Hygiene

It is quite common for people with dementia to lose interest in, or forget about, personal hygiene. Although this can be upsetting for families and carers, working out ways of coping without argument or confrontation can be worthwhile.

Possible causes of problems with bathing and some ways of helping

Lack of privacy
Washing and dressing are intimate, private activities. Many people have never undressed in front of others and may be embarrassed or humiliated by their need for assistance. They may feel particularly embarrassed if they are incontinent and may refuse to bathe or change their clothes to try to disguise the problem.

What to try
• Pull down the blinds, or close curtains and doors to create a feeling of privacy
• Cover mirrors if they don't recognise themselves
• A great deal of reassurance and patience will be needed

Environment
The person with dementia may feel uncomfortable. The room may be too hot or cold, or produce feelings of claustrophobia. They may not be used to bathing or showering daily. In past times many people did not bathe as often as they do today. It is important that you do not impose your own values about how often the person should bathe.

What to try
• Make sure the bathroom is warm enough and inviting
• Provide adequate lighting in the bathroom, especially during evening hours
• It may be helpful to play soft music in the background to create a calming and relaxing atmosphere
• Choose the best time of day for bathing. Try to be consistent with the person's bathing routine before the onset of dementia. Consider the time of day when the person is most relaxed and the type of bathing, such as bath, shower or sponge bath, that they are used to

Task is too confusing or complicated
Getting undressed, having a wash and brushing teeth can be very complex tasks because of the many steps involved. Some people with dementia may have a changed sense of perception of hot and cold water caused by damage to the region of the brain that regulates the 'internal thermostat'. They may feel a different sensation from water.

What to try
• Break down the tasks into simple steps, gently explaining each step. Use simple, respectful language
• Try offering limited choices - for example: 'Would you like to have a bath or a shower? Or: 'Would you like to have your bath now or, before bed?'
• Let the person feel the water before getting into the bath. Sometimes gently pouring water over their hands reassures them that the water isn't too hot. Saying something like: 'The water feels nice'. Or: 'This feels good' can also be reassuring and calming
• Encourage the person to undertake as much as possible themselves
• Lay out the soap, washcloth, towel and clean clothes in sequence, so that they can be used as needed

Fears
Fear of water can sometimes be a problem. A person with dementia may be unable to gauge the depth or temperature of the water and be frightened to step into it. Fear of falling may be another problem. Feeling out of control and powerless may add to a person's lack of cooperation with bathing.

The person with dementia may fear drowning, particularly if water is being passed over their head.

What to try
• Prepare the bath ahead of time. Check the water level. Some people prefer only a small amount of water in the bath; others prefer more
• Try separating hair washing from bathing. Some people with dementia associate bathing with having their hair washed and become upset because it frightens them to have water poured over their head
• Allow plenty of time and encouragement to help the person maintain their skills
• Install a hand-held shower. Installation is very easy
• Special bathroom fittings such as rails can make bathing easier. The Occupational Therapist can assist with this.

Other hygiene issues

Toilet
A person with dementia may need help with the toilet. Ensure that they are clean and dry and that underwear is changed as needed. If incontinence is a problem, make sure that they are washed carefully with warm water and dried thoroughly before putting on clean clothes. For more detailed information about continence and dementia contact the Continence and Urotherapy Service at Overdale; phone 01534 443010 / 444658.

Shaving
At first you may simply need to remind the person with dementia to shave each day. If they have been used to an electric razor, then they will probably be able to continue to shave without supervision for longer. If they are used to a traditional razor and begin to cut themselves regularly, you will need to supervise shaving or even do it for them.

Ears
A build up of ear wax can be a problem for some people and can lead to unnecessary hearing impairment. Speak to the doctor about the best way to deal with ear wax.

Change of clothes
Changes of clothes are important for hygiene and personal freshness. Encourage the person to change regularly. It may mean tactfully removing dirty clothes at the end of the day and substituting clean ones. Try to choose clothes that wash easily and need little ironing to lighten the workload. Most people enjoy being complimented on their appearance, especially when wearing new clothes, or with a new haircut. It is important that a person with dementia has this experience as well.

Dental care
Regular visits to the dentist to check on teeth, gums or dentures are very important. It is always worth advising the dentist when you make the appointment that the person has dementia and may find it difficult to cooperate. You may need to remind the person to clean their teeth, or even do it yourself.

Fingernails and toenails
A person with dementia may forget about, or have difficulty cutting their nails. It is important that this is done regularly as uncut nails can lead to problems. It may be useful to enlist the services of a podiatrist. Consider whether the person enjoys having their nails painted and manicured.

Hair
You may need to spend time finding a way to wash hair that is comfortable for the person with dementia. Some people can become very distressed by having their hair washed. A visit to the hairdresser, or a hairdresser coming to the house may be a better alternative. Many people with dementia continue to enjoy having their hair cut and styled and this can continue to be a pleasurable experience.

Did you know?

If we could delay the onset of Alzheimer's by 5 years we could halve the number of people who die with the disease.