when you are feeling anxious, you begin to breathe quickly. Rapid, shallow breathing can often lead to even worse feelings, so if you can take a moment to control your breathing, this can help you bring your anxiety back under control. Consider learning yoga and meditation to do this; you can find videos on both on YouTube or other places on the web.
A breathing exercise to help you stay calm in social situations
Sit comfortably with your back straight and your shoulders relaxed. Put one hand on your chest and the other on your stomach.
Inhale slowly and deeply through your nose for four seconds. The hand on your stomach should rise, while the hand on your chest should move very little.
Hold the breath for two seconds, then exhale slowly through your mouth for six seconds, pushing out as much air as you can. The hand on your stomach should move in as you exhale, but your other hand should move very little.
Continue to breathe in through your nose and out through your mouth. Focus on keeping a slow and steady breathing pattern of 4-in, 2-hold, and 6-out.
Challenge negative thoughts
Negative thoughts about yourself are a main source of your Social Anxiety. These can include thoughts such as:
"I know I'll just end up looking like an idiot."
"As soon as I start singing, my voice is going to start shaking and everyone is going to laugh."
"She’ll say hi and I won’t have anything to say back. She’s going to think I'm so boring."
Challenging these negative thoughts is a great way to reduce your anxiety.
How to challenge negative thoughts
First, you need to identify the main and underlying negative thoughts you have about yourself that make you so afraid of being in a social situation. Are you always worried about looking stupid in front of other people? For example, if there is a speech coming up that you have to give at school, your underlying negative thought might be: “I’m going to forget what I’m supposed to say and everyone is going to think I’m so stupid.”
The next step is to think hard about these main, underlying negative thoughts, and then challenge them head on! Here’s a tip: Ask yourself questions about the negative thoughts: “Do I know for sure that I’m going to forget what I’m supposed to say?” or “Even if I need to look at my notes or if I skip around a bit, will everyone really think that I’m stupid?” By thinking hard about these negative thoughts, you can gradually replace them with better ways of looking at this situation—and other social situations—that trigger your anxiety.
Unhelpful thinking styles
Ask yourself if you’re participating in any of the following unhelpful thinking styles:
Mind reading – Assuming you know what other people are thinking, and that they see you in the same negative way that you see yourself.
Fortune telling – Predicting the future, usually while assuming the worst will happen. You just "know" that things will go horribly, so you're already anxious before you're even in the situation.
Catastrophizing – Blowing things out of proportion. For example, if people notice that you’re nervous, it will be "awful," "terrible," or "the worst thing ever."
Personalizing – Assuming that people are focusing on you in a negative way or what’s going on with other people actually has to do with you.
Things you can do to help you feel more confident
The mind and the body are naturally linked, so if you treat your body well, then your ability to treat your anxiety in a positive way goes up, too, along with your self-confidence.
Changes that boost your confidence
Movement makes you feel surer of yourself. Exercise, run, walk, dance, or move several times during the day every day. If you hate to exercise, try pairing it with something you do enjoy—play an interactive video game that involves physical activity, or bike to your favorite bookstore instead of driving. Drumming and playing an instrument are other good ways to get moving.
Avoid or limit caffeine and sugary foods
Soda, energy drinks, and sugary foods increase anxiety symptoms. Reduce caffeine and sugar from your diet as much as possible. Your mind and body will thank you.
Do not smoke, drink alcohol, or take drugs
There are countless reasons why kids and teens (and adults) should stay away from cigarettes, alcohol, and illegal drugs, but what you may not know is that they increase your risk of having an anxiety attack.
Get enough quality sleep
When you’re not getting enough sleep, it’s harder to stay calm in social situations. Here are some tips to help you sleep better:
Make sure your bedroom is dark, cool, and quiet. Curtains, white noise machines, and fans can help.
To wind down, calm the mind, and prepare for sleep, try taking a warm bath, reading by a soft light, listening to soothing music, or practicing a relaxation technique before bed.
