Washing and bathing
As a person's dementia progresses, they will need more help with everyday activities such as washing and bathing. For most adults, washing is a personal and private activity and so it can be hard to adjust to this change. When you are helping someone with dementia to wash, it is important to be sensitive and tactful and to respect their dignity. This factsheet looks at some of the reasons why washing and bathing can become difficult for people with dementia and gives practical tips for helping a person to wash.
Personal care, including washing and bathing, can be difficult for carers and is a common source of anxiety for people with dementia. It is not hard to understand why - most of us have been carrying out these activities on our own since we were children. Other reasons for anxiety around washing and bathing include:
- Deep bath water - deep water can make some people feel worried. You can reassure them by making sure the bath water is shallow, or by setting up a bath seat for them to use.
- Overhead showers - some people find the rush of water from an overhead shower frightening or disorienting. A hand-held shower may work better.
- Self-consciousness - the person with dementia may find it embarrassing to be undressed in the presence of other people. One way to overcome this is to uncover only the part of their body that you are washing at the time, leaving the rest covered.
- Isolation - some people may become anxious if they are left on their own and may want you to stay with them while they are washing.
- Incontinence - this may be a sensitive issue for both of you. If the person has an accident, they may feel ashamed. They may refuse to admit that it has happened, or to wash afterwards. Try to be reassuring and adopt an approach that fits with the nature of your relationship with the person. A matter-of-fact approach, or humour, often works well. (See factsheet 502, Managing toilet problems and incontinence for more information.)
Talk positively and sensitively to the person about how you feel about bathing them. Reassure them that even though it is a very personal activity, you are happy to help. Ask how they feel and how they would prefer you to do things. Try to find ways to help them remain independent in as many ways as possible and offer support as unobtrusively as you can.
General tips for helping someone wash
- Try to make the experience as pleasant and relaxed as possible. Nice-smelling bubble bath or relaxing music can make wash time feel like a treat rather than a chore. Make sure that the room is warm enough for the person to be comfortable.
- Be sensitive to the person's preferences and try to work out which approaches are most likely to be effective.
- Use the time to have a chat, as well as to explain what you are doing.
- If the person finds the experience difficult, try to imagine how you would feel in their situation.
- Making a joke about any muddles or awkwardness may help you both feel better.
- Try to be flexible. You may find that different approaches work at different times, depending on the person's mood and the severity of their dementia.
- Being organised can help reduce stress. Try to make sure you have everything you need ready to hand before you start.
- Try to use toiletries that the person is familiar with and avoid having any unnecessary toiletries in the bathroom. If there are lots of products in the bathroom the person may not be able to understand what particular products are for and may use them inappropriately.
- Make sure the person is thoroughly dried - especially in the skin folds. This will prevent the skin from becoming chafed.
- Take the opportunity to apply moisturisers to the person's skin. As we get older our skin becomes drier. Dry irritated skin may lead to unsettled or agitated behaviour in someone with dementia.
- While the person is undressed, check for any red or sore areas. If you notice anything you're concerned about, mention it to the district nurse or GP. (See factsheet 512, Pressure ulcers (bed sores).)
- After the person has washed, consider styling their hair in the way they like to wear it. The person may also like to moisturise and put on perfume or aftershave after they have washed. This can boost the person's self-esteem and help create a feeling of well-being.
We all have our own routines for personal care - particularly when we get up in the morning. Try to encourage the person with dementia to continue with these routines for as long as possible. Take the time to think about which routines work best, as well as the person's preferences, so that you can help them carry on with their normal routine. Where do they like to get undressed? Do they prefer a bath or a shower? What toiletries are they used to? What dental care do they need?
Tips for encouraging independence
- Involve the person in decisions around washing, for example, ask them if they want a bath or a shower, or which soap they want to use. Giving them a choice of two options can help.
- Offer tactful reminders, for example, remind them which step comes next in their personal hygiene routine.
- Offer practical help, for example, by handing the person the soap at the point when they would normally wash, or holding out a towel when it's time for them to dry themselves.
- Give the person lots of encouragement and try not to dwell on things that do not go well.
There are some very practical considerations when someone with dementia is using the bathroom. There is the potential for the person to be scalded with hot water, to slip on the floor, or get locked in, or for the carer to strain their back.
Tips for ensuring safe bathing
- Check that the floor is not slippery. Think about using non-slip mats if necessary.
- Make sure that the room is warm before the person undresses. Older people are more sensitive to heat and cold than younger people.
- Make sure that any blinds or curtains are closed and that no-one else is likely to walk into the bathroom.
- Try to make sure that you will not be disturbed or distracted and will not have to leave the person alone.
- Check that the water temperature is not too hot or too cold. You can buy a heat sensor that sticks to the side of the bath and changes colour if the bath water is too hot, to prevent scalding.
