Have you ever come across a toddler who throws a tantrum every time you take her to bathe. Chances are we all have. And similarly, if you have an elderly loved one in your family who is suffering from dementia, you must have experienced the same behavior from that person.
In general, as a family member or a caregiver, you would know that there are times when dementia patients do not cooperate in doing any of the daily activities, be it brushing, eating or even sleeping. But the activity that they try and ignore most, is bathing. And there are enough reasons for it.
Dementia patients often experience bouts of psychological issues like feeling suspicious of individuals or things around them, feel a sense of confusion about the surroundings or even in completing relatively simple daily activities. They lack motivation and initiative to complete any task and may suffer from periods of demoralizing sadness or depression. You should always dissociate the person from the behavior and try to place yourself in the patient’s shoes. You must acknowledge that anybody with the above problems, and most likely in some form of physical pain too, is likely to be agitated and non-cooperative.
Why Do Dementia Patients Not Like Bathing
- Aquaphobia – Dementia patients have different levels of aquaphobia and in general are in fear of anything which is not properly visible or cannot be felt by any other sensory perception but touch. It is distressing for them under the shower as they cannot ‘see’ the water that is falling on or hitting their head. And like a small child, if you turn on the shower in the bathtub, you will find that the patient will immediately cringe from the water and stand in a corner of the bathtub, unable to brave the water on her head.
- Lack of privacy – There will be a stage in every dementia inflicted patient when she will not be able to take a bath herself; however, the presence of the care giver and the consequent lack of privacy will bother her. There is bound to be a lot of hesitation in these cases.
- Confusion – In later stage of dementia, patients often do not understand why they need to take a bath or if water is required to take bath or if clothes need to be removed during a bath. Therefore, it is likely that you will face a lot of resistance while trying to give her a bath.
- General discomfort – It may also happen that your patient is just not comfortable with the bathroom temperature (which may be too cold for comfort) or the water temperature (again may be too cold or too hot) or skin irritation in water. Being uncomfortable due to these reasons for a series of baths, over time, will make the person avoid taking bath altogether.
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How Often Should an Elderly Dementia Patient Take a Bath
Given the above reasons, therefore, bathing an elderly dementia patient is challenging to say the least. Having said that, it is good practice to have a full bath at least 3 times a week, with sponge baths in between, if required.
While it varies with person to person and depends upon co-morbidity or associated conditions, any less frequency of bathing may result in skin irritation, unpleasant body odors or even skin infections.
It is important to note that the skin in the elderly becomes noticeably light and sensitive and more prone to abnormalities from lack of proper care.
How You Can Convince Your Patient to Take a Bath
Often you can draw a parallel between toddlers and the elderly suffering from dementia and use the same tactics to get them to bathe.
- Rewarding – If your patient loves to do anything or eat something, you may offer to do that activity or offer that snack, immediately after bathing. This will remove her attention from the arduous and often fearsome task of bathing to the activity that will follow and act as a motivation for her to bathe.
- Logic and argument (Yours, especially) will not work – Again, much like a toddler, your patient may fail to understand the benefits of bathing and keeping oneself in good hygiene in general. You will be extremely lucky if you are able to make them understand your argument. Instead, you should work on distracting tactics like making them think about a happy incident or activity that they did recently or that they will be doing after the bath. And then, again like a toddler, they may not listen to you, but they may obey somebody that they perceive as a stricter authority, like the doctor. Or they may just believe that doctor knows best. Simply saying that her doctor has ordered for an activity to get done, may make things easier for you.
- Finally, you should make the process as enjoyable as possible for your loved one, so that there is no build-up of mental dislike against bathing, over a period of time.
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Preparing for the Bath
As a care giver, you should be well prepared for bathing your patient, taking into consideration all past experiences of bathing that person and thinking through as much as possible about her comfort.
