Bathing

Reluctance to bathe

Developing apprehension about bathing is not uncommon for some people with dementia. A once peaceful, relaxing activity may be fraught with tension and fear. Start by exploring possible reasons for the person's behaviour.

Think about the following:

• Change in routine: Did he usually take a shower or a bath? Was it once a week or every day? Was it in the morning or in the evening?
• Ease of movement: She may be afraid of stepping into the tub due to her inability to judge where the edge is or how deep the tub is, or may just fear the depth of the water. Is it easy for the person to get in and out of the tub or shower (e.g., are there hand rails)?
• Other health problems: She may not feel well. For example, she may have a flu or infection. Or depression may be causing a loss of interest in personal hygiene. As part of the disease, he may have forgotten the routine of washing or even what the bathtub is for.
• Incontinence: Incontinence may also be a problem and she may be greatly embarrassed if she has an accident.
• Communication: The task may be made more difficult if he is having difficulty communicating because bath or shower time means taking out his hearing aid or taking off his glasses. The temperature of the room or water may be too hot or too cold.
• Loss of privacy: The problem may also stem from having you assist. Is she reacting to the loss of privacy and independence? Is she uncomfortable with receiving this help? Are you uncomfortable giving it? Your discomfort may show, and may be influencing the person with Alzheimer’s disease. He may also need a lot of extra time to bathe now, and may be sensing a need to rush.

What to try

Whether or not you are able to discover a specific reason for the person's unease, you can try to make the activity easier and more pleasant. Here are some suggestions that might help:

Make bathing pleasant

• Try to maintain routines as much as possible. Did he prefer to undress in the bathroom? Or in his bedroom, where he can change into a robe?
• Play favourite music.
• Provide adequate lighting.
• Try nice-smelling bubble bath (if the person likes this).
• Praise his accomplishments.
• Pull the blinds down and close the door to create a sense of privacy.
• Prepare the bath ahead of time: lay out the soap, wash cloth, shampoo and towels, and have the water already in the tub.
• Use coloured bubble bath or a coloured bath mat to make it easier to judge the depth of water (though avoid a very dark coloured mat — it could give the impression of a hole).
• Encourage her to use the toilet before bathing to reduce the chances of an accident.
• Talk about what you are doing, how you are trying to help him do as much as he can and only help as much as you need to. Offer support and encouragement.
• If she is reluctant to bathe, try timing your requests around someone coming to visit or around the person going out.
• Wash gently; his skin may be sensitive.

Make bathing easier

• Simplify the task by giving one instruction at a time.
• Allow her to do as much of the washing as possible.
• Respect the need for modesty: allow him to bathe in underwear or a bathing suit or wrapped in a towel.
• Lay a towel or a strip of coloured tape on the tub to distinguish the edge.
• Make sure her hands are occupied by providing a wash cloth.
• If he regularly refuses to take a bath, escort him to the bathroom before raising the subject.
• Arrange to have another individual, with whom the person with dementia is comfortable, help with bathing.
• Talk to other caregivers who have faced the same challenge.
• Consider leaving in a hearing aid or leaving on glasses. You will need to be careful not to get water in a hearing aid, and will have to remove it if you are washing her hair. Keep her busy with washing and then take out the hearing aid when it is time.

Alternatives to bathing

• Try bath and shower to see what she prefers. A hand-held shower may be less frightening than the regular showerhead.
• Try a sponge bath at the sink. This might work if he has mobility problems. With a sponge bath, try uncovering only the part of the body being washed, for greater privacy.
• Try washing one part of the body each day of the week.
• If regular bathing is difficult, fill in between baths with the necessities, i.e., washing hands before eating or handling food, and after using the toilet; washing bottom and genitals daily to prevent infection; and washing face to prevent skin problems.

Washing hair

• Separate hair washing from bath time, if washing hair is part of the problem.
• Try shampoos that don't require water.
• Some people prefer to have their hair washed at a hairdresser.
• Keep a washcloth handy to cover his eyes when shampooing.

After the bath

• This is a good time to check for any problems with her skin, especially if she is usually in a wheelchair and doesn’t move around a lot, or if she is incontinent.
• Seat her when drying. Make sure to dry well, including in the creases of the skin and under the breasts. Pat dry instead of rubbing with the towel.
• Use lotion to keep skin moist.
• Use deodorant or baking soda.
• Make sure he is seated before dressing.

For safety's sake

• Install a railing in the tub to make getting in and out easier.
• Use a tub chair and shower hose if getting into the tub is a problem.
• Use a non-skid bath mat in the bottom of the tub or shower.
• Avoid bath oil that makes the tub or shower slippery.
• Assist the person in and out of the tub.
• Always supervise bathing. If you do need to leave him alone, you may want to consider removing any locks from the door.
• Make sure the floor is not slippery.
• Check the bath/shower water temperature before she steps in.
• Remember your own safety. Talk to a health-care worker who can show you the best way to assist another person without causing back strain or a possible fall.

Day to day

On some days these ideas will make bathing easier. On others you may decide that a sponge bath will be sufficient or even that no bath is best. It's true that most of us like to bathe or shower often and prefer that the person we are caring for does as well. It is important to remember that you are doing the best you can.