- You may need to remove locks from the bathroom door, or replace them with locks that can be opened from the outside. Someone with dementia may lock themselves in and panic, or they may go into the bathroom and then forget why they went in.
- Don't leave cleaning products where the person with dementia might get to them. The person may not be able to recognise them and may not understand the dangers they present.
- Don't forget your own safety. If you have to help the person get into the bath, make sure you don't strain your back. If this is becoming a problem, talk to an occupational therapist about equipment to help you (see 'Aids and equipment', below).
Aids and equipment
If washing is becoming difficult, you might find it useful to install some equipment such as bars and handrails. This equipment can help the person feel more independent and more in control of their situation, and can make washing and bathing easier and safer. Information about this sort of equipment is available from an occupational therapist, who you can contact through social services, the GP or district nurse. The service is free of charge.
An occupational therapist may suggest some of the following pieces of equipment:
- grab rails to help with getting in and out of the bath
- handrails, which can be attached to the wall near the shower, washbasin or toilet
- non-slip mats for the bath or shower
- seats to go in the bath or shower
- raised toilet seats or commodes.
Other aids, such as sensors that detect when baths are too hot, or too full, are also available. For more information, see factsheets 428, Equipment, adaptations and improvements to the home and 437, Assistive technology - devices to help with everyday living.
Involve the person with dementia as much as possible in decisions about any changes that need to be made to the bathroom.
Most people like having their hair washed regularly. Many people enjoy the feeling of having their hair washed and feel better when it is done. However, some people don't enjoy it at all. If this is the case, balance the advantages of clean hair against the disadvantages of creating tension between you and the person you are caring for.
Tips for washing someone's hair
- If you are washing the person's hair yourself, a hand-held shower may work best.
- Think about using a shampoo which will not cause stinging if it gets into the person's eyes or using a hairwash shield to prevent water running onto the person's face. Another option is a 'no rinse' shampoo that can clean the hair without using water.
- If the person prefers to have their hair washed by a hairdresser, either arrange regular trips to the salon, or find a hairdresser who will come to the house. This may be a time when you can have your hair cut too.
Using the toilet
Try to make sure that the person wipes themselves properly after using the toilet, or help them to do so if this feels appropriate. This will depend on your relationship and the amount of support that the person needs.
Tips for toilet hygiene
- Wiping from front to back, rather than back to front, helps to prevent infection.
- Moist toilet tissues, obtainable from any chemist, can clean more effectively than dry toilet paper, and can be useful to keep around in case the person has an accident.
When someone is reluctant to wash
Washing is a matter of personal choice. Today, most people in the UK bathe or shower daily, but 30 years ago it was normal to have a bath only twice a week. However, washing is not just about smelling fresh and looking well-kept. It also helps prevent ill health. Not washing enough can lead to infections and skin complaints. If the person you are caring for doesn't choose to wash as often as you would wash yourself, that's not necessarily something to worry about. But there are some minimum requirements, and if these aren't being met, you will need to be a little more persistent.
- Make sure the person washes their hands before eating or handling food and after using the toilet.
- The bottom and genitals should be washed every day to prevent infection. Urinary tract infections are common in older people. For more information see factsheet 528, Urinary tract infection (UTI) and dementia.
- The face should be washed every day to keep the skin clear.
- The person should have a full-body wash (for example, a bath, shower or sponge bath) at least twice a week. This doesn't have to be done all at once though. Make use of opportunities as they arise. For example, it may be possible to wash someone's top half one day and their legs and feet on another.
- Teeth or dentures need to be cleaned twice a day to maintain oral health. See factsheet 448, Dental care and dementia for more information.
If the person with dementia doesn't want to wash, try to remain calm and find a way to cope that does not involve confrontation. Think about what the person's routine was like before they had dementia and encourage them to maintain that level of cleanliness.
Tips for encouraging someone to wash
- Try giving gentle reminders about using the toilet or washing.
- Think about the timing of your request, or the way you phrase it. A person may adamantly refuse to wash when you suggest they should, but may decide to wash themselves later in the day - try to be flexible.
- You may find it easier to reason with the person that they should wash if they are going out, or if they are expecting visitors.
- If bathing or showering causes the person distress, a sponge bath may be sufficient.
- If the person is reluctant to change their clothing, try removing dirty clothes and substituting clean ones at bedtime, or after a bath. This can help prevent arguments. If they always want to wear the same clothes, it can be helpful to have a duplicate set of the outfit.
Last reviewed: March 2012
Next review due: March 2014
Reviewed by: Ms Jill Cunliffe, Nurse Specialist for Older People, St Helens and Knowsley Teaching Hospitals NHS Trust, Merseyside and Ms Michele Gorham, National Clinical Lead Nurse Prion Disease, National Prion Clinic Practice Manager, University College London, London
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