Caregiving Challenges: Bathing and Personal Hygiene

By Diane Blum

As Alzheimer’s progresses, poor hygiene can often become more than just an unpleasant issue. It can have medical consequences, such as bacterial infections including UTIs. Gastroenteritis and other health issues can also occur, some quite serious to an immune system weakened as Alzheimer’s progresses.

Because Alzheimer’s is a steady deterioration of cognitive functions, a person with dementia will start to get confused about seemingly simple behaviors such as how to wash his or her hair. Perceptions will start to be impacted. A tub of water can become scary 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 person with dementia may be overwhelmed by everyday products on the bathroom counter, perhaps using a hair product as toothpaste.

Understanding that your loved one’s perceptions are increasingly distorted by the disease’s progression and focusing on creating positive routines may help you as the caregiver deal with these difficult behaviors.

Bathing and Hygiene
Focus on “must do’s” to keep your loved one healthy while maintaining his or her dignity. A daily bath or shower really isn’t necessary as long as there is good hygiene after toileting and genitals are sponged daily. However, some caregivers do feel that an everyday bathing schedule is easier because a person with dementia can become familiar with the routine.

A bath or shower should be quick and efficient. Building positive associations, such as offering an after-bath ice cream treat, can help. Many caregivers use toileting as a starting point by removing the loved one’s clothing while they are on the toilet each day.

Be prepared for the bath prior to bringing your loved one 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 showerhead so that the water isn’t falling down on your loved one, which can be disorienting. Playing some calming music can be helpful, or try singing your loved one’s favorite tunes. Give your loved one a washcloth and get him or her involved in the cleaning process. Some spouses take their shower with their loved one, enlisting the “watch me” and “do what I am doing” method. Have a comfy robe and fluffy towels nearby, and keep the room temperature 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. Your loved one may prefer sitting on a shower chair rather than in the water. Give him or her a choice. 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 your loved 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 that your loved one is completely dry and use lotion or cornstarch, especially under skin folds. On days when 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. Take the opportunity to evaluate your loved one’s mouth for health issues. Look for signs of dry mouth, bleeding, or any mouth pain. Make appointments fo regular dental check-ups, and notify the dentist’s office that the person suffers from dementia.

If you can establish a daily hygiene routine, keeping it as simple and pleasant as possible, you will have a better chance of getting through it with your good humor and the your loved one’s dignity intact. Try to see things through a person with dementia’s lens. Just take a breath, smile… and try again later if need be! However, at some point 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!