Getting an aging or ill loved one to bathe is a notorious battle that many family caregivers experience. When dementia is a part of this equation, it complicates things even further. There are any number of reasons why a senior with Alzheimer’s disease or another form of dementia may become resistant to showering as the disease progresses. Understanding the underlying causes can help family caregivers better navigate these issues and help their loved ones stay as clean, healthy and comfortable as possible.

How Often Should Seniors Bathe?

Because this is 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 different definitions of what constitutes cleanliness. Where I live in the High Plains, many seniors who are now in their 80s and 90s grew up with weekly baths, often because they lived out on remote farms and 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 who are used to showering more frequently, but a change of clothes each day or so and a weekly bath is usually enough for most elders who typically aren’t exerting themselves or getting dirty on a regular basis. However, if skin issues or incontinence are part of this equation, then more frequent bathing is crucial for preventing dangerous infections.

The priority is to find a frequency that is realistic for both you and your loved one and that will help them maintain their wellbeing. If you need some assistance with determining how often a senior should bathe, don’t hesitate to ask their primary care physician for advice. He or she should be able to provide a ballpark answer, discuss the risks (if any) of not maintaining personal hygiene and suggest alternatives to full showers or baths.

Memory Loss, Confusion and Fear

Determining a bathing schedule is probably the easiest part of trying to overcome a senior’s reluctance to get in the shower or tub. Symptoms of dementia can seriously derail a senior’s previously well-established personal care routine and make it impossible for their caregiver to assist them.

For example, memory loss can lead an elder to believe they have just showered when, in reality, they have not bathed in weeks. Or, they can become confused when they begin the multi-step process of bathing. Identifying all the different products in the bathroom and their specific uses can be overwhelming. Rather than informing someone they trust that they are confused and need assistance, many elders simply avoid bathing altogether.

Even more common in seniors with dementia is a fear of bathing. They can become afraid of the shower or bath because they feel unsteady on the slick surfaces and are worried about falling and getting hurt. They may be uncomfortable in the cold bathroom and become agitated by the sensation of water hitting their skin. In the later stages of the disease, a senior with dementia may not understand the task at hand at all. Think about how frightening it would be to have water pouring down on your head when you can’t figure out why it’s happening. Confusion, discomfort and lack of understanding are bound to lead to fear and resistance.

How to Help a Senior with Dementia Bathe

It can be very challenging to try to figure out what is going on in a loved one’s head when they are suffering from dementia. Each patient is unique, and it may take some trial and error to determine why they don’t want to bathe and what you can do to help encourage and comfort them during this process. The following insights address common issues that many dementia caregivers experience at some point in their journey. One or a combination of these tips and tricks may help you accomplish the task at hand.

  • Offer an incentive. If you feel that the reason a senior isn’t bathing is because they think they’ve already done it, or they just don’t see the importance of it, 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, try to warm it up before bath time. Turning on central heat for a short period or using a small space heater can make a huge difference in the temperature of the whole room, especially because seniors get cold more easily.
    If a shower is the best route to go for your loved one, be sure to install grab bars for extra stability when getting in and out of the stall. A comfortable shower chair and a hand-held shower head are worthwhile investments as well. The chair allows the senior to rest the entire time or as needed. The shower head keeps the water from continually coming down on the person’s head and allows a caregiver to carefully direct where the stream goes and when, minimizing discomfort and fear.
  • Consider sponge baths. If a senior’s dementia is so advanced that they’re adamant about avoiding the bathroom, 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 plan b or c must become plan a.
  • Communicate while helping the senior bathe. Whether you are assisting in the shower or giving a sponge bath, it’s important to announce each step before you do it. The senior may not understand exactly what you are saying, but it will help keep them calm and included in the process. Surprises can lead to agitation, anger and confusion. Describe your every 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 blanket.”
  • Respect the senior’s modesty. Many elderly people, like my modest mother-in-law, are understandably uncomfortable with the thought of someone else helping them bathe. My mother-in-law and I were great friends and she would let me do anything for her except give her a shower. We found that hiring a professional caregiver from a home care company to come and bathe her worked best. The aide who arrived for bath visits looked like a nurse in a hospital, which made the nudity more bearable for my mother-in-law. Another benefit is that professional caregivers should be well trained in this area. Ideally, bath aides from a reputable agency are experienced and able to do a more thorough job more quickly while following safety protocols.
    Regardless of who is assisting them, seniors are often more comfortable with the arrangement, both mentally and physically, if they can remain somewhat covered during the process. Many family caregivers have had success with keeping a robe or a towel draped on their loved ones and only 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 and a thorough cleansing with a bidet attachment or a peri bottle (perineal spray bottle) after toileting can help a senior remain fresh in between full showers and baths. Keeping a loved one’s private areas clean and dry is of utmost importance, so try to focus on this task above all.

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Depression Can Affect Personal Hygiene

Another issue that may contribute to a decline in bathing and grooming habits is depression. My mother was always a clean freak, and she loved her daily bath. 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 change in mental state was that she would put on the same set of clothes every day. Part of this was simply that she saw them laying on a chair and forgot that 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 elder, then you have a reason to be concerned.

My mother’s depression lifted as she adjusted to the nursing home, and I tried to hurry that process along by buying her some new clothes and making good use of the onsite 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 have 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 is wise to seek an appointment with their doctor.

Find a Healthy Compromise

Remember that a daily bath 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, fresh and well dressed? Or is all this fuss warranted because it’s best for their own health and comfort?

Yes, cleanliness is important for good health. While we may find a daily shower comforting and rejuvenating for ourselves, the same may be more akin to torture for a dementia patient. Try to find a middle ground so that a minimum level of hygiene is maintained along with a minimum amount of unpleasantness.