Introduction
Bathing is often the most difficult personal-care activity that caregivers face. Because it is such an intimate experience, people with dementia may perceive it as unpleasant or threatening. In turn, they may act in disruptive ways, like screaming, resisting or hitting.
Such behavior often occurs because the person doesn’t remember what bathing is for or doesn’t have the patience to endure such unpleasant parts of the task like lack of modesty, being cold or other discomforts.
Personal care, including washing and bathing, is a common source of anxiety for people with Alzheimer's and their caregivers. It’s not hard to understand why – most of us have been carrying out these activities on our own since we were small children.
There are some particularly common reasons for anxiety among people with Alzheimer's, including:
- Deep bath water
Deep 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. - Overhead showers
Some people find the rush of water from an overhead shower frightening or disorienting. A hand-held shower may work better. - Incontinence
This may be a sensitive issue for both of you. If the person has an accident, they may feel ashamed. They may refuse to admit that it has happened, or to wash afterwards. Try to be reassuring. A matter-of-fact approach, or humor, may work well. Adopt an approach that fits with the nature of your relationship with the person. - Self-consciousness
The person with Alzheimer's may find it embarrassing to be undressed in your presence. One way to overcome this is to uncover only the part of their body that you are washing at the time, leaving the rest covered. - Isolation
Some people may become anxious if they are left on their own and may want you to stay with them while they are washing
Talk to the person about how you feel about bathing them. Ask how they feel and how they would prefer you to do things. Try to find ways to help them remain independent in as many ways as possible, and offer support as unobtrusively as you can. Here are some practical tips.
Encourage the person to do as much as possible, but be ready to assist when needed. Assess his or her ability to:
- Find the bathroom.
- See clearly.
- Keep balance without fear of falling.
- Reach and stretch arms.
- Remember steps in the bathing process, follow cues or examples.
- Know how to use different products (soap, shampoo, washcloth, etc.).
- Sense water temperature.
- Gather bathing supplies such as towels, washcloths, shampoo and soap before you tell the person that it’s time to bathe.
- Make sure the room is warm.
- Use large beach towels or bath blankets that completely wrap around the person for privacy and warmth.
- Have a washcloth ready to cover the person’s eyes to prevent stinging from water or shampoo.
- Make sure that soap and shampoo are easy to reach. Try using hotel-sized plastic containers of shampoo.
- Fill the tub and then assess the person’s reaction to getting into the water. It may be better to fill the tub
after the person is seated. - Use only two or three inches of water.
- Try using a hand-held shower head and make sure the spray isn’t too intense.
- Monitor the water temperature. The person may not sense when the water is dangerously hot or may resist bathing if the water is too cool.
- Help the person feel in control. Involve or coach the person through each step of bathing. Be sure the person has a role. For example, have the person hold a washcloth or shampoo bottle.
- Give the person choices. For example, ask if he or she would like to bathe now or in 15 minutes, or take a bath or a shower. Try saying “Let’s wash up” instead of “Let’s take a bath.”
- Be aware that the person may perceive bathing to be threatening. If the person resists bathing or acts out, distract him or her and try again later.
- Often praise the person for his or her efforts and cooperation.
- Always protect the person’s dignity, privacy and comfort. Try to help the person feel less vulnerable by covering the person with a bath blanket while undressing.
- Cover or remove the mirrors if a reflection in the bathroom mirror leads the person to believe there’s a stranger in the room.
- Have a familiar person of the same sex help, if possible.
- Be flexible. Allow the person to get into the tub or shower with clothes on. He or she may want to undress once clothes are wet.
- Don’t worry about how often the person bathes. Try sponge baths in between showers or baths. Wash one part of the body each day of the week. Or, consider shampooing hair at another time or on a different day.
- Pad the shower seat and other cold or uncomfortable surfaces with towels.
- Have activities ready in case the person becomes agitated. For example, play soothing music or sing together.
- Set a regular time of day for bathing. If the person usually bathes in the morning, it may confuse him or her to bathe at night.
- Use simple phrases to coach the person through each step of the bathing process, such as: “Put your feet in the tub.” “Sit down.” “Here is the soap.” “Wash your arm.”
- Use other cues to remind the person what to do such as the “watch me” technique. Put your hand over the
person’s hand, gently guiding the washing actions. - Use a tub bench or bath chair that can adjust to different heights. The person can sit while showering if it is easier.
- Washing the person’s hair may be the most difficult task. Use a washcloth to soap and rinse hair in the sink to reduce the amount of water on the person’s face.
- Be sure the person’s genital areas are washed, especially if incontinence is a problem.
- Be sure the person is washed between folds of skin and under the breasts.
- Simply the bathing process by sewing pockets into washcloths to hold soap or using soap that washes both hair and body.
- Check for rashes and sores, especially if the person is incontinent or unable to move around.
- Seat the person while drying and putting on fresh clothes.
- Be gentle on the skin. The person’s skin may be very sensitive. Avoid scrubbing, and pat skin dry instead of rubbing.
- Use cotton swabs to dry between the toes.
- Apply lotion to keep skin soft.
- Use cornstarch or talcum powder under the breasts and in the creases and folds of skin. If the person won’t use deodorant, use baking soda.
- Never leave the person alone in the bathroom.
- Lower the thermostat on your hot-water heater to prevent scalding injuries.
- Always check the water temperature, even if the person draws his or her own bath.
- Always put a nonskid mat in the tub or shower.
- Use a anti-slip bath mat outside shower stall/bathtub.
- Install grab bars and use a tub bench or bath chair that can adjust to different heights.
- Make sure there are no puddles on the bathroom floor; think about installing carpet.
Other Considerations
- If a person is absolutely refusing a bath or a sponge bath and if his/her lack of hygiene is intolerable, consult a doctor. For some people medications may ease the anxiety. Use only with very careful supervision and as A LAST RESORT. (Sometimes these medications have side effects and occasionally they increase the agitation.)
- In the later stages of dementia when total assistance with personal care may be needed, meticulous and careful attention to hygiene is important in preventing skin breakdown. This becomes a major challenge for caregivers coping with urinary and bowel incontinence.
- Bathing is a very personal and private activity. Many people have never completely undressed in front of anyone else and this can be uncomfortable and vulnerable experience. Also, when a caregiver offers to help someone who is confused, it is a strong statement that the person is no longer able to do for him/herself. This loss of independence can be terribly difficult for people with dementia. It is important to recognize that these feelings may be contributing to some of the resistance to bathing.
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