Put fears in the background by focusing on others
While you’re doing your best to ward off bad feelings in a social situation, it’s hard not to feel uncomfortable if you think that the people around you see your upset and judge it.
How can I stop thinking that everyone is looking at me?
The more you can focus on what’s happening around you, and less on the nervousness going on in your head that people are judging you, the less you’ll be affected by anxiety.
Don’t worry about yourself. Instead, focus on being interested, genuine and thoughtful—qualities that make others feel good and want to be with you. People are drawn to other people who seem interested in them. This focus on others draws people to us and helps us get out of the negative self -talk in our head.
Remember that nervousness isn’t as noticeable as you think. And even if someone notices that you’re uncomfortable, that doesn’t mean they’ll think badly of you.
Really listen to what is being said—be prepared to repeat or paraphrase what the other person says. Also take notice of what it is you think the feeling.
Focus on the present moment rather than worrying about what you’re going to say next, or beating yourself up for saying something slightly weird a few minutes ago. Remember that the most important thing to the other person is the interest that you show in them.
Face your fears
While avoiding nerve-wracking situations may help you feel better in the short term, it prevents you from becoming more comfortable in social situations and learning how to deal with them in the long term. In fact, the more you avoid a feared social situation, the more frightening it becomes.
Avoiding fears may also prevent you from doing things you’d like to do, or keep you from reaching certain goals. For example, a fear of speaking up may prevent you from sharing your perfectly drawn-up play that helps you win the basketball game.
Challenging Social Anxiety one step at a time
The key is to start with a situation that you think you can handle and gradually work your way up to more challenging situations. If socializing in the hallway in between classes makes you anxious, you might start by asking the kid who has a locker next to yours about homework, or by starting a conversation with someone in the classroom that can spill out into the hallway. Once you’re comfortable with that step, you might try approaching a group of kids nearby talking about something that excites you.
Working your way up the “anxiety ladder”
Don’t try to face your biggest fear right away. It’s never a good idea to move too fast, take on too much, or force things. This can be a mistake.
Be patient. Overcoming Social Anxiety takes time and practice. It’s a gradual step-by-step progress.
Use the skills you’ve learned to stay calm, such as focusing on your breathing and challenging negative thoughts and assumptions.
Build better relationships
Another way to challenge your fears and overcoming your Social Anxiety is to find social situations that actually make you feel supported and comfortable.
Join or start a club. If you love math, join the math team at school. If you enjoy playing chess and there isn’t a chess club, start one. Even if you meet just one new person, it’s a victory.
Volunteer doing something you enjoy, such as walking dogs in a shelter or tutoring another student in a subject you excel at—anything that will give you an activity to focus on while you are also getting to know someone with similar interests.
Feeling overwhelmed? Here's how to handle the stress
by Amy Goyer
As caregivers, many of us are already overwhelmed with our daily responsibilities, leaving us vulnerable when the stress of the holidays arrives.
During this busy season, we can be tempted to increase unhealthy behavior — such as drinking more alcohol, eating more sweets, getting less sleep and exercising less. This in turn lowers our defenses and makes every experience — both positive and negative — seem magnified. Here are some tips to help you come through the holiday season with more joy and less stress.
1. Recognize the signs of stress and burnout
As caregivers, we give and give and give, and during the holidays we give even more! All that giving can add up to high stress levels or even full-on burnout that creeps up on you before you know it.
In my book, AARP's Juggling Work and Caregiving, I explain it this way: "The prolonged stress builds up, we are robbed of energy, and sometimes we reach a point of total emotional, mental and physical exhaustion. We may lose motivation completely or feel we just don't care about our loved ones, our other relationships or our work. We may feel that we've lost ourselves in the vastness of caregiving and that nothing we can do will make a difference. If you feel like this most of the time, you may have reached burnout." Be aware of emotional ups and downs, fatigue levels, foggy thinking, inability to sit still or the opposite — feeling frozen and unable to get anything done.
