Getting an aging or ill loved one to bathe can be a notorious battle that many family caregivers experience. When dementia is a part of this equation, it complicates things even further. As their condition progresses, a senior with Alzheimer’s disease or another form of dementia may refuse to bathe for a number of reasons. Understanding why they resist can help family caregivers navigate these issues and keep their loved ones as clean, healthy, and comfortable as possible.
How often should seniors bathe?
Because this can be such a difficult task, one important consideration is how often seniors truly need to bathe. Since the U.S. is a melting pot of people and cultures from around the world, there are many definitions here of what constitutes cleanliness. Where I live in the High Plains, many seniors who are now in their 80s and 90s grew up taking weekly baths, often because they lived on remote farms where water was too precious to waste. For others, that routine was just normal behavior.
All of this is to say that if a senior won’t shower every single day, it’s unlikely that their health will suffer. This may seem inadequate to younger generations that shower more frequently, but a change of clothes each day and a weekly bath is usually enough for most elders. However, if skin issues and/or incontinence are part of this equation, then more frequent bathing is crucial for preventing dangerous infections.
The goal is to find a frequency that’s realistic for both you and your loved one. If you need some assistance with determining how often a senior should bathe, don’t hesitate to ask their doctor for advice. They should be able to provide a ballpark answer, discuss the risks of poor personal hygiene, and suggest alternatives to full showers or baths.
Why do people with dementia sometimes refuse to bathe?
Symptoms of dementia can derail a loved one’s long-standing personal care routines and make it difficult to provide assistance. Understanding the reasons behind their uncooperativeness is the first step in finding workable solutions.
Memory loss and confusion
Memory loss can lead an elder to believe they’ve just showered when they actually haven’t bathed in weeks. They may also become confused when beginning the multi-step process of bathing. For some, identifying all the different products in the bathroom and their specific uses can be overwhelming. Rather than informing someone they trust that they’re confused and need assistance, many elders simply avoid bathing altogether.
Fear of bathing
Individuals living with dementia may become afraid of showering or taking baths for many reasons. They might feel unsteady on the slick surfaces and worry about falling and getting hurt. They may be uncomfortable in the cold bathroom or become agitated by the sensation of water hitting their skin. Plus, fear of water is very common in seniors with dementia.
In the later stages of dementia, a senior may not understand the task of bathing at all. Think about how frightening it’d be to be undressed and have water pouring down on your head when you can’t figure out why it’s happening. Depending on the extent of a senior’s cognitive impairment, they may not know where they are or may not recognize the person who’s helping them bathe. Confusion, discomfort, and lack of understanding are bound to lead to fear and resistance.
Depression
Another issue that may contribute to a decline in bathing and grooming habits is depression. Before my mother developed dementia, she had always been a clean freak and loved her daily baths. She insisted on wearing fresh clothes each day and enjoyed the springtime-scented products used on her laundry. But, when she decided to move to the nursing home where my dad lived, she experienced a bout of depression.
One of the things that clued me in to her changing mental state was that she would put on the same set of clothes every day. Part of this was simply that she saw them lying on a chair and forgot they’d been worn already, but depression was another contributing factor. Seniors who are depressed often lose interest in their appearance and personal hygiene. If you see this happening to your loved one, you have a reason to be concerned.
My mother’s depression lifted as she adjusted to life at the nursing home, and I tried to hurry that process along by buying her some new clothes and making good use of the on-site beauty shop. These steps helped, and she was soon back to her old ways. If these changes in her mood and behavior hadn’t lifted, I would’ve asked the nursing home doctor to consider treating her for depression.
Depression alone can cause these changes, but this mental health condition is also a common occurrence alongside many forms of dementia. If your loved one has experienced uncharacteristic changes in their bathing and grooming habits, it’s wise to seek an appointment with their doctor.
