Bathing the Alzheimer's Patient

Bathing a patient with Alzheimer's or dementia is often a difficult task for the caregiver. Here are some suggestions.

For most adults, washing is a personal and private activity. When you are helping someone with Alzheimer's to wash, it's important to be sensitive and tactful, and to respect their dignity. A few simple considerations can help to ensure that washing and bathing remains a relaxing experience for both of you.

Personal care, including washing and bathing, is a common source of anxiety for people with Alzheimer's and their caregivers. It's not hard to understand why - most of us have been carrying out these activities on our own since we were small children.

There are some particularly common reasons for anxiety among people with Alzheimer's, including:

• 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.
• 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. A matter-of-fact approach, or humor, may work well. Adopt an approach that fits with the nature of your relationship with the person.
• Self-consciousness
  The person with Alzheimer's may find it embarrassing to be undressed in your presence. 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

Talk to the person about how you feel about bathing them. 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. Here are some practical tips.

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Encouraging independence

We all have our own routines for personal care - particularly when we get up in the morning. Try to encourage the person with Alzheimer's 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?

If the person seems confused, it can help if you break the process down into small stages. When someone's nerve pathways are damaged, it becomes harder for them to process a lot of information at once.

• Offer tactful reminders about which step comes next in their process of personal hygiene.
• 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.

Safety precautions

There are some very practical considerations when someone with Alzheimer's is using the bathroom:

• Check that the floor is not slippery.
• Make sure that the room is warm before the person undresses. Older people are more sensitive to heat and cold than younger people.
• 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 color 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 outside. Someone with Alzheimer's may lock themselves in and panic, or they may go into the bathroom and then forget why they went in.
• 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. Information about this sort of equipment is available from an occupational therapist, who you can contact through your 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, attached to the wall near the shower, washbasin or toilet
• Non-slip mats in the bath or shower
• Seats to go in the bath or shower
• Raised toilet seats.

Washing hair and Alzheimer's

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, you need to balance the advantages of clean hair against the disadvantages of creating tension between you and the person you are caring for.

• If you are washing the person's hair yourself, a hand-held shower may work best.
• If the person prefers to have their hair washed by a hairdresser, either arrange regular trips to the hairdresser, or you may be able to find a hairdresser who will come to the house.

Using the toilet and Alzheimer's

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.

• Wiping from front to back, rather than back to front, helps to prevent infection.
• Moist toilet tissues, obtainable from any chemist, are useful if the person has had an accident.

When someone is reluctant to wash and Alzheimer's

If the person with Alzheimer's doesn't want to wash, try to remain calm and find a way to cope that does not involve confrontation. It's not the end of the world if they don't shower every day. Everyone has different standards of hygiene; you may prefer to bathe every day, but they might have different ideas about cleanliness. Think about what their routine was like before they had Alzheimer's, and encourage them to maintain that level of cleanliness.

• 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. This doesn't necessarily mean that they are being difficult - it may relate to the damage that has been caused to the nerve pathways in the brain.
• 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 distress, a strip wash 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.

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The bottom line

Washing is a matter of personal choice. However, washing is not just about smelling fresh and looking well-kempt. 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 where you will need to put your foot down.

• Make sure the person washes their hands before eating or handling food and after using the toilet.
• Bottoms and genitals should be washed every day to prevent infection.
• Faces should be washed every day to keep the skin clear.
• The person should bathe or shower at least twice a week.
• Teeth need to be cleaned twice a day to prevent cavities

Helping someone wash: useful tips

• 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.
• 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 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 Alzheimer's.
• Being organized can help reduce stress. Try to make sure you have everything you need ready to hand before you start.
• While the person is undressed, check for any red or sore areas. If you notice anything you're concerned about, mention it to your district nurse or GP.
• Make sure the person is thoroughly dried, especially in the skin folds. This will prevent the skin from becoming chafed.

Source:

• Alzheimer's Society - UK, Carers' Advice Sheet 504, Nov. 2005.

next: Dressing the Alzheimer's Patien