- Room temperature: First and foremost, you should ensure that the room temperature is warm enough for a comfortable bath. Elderly patients often feel more cold than normal people, so take care to get the room temperature to the optimal level, which may be bit warm for you, but just the right temperature for your patient.
- Water temperature: Depending on whether your patient prefers hand shower, static water in bath or head shower (least likely), you should keep the water temperature adjusted beforehand to reduce chances of a surprisingly hot or cold stream, which may unsettle your patient.
- Toiletries and large towels: This is an area where you need to learn your patient’s preferences. Whatever it may be, make sure that you are not using a high chemical strong soap or shampoo. The skin in the elderly would have seen a lot but is likely to be sensitive and prone to damage from harsh toiletries. Also, keep the bathroom well stocked with warm, fresh and large towels which are often very comfortable post bath to avoid chills.
- Accessories: This may include anything from soothing music to even bath toys (some patients feel secure in the presence of floating toy ducks). Always remember to ask if she needs anything else to be more comfortable.
Making Bath Time Less Stressful
Finally, when it is time to get on with the activity, you must follow a few things rigorously to make this activity free of anxiety for your patients and progressively easier for everybody, including you.
- Make a Routine and Stick to it: If you are constantly changing the time of bath, especially across times of the day like between morning and evening, this may thoroughly confuse your patient and make her extremely moody in some instances. It is important that you establish a clear and simple routine, which makes her easier to follow her life style and have a sense of what needs to be done at what time. You must remember that dementia patients also try to get on with life, it is just that they often are unable to make sense of the activities around them. Try to schedule bath times during that part of the day when the patient is generally at her best.
- Make the Patient Feel in Control: In intermediate levels of dementia, patients do have the tendency to revolt when they feel that their independence is under threat. To quell this fear, it is important that you always give the patient a choice in the way that she would like things to happen. For example, you would already know that she will prefer a hand-held shower, instead of a head shower. However, offering that choice between a hand held and head shower, makes the patient feel in control and more independent and self sufficient. Also, you should always encourage your patient to be as independent as possible and only offer your help in a subtle manner when you know that it is beyond her. Over time, you will build up unsaid smaller routines within every activity.
- Protect Dignity and Privacy: Your presence during bath time may confuse your patient and make her uncomfortable. She would not understand that she needs supervision. It is always a good idea to let patients retain a light top gown while bathing or they can be draped in a large towel. In case of the towel, you should remember to keep the towel warm, throughout the activity. This will protect their dignity and take away the discomfort which may have crept in due to the lack of privacy.
- Environment: Finally, it may be a good idea to sync the bathroom lighting and environment as much as possible with the patient’s room. This will take away any feeling of anxiety due to stepping away from the comfort zone of her room. Always, make it a point to ask her whether she would want to listen to her favorite music or watch her favorite television show, which may help in soothing the anxiety around the activity of bathing.
Adaptive Bathroom Equipment
Depending on co-morbidity and other conditions that your dementia patient may be suffering from, adaptive bathroom equipment may make it more comfortable to take a bath in. Adaptive bathroom equipment can be any device like a shower chair or a bath lift which can be placed in the shower, an in-bed inflatable bathtub, or grab bar handles in the shower or bathtub which can act as supports during bathing. Consider investing in these equipment, if you think that it will simplify the process of bathing or make it safer for the patient.
In the extreme case where none of the above would work, and there will be such days, it is better to switch to a sponge bath. However, you should be careful to do this as an exception rather than the rule. For you, as a caregiver, only one thing is more difficult than bathing a dementia patient who does not want to take a bath – and that is giving a full bath to a dementia patient who has gotten used to sponge baths.
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Dementia-led peculiarities in behavior are challenging to handle and control. Having said that, a well trained care giver definitely makes it easier for the patient as well as for the family members. Every patient is different, however, a combination of the above may lead to bathing becoming a less stressful activity for your loved one. Well maintained hygiene, in turn, may have positive effects on other aspects of her life and may significantly delay the progress of dementia.