Finding the right balance between comfort and control is key for maintaining the hygiene of a loved one.
Maintaining hygiene for people with Alzheimer’s is one of the biggest challenges caregivers face. As dementia progresses, challenges may grow, too.
Although it is completely normal and understandable, becoming angry, frustrated or lost in sadness or thoughts of unfairness does little good. But maintaining a can-do, calm and upbeat attitude can go a long way. Don’t let the perfect become the enemy of the good, as the old saying goes.
Remember, even people with advanced memory loss continue to have wishes for privacy, dignity and a desire to avoid threat and physical discomfort.
Staying in the moment, demonstrating, humoring and rewarding progress all can advance the cause. With those points in mind, here are some hints for the nitty-gritty tasks. Others can be found at alz.org or healthinaging.org, where you can also sign up for helpful e-newsletters and access tools like an online support community.
A person with Alzheimer’s may become more resistant to bathing over time as she or he forgets the reason for bathing and becomes more sensitive to discomfort and lack of privacy. Try to adjust your level of assistance to the person’s needs: encouraging independence if possible, assisting only as necessary.
Have large towels, soap and shampoo close at hand and in unbreakable bottles. Pad the shower seat or tub surface with towels to make the cold less uncomfortable. Room temperature should not be cold, and always check water temperature to make sure it’s comfortable.
Make the bathroom safe. Install grab bars and bath seats, use non-skid mats, keep the bathroom floor dry, lower the thermostat on your water heater to prevent burns and keep sharp objects out of sight. Provide supervision for people with moderate to severe dementia at all times (by a familiar person of the same sex, if possible).
Encourage a sense of control. Give choices: bath or shower? What time of day to bathe? Keep the routine regular and coach the person for each step, encouraging her or him to help. You can guide hands with your own, or demonstrate on yourself.
Be gentle: avoid harsh scrubbing and pat dry. Attempt to get at easy-to-miss areas like skin folds and under breasts. Non-rinse soap products and non-stinging shampoo are helpful. Keep crease areas dry with cornstarch or powder.
As Alzheimer’s and other dementias progress, it becomes more likely that someone with these conditions will lose control of their bladder and bowels. An older adult may lose the ability to recognize when going to the bathroom is necessary, or forget where the bathroom is or how it functions.
To help with incontinence
Be calm and reassuring. Notice the frequency of accidents, and then remind the person to use the bathroom before that length of time is up. See if the person has ways to signal it’s time to go, such a pulling at clothing, making facial expressions or using certain words.
Set a schedule
Give the person plenty of time and privacy, if possible.
Be careful about withholding fluids (this can cause problems like dehydration), but consider reducing them before bedtime.
Clear the path to the bathroom, keep the door open and consider glow-in-the- dark tape to show the way. If nighttime is particularly problematic, consider a bedside commode or urinal.
Modify the bathroom to make it easy to use. A raised seat, grab bars and night lights are helpful.
Choose clothing that is easy to remove and to launder. Adult briefs and incontinence pads/sheets make life easier.
Dressing & grooming
It’s easy for a person with Alzheimer’s to become frustrated or even overwhelmed with choosing and putting on clothes. Again, remain calm, leave plenty of time and offer encouragement and clear instructions.
Lay out clothes or hand them in the order they should be put on. Offer a maximum of two choices. Clothes should be easy to get into (Velcro is great), comfortable, and loose- fitting. If the person wants to wear the same thing all the time, get duplicates or things that resemble each other. Aim for clean underwear. Choose comfortable supportive, non-skid shoes. Help to choose outerwear appropriate for the weather.
Demonstrate how to comb hair. Use familiar toiletries and makeup. Substitute nail files for clippers and electric shavers for hand razors. Guide hands as needed.
Maintain familiar activities like trips to the hairdresser, and seek home services, if available.
As a caregiver for a person with Alzheimer’s, you are on a hero’s journey. Reward yourself for each accomplishment, know that you can make a big difference in a person’s life and take care of yourself, too.
Patricia Bloom, MD, and Harrison Bloom, MD, both are geriatricians and dementia care experts at the Mount Sinai Department of Geriatrics in New York City, and authors of Get Up and Move Your A**! A Light-Hearted But Serious Guide to Successful Aging. Find them online at doctorsbloom.com
“Maintaining a can-do, calm and upbeat attitude can go a long way.”