Alzheimer’s patients resist bathing for numerous reasons. Bathing is intimate and personal. This can feel intrusive and embarrassing for someone with dementia. It can be the task that caregivers find most challenging. Someone with Alzheimer’s disease or another form of dementia might not understand the point of bathing. This is because of cognitive decline. Your loved one might not remember why it is important to bathe and having to undress and be washed by someone can feel like the ultimate loss of independence. Not remembering how to do something combined with being vulnerable because one can not do it by themselves can lead to anxiety and frustration, leading to refusal or resistance. In addition, there can be other reasons that your loved one is opposed to wanting to bathe. This can be because of:
– Sensory Changes. Dementia patients are more sensitive to temperature, how something feels, noise, and other environmental changes around them. How the water feels, either because of the sensation on one’s skin or due to temperature and water pressure can cause your loved one to be uncomfortable or agitated.
– Fear. This is caused by your loved one not knowing and remembering what one does in a bathroom or the normal sights and sounds of one. The sound of running water, mirrors and slick surfaces can cause confusion.
– Emotional Changes. As your loved one progresses through the stages of dementia, a normal symptom is changes in their mood and behavior. A subsequent effect of agitation, anxiety, aggression, or depression can be a newfound resistance to bathing.
– Caregiver. The caregiver is the person who sets the tone of an activity. If they approach the task with care, compassion, and dignity, your loved one is more likely to have a better experience. In contrast, if bathing is pushed and rushed, this can lead to situations that insight difficult behavior.
Don’t push too hard if your loved one refuses to take a bath. An elderly person should probably bathe a few times per week. It is important that hands, faces, and private areas be cleaned daily for health and well-being. Ask your loved one for assistance and always give them as much control as possible.
The key to making bath time manageable is planning. There are tips to help your loved one’s behavior and different bathroom upgrades to simplify this process. Remember, be gentle, avoid scrubbing, and make sure the water pressure is not too strong. Another recommendation is to not buy bathing products like soap or shampoo that come in breakable containers to prevent accidents. More keys for success are:
– Stick to a Schedule. Establishing a routine is crucial for managing symptoms of dementia, so be consistent with bath time. Before the diagnosis, your loved one might have enjoyed a shower every morning before work, or a warm bath after a long day. Look for times and conditions that are most enjoyable or tolerable. For example, if sundowning is an issue do not wait until evening to begin this process.
– Consider Frequency. How often should someone with dementia bathe? Should it be every day, or every other day, or twice a week? Though most adults shower every day or two. You may not need to bathe your loved one that frequently. Determine whether it might be sufficient to have a sponge bath twice weekly and a shower once a week.
– Choose Wisely. What’s the best way to bathe? There is no standard answer. Your loved one may prefer a shower, a bath, or (especially in late-stage dementia) a sponge bath because it causes very little stress. In the early stages of the disease, ask about preferences imparting as much control as possible.
– Encourage Independence. Speaking of control, encourage and allow your loved one to function as independently as possible. In the early stages, a verbal prompt to take a bath or shower might be sufficient. As the disease progresses, more assistance will be required. If the person can help put soap on a washcloth or wash a part of the body without help, encourage it. This can be empowering.
– Be Prepared. If your loved one is going to have a bath, have the water drawn. Gather a big towel, soap, and shampoo ahead of time, and place those items within reach. Make the bathroom comfortable by being aware of chilly surfaces and covering them with a warm towel.
– Mind Temperature. Just like infants and toddlers, older adults have delicate skin causing them to be sensitive to water temperature. There are greater risks for burns and scalds. Scalding is worse for someone with dementia, who might not understand where the pain is coming from. Simple adjustments can prevent minor and serious burns:
– Lower the temperature on your hot water heater. Many are set to 140 degrees Fahrenheit, which can scald skin in five or six seconds. By lowering the temperature by 20 degrees, you can prevent scalding. It takes five to 10 minutes for 120-degree water to scald.
– Install an anti-scald device on the faucet or showerhead, to prevent burns regardless of the setting on the hot water heater. The device prevents water from pouring if it gets too hot.
– Always test the water with your hand before your loved one bathes.
– Do Not Leave. Never leave your loved one unattended in the bath. Someone with dementia may not know the difference between the hot and cold knobs. Confusion and loss of coordination are important things to remember and supervision prevents accidents.
– Play Soothing Music. Playing music can help relax or even distract your loved one during bathing. For more on how music helps people in various stages of dementia, click here.
– Remember Dignity and Privacy. Being naked in front of a caregiver can be embarrassing. Consider shielding with a towel as your loved one undresses and let them cover up with a towel or robe as soon as they step out of the water.
– Use Visual Cues. When your loved one progresses through the stages of dementia, it will be hard for them to remember what to do in the bathroom and in what order. An easy way to help this is to use visual reminders. Think about having directions that are detailed with pictures that remind them of the steps. Also, another helpful idea is labeling things in the bathroom to help them be recognized easier.
– Consider the Sponge. Sponge baths allow you to clean your loved one without submersion or shower spray. This can be particularly useful in later stages of dementia, when bathing is more confusing for your loved one, and when getting in and out of the tub or shower becomes difficult.
Someone with dementia is more susceptible to falling, especially in the bathroom. These small and practical upgrades can lower the risk for your loved one:
– Grab Bars. These are installed on the walls of the shower to give your loved one something to hold on to. They can stick to the surface with suction cups, though mounting hardware like screws is probably preferable. Grab bars can have anti-slip grips. Poles secured from floor to ceiling of a shower are also good options.
– Non-slip Bath Mats. Hundreds of thousands of people are injured every year when they slip in the bathroom, and elderly people are particularly vulnerable. Non-slip surfaces are available that adhere to the floor of tubs and showers, and also to the tiles on the floors of the bathroom.
– Go Hand-Held. A hand-held shower head, as opposed to a traditional fixed head, allows for easy access to harder-to-clean areas. This can cut the stress of having to bend to wash important areas like under folds.
– Bath Chair. These are useful in both the bathtub and shower. Bath chairs can be sturdy, with non-slip leg tips, and adjusted to a comfortable height. This can be something important to consider because someone sitting is less likely to fall. The feeling of security can also have the added advantage of allowing for more independence.
Have your loved one sit while you finish the bath time routine, encouraging as much assistance as possible. In the early stages of dementia, these can be done independently, though you will want to supervise:
– Pat the skin dry with a towel, instead of rubbing.
– Apply lotion. This can be soothing as it also helps with dry skin.
– Powder hard-to-reach areas, like under folds.