- In the bathroom
- Providing reassurance
- Fostering independence
- Respecting dignity
- Hair washing
My Dad was very unwilling to have a bath. I think he was embarrassed for his daughter to see him naked. I talked to the day hospital he goes to and they agreed to try. The nurse had no problem at all persuading him to bath with her help.
People with dementia usually need more and more assistance with their personal hygiene. As the disease progresses, they may lose the ability to manipulate objects such as combs and toothbrushes. They might also forget what these objects are and, more important, what they are used for, forget that a task needs doing, be under the impression that it has already been done, or lose interest in keeping clean and looking good. However, the fact that the person needs more help does not necessarily mean that they will appreciate receiving it. Sometimes they might put up quite a struggle. They may resent being dependent on you and feel that you are invading their privacy. Furthermore, they might not feel that it is important to wash regularly or look after their appearance. As a carer, you are faced with the task of providing the right degree of assistance for the person’s changing needs, whilst respecting their need for privacy and independence.
Make the bathroom a safe environment
Grab rails can be fixed at various points in the bathroom to help the person with dementia to move about the room and to get in and out of the bath. It might help to have a bench seat in the bath and a shower attachment, so that they can sit down and have a shower in the bath. You could even put a chair in the shower if they find it difficult to remain standing or are unsteady and risk slipping. To avoid slipping, make sure that any rugs on the bathroom floor are well fixed. It is a good idea to remove any unnecessary objects from the bathroom which might contribute to confusion or be used inappropriately, e.g. a waste paper bin as a toilet. The items that the person needs or would like to use can be laid out or given when needed.
Men with dementia may at some time have difficulties shaving. However, this will depend on the method of shaving they are used to. Men who use a traditional razor may start to have difficulties handling it and consequently cut themselves. One solution is to supervise shaving or even do it for the man. However, by doing so, it is important to realise that you will be taking away part of his independence. An alternative solution is to persuade him to use an electric or battery operated shaver. Encouraging him to carry on shaving on a daily basis is likely not only to prolong his independence but also to contribute to a prolonged interest in his appearance and hence maintain his morale. If the problem becomes too great, it might be appropriate to encourage him to grow a beard.
A shower or a bath?
A shower might be a good idea if the person with dementia is strongly opposed to having a bath. They may have developed a particular routine over the years (e.g. taking showers during the week and a bath only once a week at the weekend). You may find that there is no need to impose a different routine. Some people with dementia find it easier to have a shower than a bath and vice versa. Some find it difficult to get in and out of the bath, others are anxious about showers. If having a bath or a shower is too problematic, you may have to settle for a body wash.
Make bathing an enjoyable activity
It is important to try to make the experience of washing as enjoyable an activity as possible. This is unlikely to be the case if the room is cold and uncomfortable or if the person with dementia feels rushed, embarrassed, treated like a child, afraid or hassled. Although it is important to make sure that someone washes properly and regularly, having a bath should not become an ordeal. Like anyone else, they might appreciate soaps, talc, bubble bath or music etc.
Measures to provide reassurance
Some people with dementia may become afraid of taking a bath and prefer not to be left alone. Fears tend to be associated with the temperature and depth of the water, as well as falling. As older people are more sensitive to extreme temperatures, the person you are caring for might find the water too hot and the room too cold. It is therefore important to bear these matters in mind when preparing the room and the water. The person might worry less about slipping if you were to run less water and use a non-slip mat in the bath. The use of coloured bubble bath or a coloured mat can make it easier to judge the depth of the water, but the mat should not be too dark a colour or it may look like a hole. You could also help by just helping them in and out of the bath, even if they then bath alone.
Try to foster independence
There are various ways of providing assistance depending on the level of understanding and ability of the person with dementia. For example, you could leave the person to wash him or herself, just prompting when necessary or you could explain or demonstrate on a step-by-step basis what to do. If possible, try to let them start or finish tasks on their own, just taking over or providing assistance when necessary. If the person can still understand images or writing, you could use notes or images to serve as prompts. Another possibility is to make all the preparations and then to leave them to wash alone (e.g. prepare a clean set of clothes, run the bath, pre-heat the room, lay out towels, shampoo and soap etc.).
Respect the need for privacy and the dignity of the person with dementia
Being present while the person with dementia washes, either to supervise or assist, can be stressful and embarrassing. Most people have spent their lifetime since early childhood washing in private and they will normally find it difficult to accept your presence during this activity. The degree of embarrassment may depend on your relationship, whether you are of the same sex and the degree of assistance needed. The person might feel less embarrassed in a medical setting so you could possibly alleviate some of the embarrassment by arranging for a nurse to assist. Alternatively, if the person attends a day centre, you might be able to arrange for staff to take care of washing.
It may still be possible for the person with dementia to have a bath or shower alone. It is a useful precaution to remove locks from the inside of the bathroom door. Otherwise, the person might lock the door and then forget or be unable to manipulate the lock. This could cause them to panic. Also, if the person were to have an accident in the bath, fall asleep or forget to get out of the bath, you would have difficulty entering the bathroom to help. To respect the person’s privacy, you could perhaps have a sign on the bathroom door to indicate when it is occupied.
People with dementia are likely to find it difficult, be unable or simply forget to cut their toe and fingernails. It is a good idea to make sure that this is done, as uncut toenails can cause problems. Some people with dementia appreciate a manicure and women with dementia might like to have their nails varnished.
Apart from keeping hair clean and neat, a well kept hairstyle can also contribute to maintaining someone’s self-esteem. A visit to the hairdresser or a home visit by a hairdresser might therefore be a good idea. It is perhaps best to wash hair as the person with dementia has always done in the past, making sure that it is not uncomfortable or painful. One method is to use a shower attachment. Another solution might be to use a dry shampoo occasionally. If you find it difficult to wash their hair at the same time as they have a bath, you might find that it helps to separate the two tasks. A short style is generally easier to manage.
Last Updated: Friday 11 September 2009