2. Anticipate your own holiday hot buttons
Are there holiday activities or toxic relatives that trigger stress or unhappy memories? Are you feeling grief or loss that overcomes you at certain times of day? Do unhelpful relatives regularly arrive for the holidays and criticize your caregiving? Are there topics it's better to avoid when the family gathers? It may be best to limit your exposure to — or even avoid — certain places, events or people. If you can't do that, prepare yourself. Minimize the drama, don't try to resolve longtime family problems over the holidays, try short encounters and develop quick exit strategies. Mentally put yourself in a protective bubble, letting negative energy bounce off without hurting, annoying or distressing you.
3. Mind your own mind-set
Acknowledge all your emotions, including fears, frustrations and sadness, during the holidays. All those emotions are perfectly normal. Try to stay mindful, concentrating on what you are doing in any given moment, rather than letting your mind wander to your ever-growing to-do list. Stay focused on the positives: Think about what you can accomplish instead of what you can't; celebrate what your loved ones can do, rather than mourning what they can no longer participate in; revel in the holiday joys you will experience, instead of missing those you'll bypass; appreciate the help you are receiving rather than resenting those who aren't supportive. Negative thinking actually activates your body's stress response, so steer your mind elsewhere when you start down the slippery slope of negative thinking.
4. Keep self-care at the top of the list
It's easy to let this slip when you're even busier than usual — just when you need it most. Keep it simple and incorporate it into your daily caregiving routine if possible.
For example: Make time for exercise; it can boost your mood. Even something as simple as walking in a shopping mall, dancing to holiday music, or stretching or doing jumping jacks while watching holiday movies can help. Try yoga, meditation or tai chi to reduce stress and help you sleep better. Limit sugary foods that can cause an energy and emotional crash as blood sugar plummets. Get outside for some mood-elevating vitamin D from sunlight, or consider therapeutic lighting if you suffer from seasonal affective disorder. Relax with some aromatherapy, using scents such as citrus and lavender to soothe yourself.
5. Know your own best stress outlets
Only you know what works best for you as a stress reliever. It may be writing in a journal, laughing at a funny movie, talking with a friend, going for a walk or sharing your thoughts on social media such as Facebook. Make a list of outlets you can keep handy when you start to feel stressed out.
6. Connect with support
With everyone so busy this season, online message boards or groups can be a convenient way to seek support. And don't forget professional help from a counselor or therapist.
7. Plan ahead and focus on what is most meaningful
Perfection is not the goal of the holidays — joy is! Cramming more into your already crazy schedule can push you over the edge, so consider what is really doable before you commit. Remember, you'll be happier if you can go with the flow and expect the inevitable delay, crisis or disappointment. Above all, making good memories with your loved ones is especially valuable at this time.
8. Ask for help for yourself and those you care for
Now is the time to seek help with both your caregiving responsibilities and your holiday preparations or personal matters. Even if you don't usually pay for help, consider doing so now, since hiring someone to assist for a few hours can be a huge relief. A personal assistant or concierge can complete items on your holiday to-do list or handle some of your home tasks, such as organizing mail, doing laundry, cleaning or running errands. You might also take advantage of paid care for your loved ones, including using individual caregivers, adult day care centers or respite care programs that can free you up for holiday activities.
9. Simplify your holiday activities
Many of us love to go all-out for the holidays, but it will be less stressful if you can scale back and find a way to simplify while still enjoying the spirit of the season. You could choose just a few decorations or foods that are most significant to you and feel doable, or cut back to two or three holiday activities that fill your heart with joy. Set limits and you'll be OK.
10. Start new traditions
Instead of focusing on what you're not doing, try doing something new. If cooking holiday meals is too much for you, eat out or order a prepared meal to have at home to give you more time with family and less time cleaning up. Give the gift of time or attention rather than costly presents. Attend a holiday concert you've never gone to before. Can't make it to a holiday gathering? Use technology and have a video visit.
Amy Goyer is a caregiving expert for AARP and the author of Juggling Work and Caregiving.
