Diane Blum

Freelance Writer

"Difficult Behaviors: Bathing & Personal Hygiene (Alzheimer's)"
posted Mar 2014 on The Alzheimer's Association
As with most things related to Alzheimer’s caregiving, dealing with difficult behaviors requires planning, simplification and patience. As Alzheimer’s progresses, poor hygiene can often become more than just an unpleasant issue: it can have medical consequences, such as bacterial infections(UTIs). Gastroenteritis and other health issues can occur, some quite serious to an already weakened immune system.
Because Alzheimer’s is a steady deterioration of cognitive functions, a person with dementia (PWD) will start to get confused about seemingly simple things, like how to wash their hair. Perceptions will start to be impacted; a tub of water can become a scary thing as the ability to perceive depth is lost. Mirrors can create a sense of strangers being present in the bathroom. A smelly shirt may be more comforting than a freshly laundered – but unfamiliar – replacement. A PWD may be overwhelmed by everyday products on the bathroom counter, perhaps using a hair product as toothpaste.
Understanding that a PWD’s perceptions are increasingly distorted by the disease’s progression, and focusing on creating positive routines, may help caregivers get through difficult behaviors.
Bathing and hygiene
Focus on “must do’s” to keep a PWD healthy while maintaining their dignity. You really don’t need to have a bath/shower every day as long as there is good hygiene after toileting and genitals are sponged daily. Some caregivers do feel that an everyday bathing schedule is easier for a PWD to become familiar with.
A bath or shower should be quick and efficient. Building positive associations (like an after-bath ice-cream treat) can help. Many caregivers use toileting as a starting point, by removing the PWD’s clothing while they are on the toilet each day.
Be prepared for the bath prior to bringing the PWD into the bathroom. Running water may be frightening; have it ready, along with towels and products. Cover mirrors if necessary. Use a small amount of water, and make sure to use a non-skid safety mat. If using a shower, use a hand-held shower-head so that the water isn’t falling down on the PWD, which can be disorienting. Having some calming music can be helpful, even singing favorite tunes. Give the PWD a wash-cloth and get them involved in the cleaning process. Some spouses take their shower with their PWD, enlisting the “watch me” and “do what I am doing” method. Have a comfy robe and fluffy towels nearby, and the room temperature kept warm.
Simplify the process by using combination body wash and shampoo. Maybe opt to wash hair less frequently, perhaps using a dry shampoo out of the bath on other days. Sitting on a shower chair may be preferred over sitting in the water; give the PWD choices. There may be issues related to the lack of privacy, especially relating to exposure of genitals. Try an alternate person of the same sex to assist a PWD in the shower, or make sure to cover genitals with a washcloth during a bath. More suggestions for bathing care, including safety tips, can be found on the Alzheimer’s Association website’s bathing section.
Ensure the PWD is completely dry and use lotion or cornstarch, especially under skin folds. On days where a bath or shower doesn’t take place, substitute with a sponge-bath or use wet wipes.
Buy duplicates of favorite clothes, so you can wash a set at a time. Have fewer clothing choices, and use comfortable, easy-to-work-with button in the front or Velcro.
Don’t forget dental care
It’s important to establish a daily routine of dental care. You can apply the paste (or even go without), do the brushing yourself, or try a “watch me” technique. Clean dentures daily and attempt flossing by using a floss holder or picks. You can ask the dentist about anti-microbial rinses. Minimize products on the counter to reduce confusion. Dental care shouldn’t be rushed, and take the opportunity to evaluate the PWD’s mouth for health issues; look for signs of dry mouth, bleeding or any mouth pain. Make regular dental check-ups, and notify the dentist office that the person suffers from dementia.
If you can establish a daily routine around hygiene, keeping it simple and as pleasant as possible, you will have a better chance of getting through it with your humor and the PWD’s dignity intact. Try and see things through a PWD’s Alzheimer’s lens – which means, don’t expect your reasoning to matter. Just take a breath, smile… and try again later! If it never seems to work out, you might want to consider a home health aide for bathing care.
And don’t forget to pour yourself a nice bubble-bath and soak some of that caregiver stress away, as well!
Let's get creative!