Although it can be quite common for people with dementia to forget about personal care and hygiene, it is one area where you, as their carer, will have to be diligent as well as patient.
The area of personal care and hygiene is very different for each person. It is certainly not a “one size fits all” scenario. As a carer, if you remember this it may alleviate some of the anxiety and frustration that seem to surround these tasks.
The Good Old Days
Understanding the cause of the anxiety or resistance to a task will help you implement strategies that may assist when caring for someone with dementia.
Ask your client, if able, or a close family member about their personal care habits in the past. For many older people having a shower on only a few days a week was a normal part of their routine. Find out if they usually wash or shower in the mornings or evenings and, if feasible, stick to that time of the day, or as close as possible.
If they seem to have a genuine fear of the shower, ask them to sit in a chair and use a handheld shower; some people can feel as if they are drowning when water is running over their head. Try using the small basin to wash with instead of having the shower water running constantly.
Setting the Scene
Make sure that you have gathered all the items you need and have them within easy reach. If you have to constantly leave the room to gather towels or toiletries your client may become confused or anxious.
Personal care is private. To make this time more pleasurable for your client there are things that you can do with the environment. Make sure that the bathroom is not too cold or too hot. Ensure that there is adequate lighting, as older people have a tendency to be afraid of falling. If your client enjoys music try playing some soft music in the background to create a calm atmosphere.
Make sure that you have gathered all the items you need and have them within easy reach. If you have to constantly leave the room to gather towels or toiletries your client may become confused or anxious. Handing items, such as soap or facewashes, to clients at the appropriate time may help overcome discomfort or embarrassment.
Draw the blinds and keep the door partially closed to ensure privacy.
Use rubber mats to prevent slipping and make sure that the floor surface is not slippery. If there are locks on the door make sure that they are accessible from the outside in case of emergency. Do not store any cleaning fluids in the bathroom and have a temperature control on the water tap in the shower.
If your client is taking a bath, do not have the water too deep; people with dementia quite often have a lack of depth perception and the water will seem like an enormous lake. Similarly, if using a shower chair do not have a white chair in a white bathroom as they will feel like they are going to sit in a deep hole.
Tools of the Trade
After washing you may have to help with shaving, oral care, hair and dressing. It is important to encourage independence with your client and it may take a few simple prompts to help your client start the action. An electric shaver for men is often easier (and safer) to use than razor blades. Remember, though, that for some people the sound of the electric shaver may be frightening.
If you need to assist with shaving or oral care, try standing or sitting next to the person in front of the mirror. Place the shaver or toothbrush in their hand, gently put your hand over theirs and guide them through the first motions. Placing your free hand on their other shoulder will give them reassurance and not be so confrontational. Remember whether they are right- or left-handed.
Having suitable equipment will help make the tasks easier. Shower chairs, grab rails and handheld showers are just some of the aids that can assist. Occupational therapists can help assess what equipment may be right for your client.
All’s Well that Ends Well
Deciding on which strategies will help when caring for a person with dementia may involve a number of people. As I mentioned earlier, discussing with your client (if able) what they are familiar with will help to reduce anxiety. If this is not possible, talking to a close family member or partner may be useful. Occupational therapists can assist with safety items and equipment.
People with dementia can easily become confused and overwhelmed, so breaking the task down into smaller, simpler steps may be helpful. Have confidence with the task at hand and approach the person with reassurance and patience.
Remember, there is no “One size fits all” solution, so be flexible; if no amount of cajoling is working when you need to wash someone’s hair, maybe a trip to the hairdresser will do the trick…..after all, who wouldn’t like that!
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Susan Tredenick is a healthcare consultant with extensive experience in aged and community care. Operating in a range of industries, including Not-for-Profit, NGO and Private companies, she has a special interest in supporting people to be engaged with their healthcare management. Working with innovative companies allows this to be a reality as well as develop her interest in delivering speaking engagements to the community. With a background in nursing and management, her career includes roles in clinical and case management as well as project management with Telehealth and Telecare Research.