Read: The Link Between Dementia and Depression
Tips for helping a senior with dementia bathe
It often takes some trial and error to determine why a person living with dementia doesn’t want to bathe and what you can do to help encourage and comfort them throughout this process. The following insights address common issues that many dementia caregivers experience at some point in their journey. One or more of these tips and techniques may help make bathing less stressful for both of you.
- Offer an incentive. If you suspect a senior isn’t bathing because they think they’ve already done it, or they just don’t see its importance, try associating the process with something they enjoy. Give them a fun incentive to cooperate. For example, say, “Let’s both get cleaned up and then we’ll go to your favorite restaurant for lunch.” Taking the focus off bathing and putting it on the outcome may help motivate them.
- Prioritize safety and comfort. Make sure they feel safe and comfortable in the bathroom throughout the process. If the room tends to be cool, warm it up before bath time. Using a space heater can make a huge difference since seniors get cold more easily.
If a shower is the best option for your loved one, be sure to install grab bars for extra stability. A comfortable shower chair and a hand-held shower head are worthwhile investments as well. The chair allows your loved one to rest as needed. Meanwhile, the shower head keeps the water from continually coming down on their head and allows you to carefully direct where the stream goes, minimizing discomfort and fear.
Visit AgingCare’s Senior Product Guide for bathing products recommended by experienced caregivers. - Consider sponge baths. If a senior’s dementia is so advanced that they cannot or will not shower or bathe, you may want to try a different tactic. Bathing doesn’t have to entail a full bath or shower. When done correctly, a person can get clean with sponge baths, dry shampoos, and no-rinse personal care products. In caregiving, especially with dementia patients, sometimes plans B or C must become the new plan A.
- Communicate while helping the senior bathe. Whether you’re assisting in the shower or giving a sponge bath, it’s important to announce each step before you do it. Your loved one may not understand exactly what you’re saying, but it will help them remain calm and included in the process. Surprises can lead to agitation, anger, and confusion.
Describe each move in a low, soothing voice. For example, say, “I’m going to wipe your face with this warm cloth, okay?” or, “I’m going to lift your arm and wash, but I’ll keep you warm and comfortable under this towel.” - Respect the senior’s modesty. Many elderly people are understandably uncomfortable with the thought of someone helping them bathe. My mother-in-law was an excellent example. We were great friends, and she’d let me do anything for her when I was her caregiver — anything except give her a shower. We found that hiring a professional caregiver from a home care company to come bathe her worked best.
One benefit of using a home care company is that many of the professional caregivers are well-trained in bathing services. Bath aides from reputable agencies are experienced and are typically able to do a quick and thorough job while following safety protocols. The aide who arrived for my mother-in-law’s bath visits looked like a nurse in a hospital, which made the nudity more bearable for her.
Regardless of who’s assisting them with bathing, seniors are often more comfortable with the arrangement if they can remain partially covered. Many family caregivers have had success keeping a robe or a towel draped on their loved one and briefly uncovering one area at a time for cleaning. This helps them stay warmer and feel much less exposed. - Find a stopgap solution. A full bath or shower isn’t needed every single day, but there are certain areas of the body that warrant more frequent attention. A few quick passes with an adult-sized wet wipe under the arms each day may be sufficient. A thorough cleansing with a bidet attachment or a peri bottle (perineal spray bottle) after toileting can help a senior remain fresh in between showers or baths. Keeping a loved one’s private areas clean and dry is of utmost importance, so try to focus on this task above all.
Strike a healthy compromise
Remember that a daily bath or shower isn’t always necessary. If you’re tiring yourself out trying to get a senior to stick to their old personal hygiene routines, it’s important to take a step back and assess your motives. Are you trying to get your loved one to adhere to your own standards for cleanliness? Are you afraid of what others may think if your loved one isn’t always clean and well-dressed? Or, is all this fuss warranted because it’s best for their health and comfort?
Yes, cleanliness is important for good health. While we may find a daily shower comforting and rejuvenating, the same may be akin to torture for a person living with dementia. Try to find a middle ground where a certain level of hygiene is maintained and unpleasantness is kept to a minimum.