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 find 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 help. 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:

• approaching the person with a great deal of reassurance
• 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

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:

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

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 is common now, so 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 day for bathing – try to match the person’s bathing routine from before the onset of dementia, and bathe when they are most relaxed
• choosing a type of bathing – a bath, shower or 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 also have a changed sense of hot and cold, caused by damage to the region of the brain that controls their ‘internal thermostat’, and may feel a different sensation from the water itself. Things you can try include:

• breaking the tasks down into simple steps, gently explaining each step using simple, respectful language
• offering limited choices – for example, ‘Would you like to have a bath or a shower?’ or ‘Would you like your bath now or before going to bed?’
• letting the person feel the water before getting in – gently pouring water over their hands, or saying something like ‘The water feels nice’, can be reassuring and calming
• encouraging the person to do as much as possible themselves
• laying out the soap, washcloth, towel and clean clothes in sequence, so the person 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 so 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 may also fear drowning, particularly if water is passed over their head. Things you can try include:

• preparing the bath ahead of time and checking the water level – some people prefer only a small amount of water, while others prefer more
• separating hair washing from bathing – some people associate bathing with having their hair washed and become upset, because it frightens them to have water poured over their head
• allowing plenty of time and encouragement to help the person maintain their skills
• installing a hand-held shower
• fitting bathroom aids such as rails to make bathing easier – an occupational therapist can provide advice
• washing from a basin rather than a bath or shower, if that is what the person prefers

Toileting#

A person with dementia may need help with toileting#

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

Shaving#

At first, carers may simply need to remind the person 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#

Changing clothes is important for hygiene and personal freshness#

Encourage the person to change regularly#

This 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, and it is important that the person with dementia has this experience too.

Dental care#

Regular visits to the dentist to check teeth, gums or dentures are very important. When you make the appointment, it is always worth telling the dentist that the person has dementia and 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#

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#

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#

The carer may need to spend time finding a way to wash hair that is comfortable and acceptable to the person with dementia, as 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#

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.

Remember that you are not alone#

Independent living and assistive equipment services can offer advice designed to promote safe living. Information is often available on products to assist with personal hygiene, including hot water systems and temperature regulators, as well as advice on home modifications and home design.

Key points#

• It is quite common for people with dementia to forget about personal care and hygiene
• Understanding the cause can help you decide which strategies may be helpful when caring for a person with dementia
• It is important that you do not impose your own values about how often the person should bathe
• Getting undressed, having a wash and brushing teeth can be very complex tasks because of the many steps involved
• Allow plenty of time and encouragement to help the person to maintain their skills