Dementia - hygiene

It is quite common for people with dementia to forget about personal care and hygiene. They may neglect basic activities such as bathing and changing their clothes. This can be puzzling and upsetting for families and carers. Understanding the cause can help you decide which strategies may be helpful when caring for a person with dementia.

There are a number of things you can try to help the person manage their hygiene. Try to work out ways of coping without argument or confrontation. Approaching the person with reassurance and patience can help overcome obstacles.

Bathing and dementia

Carers can use a number of strategies to overcome problems with bathing.

Provide privacy for washing and dressing

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.

Things you can try include:

• pulling down blinds or closing curtains and doors to create a feeling of privacy
• covering mirrors if the person doesn’t recognise themselves in the mirror
• approaching the person with a great deal of reassurance and patience.

Improving the environment for bathing

The person with dementia might feel uncomfortable during the bathing process. The room may be too hot or cold, too dark or may produce feelings of claustrophobia.

Things you can try include:

• making sure that the bathroom is warm enough and inviting
• providing adequate lighting in the bathroom, especially during evening hours
• playing soft music in the background to create a calming and relaxing atmosphere.

Routines to help with bathing

The person may not be used to bathing or showering daily. In past times, many people did not bathe as often as they do these days. It is important that you do not impose your own values about how often the person should bathe.

Things you can try include:

• choosing the best time of the day for bathing – try to match the person’s bathing routine before the onset of the dementia
• bathing at the time of day when the person is most relaxed and choosing a type of bathing – bath, shower, sponge bath – with which they are familiar.

Making bathing simpler

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 hot and cold, caused by damage to the region of the brain that controls their ‘internal thermostat’. They may also feel a different sensation from water itself.

Things you can try include:

• Break down the tasks into simple steps, gently explaining each step – use simple, respectful language.
• Offer the person 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 going to bed?’.
• Let the person feel the water before getting into the bath – sometimes gently pouring water over their hands reassures them, or saying something like ‘The water feels nice’ or ‘This feels good’ is also reassuring and calming.
• Encourage the person to do as much as possible themselves.
• Lay out the soap, washcloth, towel and clean clothes in sequence so that the person with dementia can use them as needed.

Fear of bathing

Fear of water can sometimes be a problem. The person may not be able to gauge the depth or temperature of the water, and will then be frightened to step into it. Fear of falling may be another problem.

Feeling out of control and powerless may add to a person being uncooperative with bathing. The person with dementia may fear drowning, particularly if water is being passed over their head.

Things you can try include:

• Prepare the bath ahead of time – check the water level, because some people prefer only a small amount of water in the bath, while others prefer more.
• Separate 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 to maintain their skills.
• Install a hand-held shower – installation is very easy.
• Fit special bathroom aids, such as rails, to make bathing easier – the Independent Living Centre can provide advice.
• Wash from a basin rather than a bath or shower if that’s what the person with dementia prefers.

Toileting and dementia

A person with dementia may need help with toileting. Make sure that they are clean and dry, and that underwear is changed as needed. If incontinence is a problem, make sure that the person is washed carefully with warm water and is thoroughly dry before putting on clean clothes.

Shaving and dementia

At first, carers may simply need to remind the person with dementia to shave each day. If they are used to an electric razor, they can probably continue to shave without supervision for longer, and so maintain their independence. If they are used to a traditional razor and begin to cut themselves often, carers will need to supervise shaving or may even need to do it for them.

Changing clothes and dementia

Changing clothes is 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 putting on clean ones.

To lighten the workload for carers, try to choose clothes that wash easily and need little or no ironing. Most people enjoy being complimented on their appearance, especially when wearing new clothes or sporting a new haircut. It is important that the person with dementia has this experience as well.

Dental care and dementia

Regular visits to the dentist to check on teeth, gums or dentures are very important. When you make the appointment, it is always worth advising the dentist that the person has dementia and that they may not be able to cooperate.

As a carer, you may need to remind the person to clean their teeth, or even do it for them.

Ear care and dementia

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

Fingernail and toenail care and dementia

A person with dementia may forget about, or have difficulty, cutting their nails. It is important that this is done regularly, because 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 care and dementia

The carer may need to spend time finding a way to wash hair that is comfortable and acceptable to the person with dementia. Some people can become very distressed when having their hair washed.

It might be better to visit the hairdresser or have the hairdresser come to the home. Many people with dementia enjoy having their hair cut and styled, and this can continue to be a pleasurable experience.

Equipment and support for carers

Dealing with dementia-related behaviours day in and day out is not easy. It is essential that you seek support for yourself from an understanding family member, a friend, a professional or a support group such as Dementia Australia. Remember that you are not alone.

The Dementia Behaviour Management Advisory Service (DBMAS) is a national telephone advisory service established to support carers and care workers of people with dementia, who experience dementia-related behaviours.

The Independent Living Centre offers a number of services designed to promote safe living. Information is available on products to assist with personal hygiene, including hot water services and temperature regulators. Advice is also available on home modifications and home design.

Where to get help

• Your GP (doctor)
• Your local council
• Your local community health centre
• National Dementia Helpline, Dementia Australia Tel. 1800 100 500
• Aged Care Assessment Services Tel. 1300 135 090
• My aged care Tel. 1800 200 422
• Cognitive Dementia and Memory Service (CDAMS) clinics
• Carers Victoria Tel. 1800 514 845
• Carer Gateway Tel. 1800 422 737
• Dementia Behaviour Management Advisory Service (DBMAS) Tel. 1800 699 799 – for 24-hour telephone advice for carers and care workers