‘The struggles with showering’: Support for Carers as dementia progresses

One of the greatest challenges facing caregivers of people in the latter phases of Alzheimer’s Disease or dementia is ensuring that their loved ones are regularly bathed.

Overtime if personal hygiene is not attended to regularly it can result in urinary tract infections, skin conditions and a variety of other health ailments.

However that said, showering a person with dementia at later stages for some is not always possible. With many caregivers finding this to be one of the most difficult tasks to negotiate.

Whilst showering is important, the person with dementia in some instances cannot not recognise this and leaving many family carers approaching the bathing process with dread because people with dementia often put up such resistance.

Below are five measures to help make the battle of showering process more enjoyable for their loved ones and for caregivers.

1. Recognise that people with dementia see things differently

People who have entered stage 5 or 6 of dementia often begin to view bathing as an unnecessary activity or an annoying disruption. Additionally, some people in the latter stages of dementia begin to resist the showering process due to one of the following reasons:

  • They experiences fears associated with the possibility of falling
  • Changes to the brain can cause an unpleasant sensation when water hits the skin
  • The person can feel a sense of embarrassment and vulnerability due to being unclothed
  • Loss of independence, stirring frustration and agitation or anger
  • Confused as to why someone needs to help them in the shower, when they believe they can do it themselves
  • Scared, which is demonstrated in a fight or flight response – to protect themselves

In addition to recognising these fears and feelings, caregivers must remember that they should not try to reason or argue with the person who have dementia, as their disease makes reasoning at this stage challenging.

2. Create a comfortable showering environment in advance

This step is critical to a safe and pleasant bathing experience. Before bringing the person into the showering area, a caregiver should ensure that the showering area is safe, secure and comfortable. Below are some simple ways of creating a safe and comfortable bathing environment:

  • Place a non-slip mat on the floor to help prevent falls
  • Ensure that the bathroom is warm and properly illuminated
  • Make sure that the area is free of sharp objects such as a razors, electric devices and clutter
  • Make sure that there are securely fastened handrails to assist them getting in and out of the shower
  • Gather towels, soap and clothing and have them ready in advance
  • Warm towels and washcloths in the dryer to enhance their comfort

3. Take steps to help the person maintain his or her privacy and dignity

As mentioned those will later stage dementia often dread the showering process because they feel uncomfortable being unclothed in front of other people or to them ‘strangers’. Whenever possible, the showering process should occur in a private bathing area away from the view of others or individuals walking in and out. Additionally, they may feel vulnerable and embarrassed about being disrobed often respond more positively to being bathed by a caregiver of the same gender. Finally, caregivers can deliberately place a warm moist towel across the person they are caring for’s shoulders and over the chest area to get the person accustomed to the feeling of moisture while simultaneously offering coverage of the person’s body.

4. Encourage the person to play an active role in the showering process

By inviting the person with dementia to participate in showering process where possible, the bathing process can become a bit less threatening. Which may mean getting them to wash their face and chest, or hold the hand held shower, with the carer leading the direction. As the caregiver you will know your loved ones capabilities better than anyone, where you think they can manage washing themselves then let them try. Whilst it’s important to give your loved one choice where possible, too many choices or asking too many questions can make them too distress. Some suggestion to help with including them in the showering process but not making them too overwhelmed is to ask the following:

  • Do you want this pink jumper or the blue one?

[Show them each item close up and speak clearly and at eye level]

  • Do you want this soap or that one?

[Only give two options and show them, anymore and it will be confusing, speak slowly and clearly at eye level]

Everyone is different and the above questions are only an example. The extent to which your loved one will be able to respond will depend on the individual. The key is to not ask open ended questions, give too many options, or ask them the question as you are walking away from them.

In addition to these questions, caregivers can involve their loved one by giving them an active role in the bathing process. For instance, caregivers can ask the person they are caring for to be in charge of holding the soap or the sponge. People can also choose their favourite towels or robes.

5) Slowly ease the person with dementia into the shower

There are measures that caregivers can take to help make the bathing process more pleasant for people with dementia. If the person resist going to the shower, you may like to try showering them straight after they have been to the toilet, where you start running the hot water and remind them how much they enjoy the warm water on their back. Watch the video below, for other suggestions also.

Clearly, the showering process can present a challenge to people with late stage dementia and their caregivers. We hope some of the suggestions provided help you or your family when showering someone with dementia.

Video:Teepa Snow demonstrating how to bath a patient with dementia

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