Hello everyone, I'm fairly new to caregiving and new to this site. My mother in law (85) who lives with me and my husband has been diagnosed with dementia, ocd and other conditions. She is somewhat bilingual, however she has very little comprehension in either language.
Our unique problem is that she demands to shower everyday. Her showers last for a full 2 hours (she turns water on and off). She has for the last 3 months suddenly become aware of her hair follicles and says its dirt. Its gotten to the point of that she is literally scrubbing the hair off of her head. She is almost bald on the sides of her head. We have taken her to the doctor. No sign of bacteria, skin conditions other than she is going bald on the areas she rubs the hair off. We have tried to get her to shower less, lessen the time in the shower etc. She becomes like in a trance and cannot stop scrubbing. She will get very agitated and a few time violent when we try to gently stop her from rubbing her hair off ( she also is rubbing skin off on her legs and face in the shower).
Can anybody recommend a soft wash mitts that can't be taken off in the shower that can be used on a daily basis? I was thinking if she can't use her fingers to rub her hair and skin off she can take her long showers, We just don't want her harming herself. I'm thinking if her fingers can't feel the hair follicles it will stop the behavior.
She also has become aware that her skin feels different on her face and is rubbing that to the point of rubbing skin off. This happens throughout the day. I bought her stress balls and fidget toys to keep her hands busy.
I appreciate everyone who has taken the time to read and I am hoping someone can help me with advice, ideas really anything as I am someone stressed out on a daily basis.
Much respect to all who have been and are current caregivers.
Has she been dxed with dementia? Good thing to look into.
As far as some soft mitts to wear, I'd just hit google or Amazon and start looking for some very soft gloves or mitts for showers. And make sure she has extremely gentle soaps and body washes. After these epic showers (!) make sure she has access to a very hydrating body lotion.
The problem is mental--lack of basic knowledge. She likely won't get that back, so stop trying to 'change' what is now the new norm.
I think a gentle sedative to calm her down, maybe some music playing while she showers, and calm, gentle voices helping her to not over clean could help.
There are such devices like protective the protective mitts that a person cannot remove themselves that prevent them from hurting themselves. I had a homecare client who had to wear the mitts all the time. They were ordered online for around 30 dollars. Before my client's family were willing to spend the money and order the protective mitts, we were using oven mitts secured with duct tape that were removed for periods of time like when she was washed and fed.
I'm going to assume that since she's mostly non-verbal that her dementia is at a point where she can't shower herself unassisted. Is she still mobile? If not then stop showering her daily. A good sponge bath will be enough. For now what you will have to start doing is shut the water off after you've adequately cleaned her up. No more two hours in the shower. She will probably become agitated and upset but that will be far easier on her than how she's harming herself now.
Her doctor may be able to prescribe medications to help with her agitation. Order the protective mitts though. She won't have to be in the mitts 24 hours a day. You can keep them off until she starts picking at her hair and skin. Then put them back on. The protective mitts will be a godsend for you both.
The water supply can be adjusted or even turned off at a certain point.
There are medications for OCD behaviors. Ask the doctor.
An alarm can be set across the room from the shower, so she must get out to turn it off.
Supervised or assisted showering may be necessary now. Interrupt, redirect her thought process in a nice creative way.
You will need to find a way to refuse her demands for daily showers and to close off the bathroom that contains a shower or a tub, and either have her use a potty chair or a water closet where she cannot see a shower stall. Long periods of time in water contributes heavily to dry skin and increases the urge to pick and scratch, etc. It's not recommended for a dementia sufferer to bathe more than 3x per week at most.
And even still, this only addresses the behavior that goes on while bathing. There is still the other behaviors that go on while she's not bathing that will destroy her skin. Call the doctor to see if medication can be prescribed to curb the OCD that's compelling her to rub & scratch, etc. Expecting her to wear mitts is unrealistic as it's likely she will immediately remove them! Dementia sufferers are very unhappy wearing ANY extra items on their bodies.
Placement for your MIL would solve the issue of bathing for hours on end b/c it would not be permitted in a managed care environment. It would not, however, solve the other behaviors that she is exhibiting. Ask the doctor what he recommends (in addition to medication) if he is experienced with dementia behaviors in general. If not, I would find a new doctor who is.
When dementia reaches a certain stage, 24 hour per day supervision in managed care (usually) becomes a requirement. You may want to look into Memory Care or Skilled Nursing at this point.
Here is a Google link to 'scratching & rubbing compulsively' that will give you a lot of reading material to look over:
https://www.google.com/search?q=scratching+%26+rubbing+compulsively+with+dementia&rlz=1C1CHBD_enUS896US896&oq=scratching+%26+rubbing+compulsively+with+dementia&aqs=chrome..69i57j33i10i160.13886j1j7&sourceid=chrome&ie=UTF-8
Wishing you the best of luck with a very difficult situation.
