Dementia and Personal Hygiene
As Alzheimer’s or Dementia progresses, personal hygiene can become a struggle. For those caring it can be confusing as to why they have become so afraid to bathe. Why are they so resistant to getting undressed, or seem in pain when the water hits their skin? Below are some of the reasons your loved one refuses to bathe and what you can try to make the process easier for them.
Why are people scared?
As your skin ages it can become sensitive to temperature, make sure when running a bath you check the temperature ensuring it isn’t too hot or too cold. There is often a difficulty with depth perception, this altered sensation can mean they no longer can see the water and become afraid of something they can feel but cannot see. This heightened sensitivity can lead to sensory overload and the shower water can feel like a thousand tiny knives hitting their skin.
There is also a sense of shame for them. Who are you? Why are you taking my clothes off? And a sense of helplessness and lack of autonomy. Lastly the environment can have an effect, do they feel afraid of falling, slipping, not having anything to catch themselves. It the room cold?
Why must you persevere
The number one reason is to prevent ill health and infection. Infection prevention can stop your loved one being admitted to hospital as well as helping them stay clean for their own mental health & dignity.
Now you understand a few reasons as to why your loved one doesn’t want to bathe, here are a few things you can do to help them.
What you can do
Don’t rush, take your time and stay calm.
Create a Routine
Think about the timing of when you are asking them to bathe, or the way you are phrasing it. A person may refuse to wash when you suggest they should, but may decide to wash themselves later in the day. Try to be flexible and think about the following questions:
- Where does the person prefer to get undressed?
- When do they like to get changed, for example before breakfast or after?
- Do they prefer a bath or a shower?
- What toiletries are they used to?
Give them a reason as to why you are asking them to bathe – such as if they are going out or expecting visitors.
If they become aggressive when you suggest washing, change the subject or distract them and try again later.
Comfortable environment
Create a well lit and clutter free space, make sure no one will walk in. Close the blinds for privacy and cover any mirrors and someone with Dementia may not recognise themselves anymore. Below are some things you can do to reduce the fear of entering a bathroom.
- Grab rails to help with getting in and out of the bath
- Non-slip mats for the bath or shower
- Seats to go in the bath or shower, if the person would prefer to sit or is unsteady on their feet.
- Bath boards and powered bath seats that can help a person get in and out of the bath
Don’t forget your own safety
If you help the person get into the bath, make sure you don’t strain your back, or injure yourself if you need to manually handle a person if they are lashing out.
Temperature/ Water Issues
Check the water temperature is not too hot or too cold. You can buy a heat sensor or special plug that changes colour if the bath water is too hot, which can prevent scalding. You can also buy plugs that release excess water if the water level gets too high.
The person may feel reassured if they can feel the water with their hands before getting into the bath or stepping into the shower.
Deep bath water can make some people feel worried. You can reassure them by making sure the bath water is shallow, or by setting up a bath seat for them to use.
Some people find the rush of water from an overhead shower frightening or disorientating. A hand-held shower attachment may work better and will make it easier to clean all over.
Make items such as towels and dressing gowns easy to see by choosing colours that contrast – a green towel will be easier to see than a white one if the walls are white.
You may need to remove locks from the bathroom door, or replace them with locks that can be opened from the outside. Someone with dementia may lock themselves in and be unable to get out.
Lock away cleaning products, medications, nail scissors and razors. The person may not be able to recognise that these are potentially harmful.
Before washing
Discuss and put out what the person will wear after they wash, either nightwear or their outfit for the day. This means they can change more quickly, so they spend less time in a damp towel.
If they seem shy. Embarrassed or reluctant, think about their personal space and privacy. Try uncovering only the part of their body that you are washing. A towel or robe can be useful for this.
Try to use toiletries that the person is used to and avoid any that are unnecessary.
Whilst the above are just a few things you can do to help a loved one bathe, sometimes it can still be too difficult to get them to properly wash. In those circumstances or even for the in-between days there is Nilaqua.
Nilaqua is a unique range of ‘Towel Off’ No Rinse Shampoos and Skin Cleansers that allow you to wash gently without water. The Alzheimer’s Society on their Bathing Fact Sheet says “Alternative options include dry shampoos. Or there are ‘no rinse’ shampoos that can clean the hair without using water – such as Towel Off Shampoo available from the Alzheimer’s Society online shop.” This enables you to perform the task outside of the bathroom.
It’s incredibly simple to use, for the Shampoo simply pour the liquid directly onto your hair, massage until it lathers just like regular shampoo. This lifts all the grease and dirt into the solution, and then just towel dry your hair like normal. By towel drying you are removing the solution with the dirt from your hair, onto the towel. You can then style your hair however you like. This is therapeutic and smells of apples providing dignity.
The Skin Cleansing foam works in the exact same way, but is a foam instead which is useful for those who want to see a white item on their skin, instead of clear water. Simply foam onto the body, massage in to lift all dirt and whilst wet and soapy, towel off. Meaning you are clean and the towel is dirty.
We developed the skin cleanser into a foam to help with aqua phobia. You can target the areas needing cleaning and not have to worry about liquid running everywhere. This is dermatologically tested, doesn’t contain any aerosols, with counter emollients or barrier creams needed. Plus it can be used all over the body including intimate areas and incontinence. This will clean everything including sweat, blood, faeces and urine. Designed for long term use and will not degrade the skin over time. Anyone who is in the later stages of Alzheimer’s / Dementia and becomes incontinent, you can use the Skin Cleansing Foam with a little water for heavy soiling.
The benefit to ‘Towel Off’ waterless products are that you can wash anywhere, even from the comfort of an armchair whilst they are watching TV. It promotes independence by giving them the opportunity to wash themselves, and also providing dignity as you can wash an area at a time so that the person isn’t completely uncovered the whole time.
We hope these tips and rinse free alternatives help at bath time. We always advise you to consult your Admiral nurse if you are experiencing difficulties bathing.
