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Dementia and Bathing

Author: Helen Dennis, Specialist on Aging

Question: I currently assist an 84-year old woman with early dementia. The housekeeper and I have told her repeatedly that she has an odor and needs to shower, but she refuses. Any suggestions?

Answer: Dementia is a progressive brain disease that causes a significant deterioration of intellectual abilities. The two most common forms in older people are Alzheimer’s disease and multi-infarct dementia, sometimes called vascular dementia. This latter type of dementia is caused by reduced blood flow to part of the brain. Both Alzheimer’s disease and vascular dementia are irreversible.

Symptoms, however, can be reversed if they are caused by drugs, alcohol, high fever, dehydration, poor nutrition and bad reactions to medicines.

Caregiving is a challenge in caring for a dementia victim, and bathing is considered one of the most difficult personal-care activities that caregivers face.

Where to begin with a resistant victim? Consider exploring reasons for the person’s behavior.

The Alzheimer’s Association outlines situations and conditions that cause problems with bathing. Here are some examples: inability to find the bathroom; lack of privacy; depression causing a lack of interest in personal care; fear of falling and the sound of running water; belief that the bath has already taken place; a change in daily routine; and forgetting how to perform the task.

Several tips recommended by the Alzheimer’s Association and the Alzheimer’s Society of Canada may remove some of the fears and barriers to bathing:

  • Bathing should be a regular routine, done at the same time of day and using the same steps.
  • Prepare the bath ahead of time, laying out the soap, washcloth, shampoo and towels, and have the water in the tub.
  • Make the bath warm and inviting; provide adequate lighting.
  • Respect the need for modesty. Allow the person to bathe in underwear, a swimsuit or wrapped in a towel.
  • Use large beach towels or bath blankets that completely wrap around the person to ensure privacy and warmth.
  • Try using a hand-held showerhead and make sure the spray is not too strong.
  • Lay a towel or colored tape on the tub to distinguish the edge.
  • Consider sponge-bathing if the individual resists a bath or shower.
  • Stay calm and move step by step in the bathing process. A bath may take all morning.
  • Don’t use slippery oils or bubble bath.
  • Provide handrails, a bench and non-slip strips.
  • Keep the bath area safe – remove electrical appliances, use a nonskid bath mat and a bath/shower chair.
  • Avoid forcing or arguing.

If the person resists getting undressed for a bath, consider these additional tips:

  • Distract the individual with a simple, funny story or song.
  • When the clothes are off, remove them out of sight. The clothing that will be worn next should be in view.
  • If a person clutches his or her clothing so they cannot be removed, give the individual something to hold as a distraction such as a book or juice drink.

In communicating, use simple words, short sentences and a gentle and calm voice. Avoid baby talk, and call the person by name, limiting distractions such as the radio or television.

These tips lead us to some key questions: Does this woman have a caregiver? Are there plans to provide one? Is the housekeeper the care provider?

The caregiving needs of individuals in the early phases of dementia may be minimal. Their needs, however, will increase with time.

It is hard for us to imagine the fears experienced by one suffering from dementia. Just think how it would feel if every experience we have was brand-new. Think of the sounds we hear, what we see and what we cannot understand. It is beyond comprehension. Yet, that is the experience of many victims.

To find more information, contact the Alzheimer’s Association website at www.alz.org.

© Helen Dennis 2010, all rights reserved.

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