Enjoying mental health means having a sense of wellbeing, being able to function during everyday life and feeling confident to rise to a challenge when the opportunity arises. Just like your physical health, there are actions you can take to increase your mental health. Boost your wellbeing and stay mentally healthy by following a few simple steps.
Connect with others. Develop and maintain strong relationships with people around you who will support and enrich your life. The quality of our personal relationships has a great effect on our wellbeing. Putting time and effort into building strong relationships can bring great rewards.
Take time to enjoy. Set aside time for activities, hobbies and projects you enjoy. Let yourself be spontaneous and creative when the urge takes you. Do a crossword; take a walk in your local park; read a book; sew a quilt; draw pictures with your kids; play with your pets – whatever takes your fancy.
Participate and share interests. Join a club or group of people who share your interests. Being part of a group of people with a common interest provides a sense of belonging and is good for your mental health. Join a sports club; a band; an evening walking group; a dance class; a theatre or choir group; a book or car club.
Contribute to your community. Volunteer your time for a cause or issue that you care about. Help out a neighbour, work in a community garden or do something nice for a friend. There are many great ways to contribute that can help you feel good about yourself and your place in the world. An effort to improve the lives of others is sure to improve your life too.
Take care of yourself. Be active and eat well – these help maintain a healthy body. Physical and mental health are closely linked; it’s easier to feel good about life if your body feels good. You don’t have to go to the gym to exercise – gardening, vacuuming, dancing and bushwalking all count. Combine physical activity with a balanced diet to nourish your body and mind and keep you feeling good, inside and out.
Challenge yourself. Learn a new skill or take on a challenge to meet a goal. You could take on something different at work; commit to a fitness goal or learn to cook a new recipe. Learning improves your mental fitness, while striving to meet your own goals builds skills and confidence and gives you a sense of progress and achievement.
Deal with stress. Be aware of what triggers your stress and how you react. You may be able to avoid some of the triggers and learn to prepare for or manage others. Stress is a part of life and affects people in different ways. It only becomes a problem when it makes you feel uncomfortable or distressed. A balanced lifestyle can help you manage stress better. If you have trouble winding down, you may find that relaxation breathing, yoga or meditation can help.
Rest and refresh. Get plenty of sleep. Go to bed at a regular time each day and practice good habits to get better sleep. Sleep restores both your mind and body. However, feelings of fatigue can still set in if you feel constantly rushed and overwhelmed when you are awake. Allow yourself some unfocussed time each day to refresh; for example, let your mind wander, daydream or simply watch the clouds go by for a while. It’s OK to add do nothing’ to your to-do list!
Notice the here and now. Take a moment to notice each of your senses each day. Simply ‘be’ in the moment – feel the sun and wind on your face and notice the air you are breathing. It’s easy to be caught up thinking about the past or planning for the future instead of experiencing the present. Practising mindfulness, by focusing your attention on being in the moment, is a good way to do this. Making a conscious effort to be aware of your inner and outer world is important for your mental health.
Ask for help. This can be as simple as asking a friend to babysit while you have some time out or speaking to your doctor (GP) about where to find a counsellor or community mental health service. The perfect, worry-free life does not exist. Everyone’s life journey has bumpy bits and the people around you can help. If you don’t get the help you need first off, keep asking until you do.
Adult day services is a professional care setting in which older adults, adults living with dementia, or adults living with disabilities receive individualized therapeutic, social, and health services for some part of the day.
Adult day service centers provide a coordinated program of professional and compassionate services for adults in a community-based group setting. Services are designed to provide social and some health services to adults who need supervised care in a safe place outside the home during the day. They also afford caregivers respite from the demanding responsibilities of caregiving. Adult day centers generally operate during normal business hours five days a week. Some programs offer services in the evenings and on weekends. Although each facility may differ in terms of features, these general services are offered by most adult day centers:
Social activities—interaction with other participants in planned activities appropriate for their conditions
Meals and snacks—participants are provided with meals and snacks, those with special dietary needs are offered special meals
Personal care—help with toileting, grooming, eating and other personal activities of daily living
Therapeutic activities—exercise and mental interaction for all participants.
