There are many reasons why a person with dementia might have difficulty carrying out their personal care. Dementia affects each person differently, and you also will react to the situation in a different way to someone else, so you will need to find an approach that suits you both.
It’s important to remember to encourage the person with dementia to continue to do as much as possible for themselves for as long as possible. This means things will take longer to get done, and may lead to frustration at times, however, it will help them to remain independent and feel better about themselves for longer.
Here are some of the reasons that bathing and dressing may be challenging, along with some possible solutions.
Washing and dressing are intimate, private activities. Many people may have never undressed in front of others before so may feel embarrassed or humiliated.
- Pull down the blinds or close curtains and doors to create a feeling of privacy.
- Cover mirrors if the person with dementia doesn’t recognise themselves and gets frightened.
- Give the person a lot of reassurance and be patient.
- If they are able to manage most of the task, help them only when necessary
- Provide encouragement and ensure the experience is a positive one by using soaps etc that the person likes.
Some older people, and especially those with dementia, feel the cold more and might be reluctant to undress. Noise, other people, bright lights and clutter in the room can also be distracting. They may not be used to bathing or showering each day.
- Make sure the room is warm and inviting
- Have enough lighting and make sure it’s the same brightness in all rooms. Soft background music may help create a calming and relaxing atmosphere.
- Try to stick with the person’s previous bathing routine, and/or time their bath or shower for the time of day they are most relaxed.
Getting undressed, having a wash and brushing teeth can be very complex tasks because of the many steps involved. Some people with dementia may have
a different perception of hot and cold water, and how water feels.
- Break down the tasks into simple steps and gently explain each step using simple, respectful language.
- Try offering limited choices, such as, “Would you like to have a bath or a shower?”
- Encourage the person to do as much as possible themselves.
- Lay out the soap, facecloth, towel and clean clothes in the sequence you will need them, making sure they are all within easy reach.
- Let the person with dementia feel the water before getting into the bath or shower. Sometimes gently pouring water over their hands reassures them the water isn’t too hot.
- Saying something like, “The water feels nice” or “This feels good” can also be reassuring and calming.
They may be unable to gauge the depth or temperature of the water so are frightened to step into it, or may be worried they will fall. They may fear drowning, particularly if water is being poured over their head. Depression or a physical illness can cause a loss of interest in personal hygiene. They may now have problems with balance or walking, or with their eyesight, or have trouble fastening buttons or closing a zip. The side effects of some drugs can also cause dizziness or stiff joints.
- Some people prefer smaller or deeper baths – check what the person with dementia prefers.
- Allow plenty of time for the bath and encourage them to do as much as they can for themselves.
- Prepare the bath ahead of time.
- Install a hand-held shower and grab rails.
- Try separating hair washing from bathing. Some people with dementia associate bathing with having their hair washed and become upset because it
frightens them to have water poured over their head.
- Washing their hair from a basin rather than a bath or shower may be a better option.
- Organise for the person with dementia to have a thorough medical examination to find any possible physical or medical reasons contributing to any challenges while dressing, their vision or glasses prescription checked and an evaluation for depression.
Some people with dementia can’t remember whether they are getting dressed or undressed. They may know they are holding a piece of clothing but can’t remember which part of the body it goes on.
They may forget to change their clothes, put them on in the wrong order or put on too many layers.
- Try using the ‘task breakdown’ technique to separate the task into simple, manageable steps and do them one step at a time.
- You may have to gently remind the person about each step, or do several of the steps yourself.
- Give them reassurance and praise for each successful step – this will make both of you feel more positive.
- Put out the clothes in a pile with the first item to be put on at the top.
- Try laying out lightly coloured clothing on a dark bedspread – the contrasting colours may help them see the clothes if they are having eyesight issues.
- Put away distracting things, such as out-of-season clothes.
It’s important to encourage a person with dementia to choose their own clothes, although it might be difficult for them to make even simple decisions.
- Simplify the number of choices – offer two outfits to choose between, or a choice such as between “a white or blue shirt”.
- Take inappropriate or out-of-season clothes away from the dressing area.
Some people with dementia find it hard to judge hot and cold weather.
- If the extra clothes aren’t causing them any problems, it’s probably easier to leave well alone.
- Pack away extra clothing so it’s not visible and put out only what’s appropriate to wear.
It’s important to maintain the person’s individual style as much as possible. Everyone has their own style of dressing and buying new clothes that are very different from how they used to dress may cause problems.
- Choose clothing that’s easily washable and doesn’t need ironing.
- For some people, buttons, snaps, hooks, zippers and belt buckles are too difficult to manage, so maybe replace them with Velcro tape.
- Busy, bright patterns on clothes can be distracting – choose clothes with simple patterns and with solid contrasting colours because these tend to be easier to see.
- Slip-on shoes are easier to put on – make sure shoes have non-skid soles.
In the past, many people didn’t change their clothes as often as we tend to today, so the person you are caring for may want to wear their clothes beyond the time you believe they should be in the wash.
- Rather than arguing, think about buying a couple of the same outfits so the person still has the comfort of wearing familiar clothes.
- Tactfully take the dirty clothes at the end of the day and put down clean clothes in their place.
- Compliment the person on their appearance when they are wearing clean clothes.
- Being reminded to change your clothes can be an embarrassing and humiliating experience, so choose your words carefully when suggesting they change.
- Even if the person with dementia does want to wear the same clothes, encourage them to dress themselves as much as possible because keeping their independence builds up their pride and self-esteem.