3. Understanding the issues around washing and bathing
Personal care activities, including washing and bathing, are extremely private. They are a common source of anxiety for people with dementia and can also be difficult for carers. It is not hard to understand why - most of us have been managing this on our own from a young age. Needing assistance from another person with something so personal raises many issues, such as respecting the person's privacy as well as addressing their cultural needs. Other reasons why a person with dementia may feel anxious about 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 disorientating. 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 gentle humour, often works well.
Talk positively and be sensitive towards the person when discussing how you feel about bathing them. Reassure them that, despite it being a very personal activity, you are happy to help. Ask how they feel and what they would prefer. Try to find as many ways as possible to help them remain independent, and offer support as unobtrusively as you can.
Helping someone wash: tips for carers
- Try to make the experience as pleasant and relaxed as possible. Nice-smelling bubble bath or relaxing music can make washing feel like a luxury rather than a chore. Also 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 step by step what you are doing.
- If the person finds the experience difficult, try to imagine how you would feel in their situation.
- Making light of any muddles or awkwardness may help you both deal better with the situation.
- 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 familiar to the person and avoid any that are unnecessary. If there are a lot of products, the person may not be able to understand what each one is 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. Use the towel to pat dry rather than rubbing.
- Take the opportunity to apply moisturiser to the person's skin. As we get older our skin becomes drier, and 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.
- 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 their self-esteem and help create a feeling of well-being.