In general, there are three types of adult day centers:
social (which provides meals, recreation and some health-related services)
medical/health (which provides social activities as well as more intensive health and therapeutic services) and
specialized (which provide services only to specific care recipients, such as those with diagnosed dementias or developmental disabilities.
Caring for Yourself When You Are Caring for Others?
Caregivers often report stress, loss of sleep, and poor personal health. experts suggest four strategies that can help you take care of yourself, as well as others.
Identify local support services. Local agencies can connect you to services and benefits such as adult day care, respite care (temporary breaks for caregivers), training programs, and caregiver support groups both in your community and on the Internet. To find your local Area Agency on Aging and connect to support groups and other caregiving services, visit the Eldercare Locator at www.eldercare.gov. Identify local respite care providers at the Access to Respite Care and Help (ARCH) National Respite Network and Resource Center at archrespite.org or 1-800-473-1727.
Make connections with others. Sharing experiences with others can help caregivers manage stress, reduce feelings of isolation, and recognize that they are not alone. Caregivers should find someone they can talk to about their feelings, like a fellow caregiver, clergy, friend, family member, or therapist. Go to the Ask Medicare site at www.medicare.gov/caregivers and click on “Caregiver Topics,” then “Support for Caregivers,” then “Taking care of yourself,” and “Connect with resources to make your life easier” for links to messages boards, discussion groups, and forums.
Ask for help. Speak up when you need support or assistance. Help can come from community resources, family, friends, and professionals. Consider getting help to manage meals, transportation, social activities, and services to assist with other daily needs. Visit “Lotsa Helping Hands” at www.lotsahelpinghands.com, a free service for creating private online communities where family and friends can stay informed and easily provide assistance to caregivers, share a common calendar, and find additional resources.
Take care of your own health. Managing your own health is important to make sure you are healthy enough to help others. Eat properly, get regular exercise, and set aside some time each week to do something you enjoy. Continue to get regular check-ups and see your doctor if you experience any health problems.
Intellectual disability is a disability characterized by significant limitations in both intellectual functioning and inadaptive behavior, which covers many everyday social and practical skills. This disability originates before the age of 18.
Intellectual functioning—also called intelligence—refers to general mental capacity, such as learning, reasoning, problem solving, and so on.
One way to measure intellectual functioning is an IQ test. Generally, an IQ test score of around 70 or as high as 75 indicates a limitation in intellectual functioning.
Adaptive behavior is the collection of conceptual, social, and practical skills that are learned and performed by people in their everyday lives.
Conceptual skills—language and literacy; money, time, and number concepts; and self-direction.
Social skills—interpersonal skills, social responsibility, self-esteem, gullibility, naïveté (i.e., wariness), social problem solving, and the ability to follow rules/obey laws and to avoid being victimized.
Practical skills—activities of daily living (personal care), occupational skills, healthcare, travel/transportation, schedules/routines, safety, use of money, use of the telephone.
Standardized tests can also determine limitations in adaptive behavior.
Age of Onset
This condition is one of serveral developmental disabilities—that is, there is evidence of the disability during the developmental period, which in the US is operationalized as before the age of 18.
But in defining and assessing intellectual disability, the AAIDD stresses that additional factors must be taken into account, such as the community environment typical of the individual’s peers and culture. Professionals should also consider linguistic diversity and cultural differences in the way people communicate, move, and behave.
Finally, assessments must also assume that limitations in individuals often coexist with strengths, and that a person’s level of life functioning will improve if appropriate personalized supports are provided over a sustained period.
Only on the basis of such many-sided evaluations can professionals determine whether an individual has intellectual disability and tailor individualized support plans.
As a caregiver, there are many competing priorities between meal preparation, handling finances, basic grooming and care, and managing dental and medical appointments for yourself and your loved ones, which can be the source of much anxiety and stress.