I would try to shorten the bathing process since she is probably drying her skin out the the point of it becoming itchy. Try supervising the bath and when she is done, get her to dry off and spend more time applying a mild, creamy lotion to her body. There are leave in conditioners for her hair that may help the skin on her head to feel better.
If she is tending to irritate her skin outside of bath time, try giving her more lotion to apply during those times. Also consider distraction techniques to get her to focus on other activities throughout the day. Some people have found success with a mild anti-anxiety medication to relieve the sypmptoms.
He gets sponge baths now so no problems in the shower.
I would just set a timer for 10 minutes and cut the water off.
It's just going to dry out her skin.
My Dad seem to stop scratching and picking when I applied organuc coconut oil all over every day.
Old peoples skin gets really dry and itches and taking long showers every day makes it worse.
If she's bald on one side and thinks her hair is dirt, shave her head and she won't feel any more dirt, just a smooth head.
Mare sure you put coconut oil all on her arms, face, ect whatever area she picks at. Tell her it's medicine.
My Dad seemed to pick less when the coconut oil is applied.
I believe the less meds the better.
My 96 yr old Dad isn't on any meds unless he gets a UTI which is a urinary infection from his cathiter.
The only meds I would consider is pain meds if he ever gets in pain.
MEd's just causes other side effects which makes you have to take more meds which causes more side effects...just a vicious cycle..
Play soothing music for her.
GI've her things to do, even helping you fold a hand towel, my dad likes to do that only he gets tired after finding one.
Give her a nice foot massage, my dad loves them and it puts him right to sleep.
Last stage Caregiving is very hard and can drive you crazy but try to treat them how you would want to be treated.
Remember it's not forever.
When loved one passes away,, you will know you did all you could and have no regrets..
Prayers
Prayers
Usually there is a shut off valve that would be in the room, but might not be easily accessible (this house did NOT have any, so while refurbishing I am having them added.)
IF she is showering and is relatively clean (10-15 min?), have your husband shut off the main water supply to the house. No more water, perhaps she can be coaxed out to dry and be done. Shutting off the water heater suggested by someone could take too long to end the shower and would take too much energy and time to heat up again!
This link has some information about this type of condition (Dermatillomania):
https://www.theadvocate.com/baton_rouge/entertainment_life/health_fitness/article_d3c5034c-91d2-11e8-bfd4-0f91075018f9.html
This link has some information AND some non-prescription treatments:
https://www.alzheimerslab.com/skin-picking-in-alzheimers-patients/
The "natural" treatments will NOT treat the underlying disorder. This one does mention how this is an OCD behavior and because of dementia the normal "therapy" session isn't going to change anything. I don't like using medications if there is a more natural way around treatment, but in this case, she IS going to end up with some serious issues. Shaving her hair off might help with the scalp, but not with her skin. She could start on the other hair follicles. The fidget items are suggested, as are gloves, but they will only work for a while, if she will even comply. My mother didn't have this condition, however she DID bruise her shin and developed cellulitis.
https://www.mayoclinic.org/diseases-conditions/cellulitis/symptoms-causes/syc-20370762#:~:text=Cellulitis%20(sel%2Du%2DLIE,face%2C%20arms%20and%20other%20areas.
"Cellulitis usually affects the skin on the lower legs, but it can occur in the face, arms and other areas. It occurs when a crack or break in your skin allows bacteria to enter.
Left untreated, the infection can spread to your lymph nodes and bloodstream and rapidly become life-threatening."
Because mom never said anything, we don't know how long it festered, but it took TWO rounds of antibiotics, wound care and compression stocking.
Since your MIL is elderly and damaging her skin, she could end up developing cellulitis or other infection. The older we get, the thinner and more sensitive our skin is. With her constantly abrading her scalp and face, I would discuss with her doctor and consider some kind of anti-anxiety medication. When my mother was moved to MC, they used Lorazepam, mildest dose, during the transition. I managed her meds and finances, so I know it was not refilled. Later she used it again due to UTI-induced sun-downing. Mildest dose both times. During the second round, I was able to observe her, being there various times of the day. She was never "doped" up or drowsy, it was just enough to take the "edge" off. The other nice things about this medication is it worked first time, every time and we didn't have to wean her off of it when it was no longer needed.
This link discusses some of the issues, including cellulitis and medication:
https://www.healthline.com/health/picking-scabs#takeaway
Summary:
Try to cut the showers down to 15-20 m by shutting the main water off.
Perhaps try to limit the showers to every other day.
Consult with her doctor regarding an anti-anxiety medication.
Try some of the "natural" treatments on her skin.
Consider shaving her head.
Continue using any "fidget" items, introduce more.
Perhaps try some "busy" activities, like folding towels, when done, give more!
Consider mitts, but don't force the issue.
Be VERY aware of infections.
Good luck to your mother in law.