Whether the appointments are for you or a care recipient, consider the following checklist to assist you in managing these appointments to remain on task and organized within the larger caregiving role.
Prior to the Visit:
Identify concerns and document symptoms
In the case of a care recipient's appointment, discuss the intent of the visit the day of the visit, including preparing the care recipient for possible testing.
Confirm the appointment and arrival time
Update the medication list and include any over-the-counter and herb supplements
Bring insurance cards and picture identification required by many physicians offices on a regular basis
During the Visit:
Assist the care recipient with reporting issues, describing symptoms accurately from your perspective, providing additional information to assist the medical professional with a diagnosis
Record recommendations or request something in writing
Ask questions and seek clarification on instructions
Verify any follow-up diagnostics or appointments that are needed
If any diagnostic testing is done the day of the visit, ask when test results will be available and record those dates for follow-up
Following the Visit:
Review any notes you recorded during the meeting
Discuss the visit with the care recipient to ensure understanding of diagnosis, prognosis, and/or expectations
Note any additional appointments on calendars and planners as appropriate
Remove any medications no longer needed from the medication supply
Add any new medications as directed to the medication supply
Make any changes to the medication list
Call for any test results if you have not heard
Call to clarify any additional issues or concerns
Follow-up with the office if appropriate to update them on you or your care recipient's condition (positive or negative)
Activities of Daily Living: Tips for the Family Caregiver
Activities of daily living (ADLs) are the everyday activities involved in personal care such as feeding, dressing, bathing, moving from a bed to a chair (also called transferring), toileting and walking. Physical or mental disabilities can restrict a person's ability to perform personal ADLs. It is extremely difficult to depend on another person to perform these basic tasks. It can also be difficult for the new caregiver to undertake these tasks for a loved one. When a friend or family member becomes disabled, the inclination of the caregiver is to over-care.
Caregivers will almost always benefit from learning:
The significance of ADLs in the world of caregiving,
What type of ADL care is needed in a specific caregiving scenario, and
How to perform ADL care appropriately to meet the unique needs of your loved one.
Significance of ADLs
"Activities of daily living" is a commonly used term in the health care and professional caregiving world to describe a person's ability to care for him or herself. Often the ability or inability to perform specific ADLs is used as qualifying criteria for special services or programs. For example, services that measure ADLs as a part or all of their eligiblity criteria include:
Adult Day Care Centers
Home Health Agencies
Nursing Homes and
As a caregiver you should ask the health care professionals in your life to tell you how they use ADLs to determine eligibility for services or to make a plan of care.
Types of Care
In evaluating an individual, a plan of care must be developed that allows for meeting both the physical and psychosocial needs of the care recipient. There are two types of goals associated with a plan of care: rehabilitative and habilitative.
If the inability to provide self-care is the result of a health crisis such as a stroke, the care recipient may be totally dependent and require assistance with all ADLs. However, this dependence may be temporary and there may be an excellent prognosis for full or partial recovery. In such cases, the plan of care is rehabilitative with the goal of restoring independence.
Some diseases, such as dementia of the Alzheimer's type, cause a gradual loss of the ability to provide self-care. The plan of care in such cases is then habilitative with the goal of helping the person to function at their highest level.
Caregiver Tips for ADL Care
Evaluate the severity of the condition and develop a plan. It is difficult to predict the long-term effects of an event such as a stroke or of Alzheimer's disease. The first decision to be made is: Who is the caregiver? Families may be unable to provide the needed care. With the guidance of the health care professionals families must answer this question. Next, they must be educated about what care is needed and how to provide it. Families need this information even if they will not be the direct caregiver, as they will be the most important partner of the health care professional.
Help only when help is necessary.This often presents the greatest challenge. We all have been conditioned to see people who are unable to care for themselves as sick. We confine them to bed and do for them what they can in fact do for themselves. While acceptable in early life, this type of care can be the death knell for an older person. Even short periods of confinement can result in serious muscle loss and weakness.
Break big tasks into smaller tasks.If the plan is rehabilitative, as with a stroke, the care recipient may be overwhelmed by the inability to perform simple tasks. Depression, fear and humiliation are major obstacles. If tasks are too complex, the care recipient may feel frustrated and defeated. If the care is habilitative, as with dementia, the care recipient may have permanently lost the ability to complete complicated tasks. Presenting the care recipient with such tasks can result in angry, even violent outbursts that can result in injury to the caregiver.
Encourage movement and exercises.This is essential in rehabilitative and habilitative care. Mobility increases independence and decreases complications due to inactivity. Exercises that put the major muscle groups through the full range of motion (ROM) must be encouraged. If the care recipient is unable to do ROM exercises independently, then these must be done passively. This means that the caregiver moves the affected limb through the ROM. It is important to remember that even the smallest efforts, if done consistently, will lead to greater independence. Complications of immobility include muscle wasting, pneumonia, constipation, edema (swelling), pressure ulcers, urinary problems, osteoporosis, and blood clots.
Provide training as needed. Regaining lost abilities or learning new ways of doing things is never easy. Caregivers must first learn what to do and how to do it. Then they must teach their care recipient. It may be easier and quicker for the caregiver to perform the task, but this temptation must be resisted. Over caring for someone can result in severe, even permanent physical and psychological harm. Even though someone may not be able to bathe their own body completely - a wash cloth and encouragement can go a long way to maintaining dignity and some sense of control. Being able to accomplish bathing his or her own face can be a major triumph for a person recovering from a stroke.
Encourage the use of assistive devices. Mobility aids include wheelchairs, canes and crutches and walkers. Sensory assistive devices include: vision aids, hearing aids and dentures. Other assistive devices include everything from uniquely designed eating utensils, to special devices that facilitate enjoyment of hobbies such as reading, playing music and gardening. These devices encourage independence. Physical Therapists and Occupational Therapists are specially trained health professionals who can teach care recipients and caregivers about these devices and how to use them correctly.
Recognize the need for dignity. Care must be provided in a manner that preserves dignity. The humiliation of losing the ability to self-toilet can be worsened by insensitive care. Closing doors, avoiding excessive exposure, allowing choice and participation in care is essential. Frequent clothing changes for people who are incontinent is critical. Daily shaves, frequent manicures, and regular visits to the hairdresser can also contribute to the care recipient's sense of well being. Encouraging independence is important, as is knowing how to intervene when the care recipient's attempts at self-care are inadequate.
Recognize changes in skin condition.The skin is the largest organ of the human body and the condition of the skin is a barometer of health. Dry skin is a normal part of aging. Keeping the skin clean (using oil-based cleansers) and well lubricated is especially important for the care recipient who has lost mobility. Caregivers must assist the care recipient with frequent position changes if the care recipient is unable to do so independently. Skin should be examined regularly for signs of pressure, especially on the bony parts of the body. If pressure is not relieved, bedsores (pressure ulcers) can form. If left untreated these ulcers can penetrate through the skin, into the muscle and bone. Pressure ulcers are extremely painful and often require surgical repair.
Monitor nutrition closely. Eating a well-balanced diet is especially important for people who are very ill. Two common, serious hindrances to good nutrition are difficulty swallowing and problems with chewing. Food may need to be pureed and liquids thickened to facilitate swallowing and to prevent choking. Care recipients with dementia may have a greater caloric need. Serving six small meals is often preferable to the traditional three meals per day. Also, speak with your health care professional about the benefits of a nutritional supplement.
Provide for psychosocial needs. Care recipients who are ill or disabled have an increased need for acceptance from family, friends and care providers. Entertainment and social interaction are essential to all of us; especially if we are recovering from an illness or living with a deteriorating health condition. Caregivers should observe closely for signs of withdrawal and isolation. Care recipients with dementia often benefit from activities such as music and reminiscence therapy. Reminiscence therapy is remembering the past by looking at pictures or talking about different events.
Author: Christine Stacy, BS, RN, Adult Care Education Consultant