Dementia and personal hygiene

It is quite common for people with dementia to forget about, or lose interest in, personal hygiene. They may neglect basic activities such as bathing and changing their clothes. This can be perplexing and upsetting for a carer. Understanding the cause can help you decide which strategies may be helpful when caring for a person with dementia.

There are a number of things you can try to help the person manage their hygiene. Try to work out ways of coping without argument or confrontation. Approaching the person with reassurance and patience can help overcome obstacles.

Lack of privacy

Washing and dressing are intimate, private activities. Many people have never undressed in front of others and may be embarrassed or humiliated by their need for assistance. They may feel particularly embarrassed if they are incontinent and may refuse to bathe or change their clothes to try to disguise the problem.

Things you can try include:

• Pull down blinds or close curtains and doors to create a feeling of privacy.
• Cover mirrors if the person doesn’t recognise themselves.
• Approach the person with a great deal of reassurance and patience.

Environment

The person may feel uncomfortable. The room may be too hot or cold, too dark or may produce feelings of claustrophobia.

Things you can try include:

• Make sure that the bathroom is warm enough and inviting.
• Provide adequate lighting in the bathroom, especially during evening hours.
• It may be helpful to play soft music in the background to create a calming and relaxing atmosphere.

Routine

The person may not be used to bathing or showering daily. In past times, many people did not bathe as often as they do today. It is important that you do not impose your own values about how often the person should bathe.

Things you can try include:

• Choose the best time of the day for bathing. Try to match the person’s bathing routine before the onset of the disease.
• Consider the time of day when the person is most relaxed and the type of bathing – bath, shower, sponge bath – with which they are familiar.

Task is too confusing or complicated

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 changed sense of perception of hot and cold water, caused by damage to the region of the brain that regulates their ‘internal thermostat’. They may also feel a different sensation from water.

Things you can try include:

• Break down the tasks into simple steps, gently explaining each step. Use simple, respectful language.
• Try offering the person limited choices – for example: ‘Would you like to have a bath or a shower?’ or ‘Would you like to have your bath now or before going to bed?’
• Let the person feel the water before getting into the bath. Sometimes gently pouring water over their hands reassures the person that the water isn’t too hot. Saying something like ‘The water feels nice’ or ‘This feels good’ is also reassuring and calming.
• Encourage the person to do as much as possible themselves.
• Lay out the soap, washcloth, towel and clean clothes in sequence so that the person with dementia can use them as needed.

Fears

Fear of water can sometimes be a problem. The person may not be able to gauge the depth or temperature of the water and will then be frightened to step into it. Fear of falling may be another problem. Feeling out of control and powerless may add to a person being uncooperative with bathing.

Things you can try include:

• Prepare the bath ahead of time. Check the water level. Some people prefer only a small amount of water in the bath, while others prefer more.
• Try separating hair washing from bathing. Some people with dementia associate bathing with having their hair washed and become upset because water being poured over their head frightens them.
• Allow plenty of time and encouragement to help the person to maintain their skills.
• Install a hand-held shower. Installation is very easy.
• Special bathroom fittings, such as rails, can make bathing easier. The Independent Living Centre can provide advice.

Other hygiene issues

There is a range of other things you can try to help a person with dementia manage their hygiene.

• Toileting – the person may need help with toileting. Make sure that they are clean and dry, and that underwear is changed as needed. If incontinence is a problem, make sure that they are washed carefully with warm water and dried thoroughly before putting on clean clothes.
• Shaving – at first, carers may simply need to remind the person with dementia to shave each day. If they have been used to an electric razor, they will probably be able to continue to shave without supervision for longer and so maintain their independence. If they are used to a traditional razor and begin to cut themselves often, carers will need to supervise shaving or may even need to do it for them.
• Changing clothes – changing clothes is important for hygiene and personal freshness. Encourage the person to change regularly. It may mean tactfully removing dirty clothes at the end of the day and substituting clean ones. Try to choose clothes that wash easily and need little ironing to lighten the workload. Everyone enjoys being complimented on their appearance, especially when wearing new clothes or with a new haircut. It is important that the person with dementia has this experience as well.
• Dental care – regular visits to the dentist to check on teeth, gums or dentures are very important. It is always worth advising the dentist that the person has dementia when you make the appointment and that they may not be able to cooperate. As a carer, you may need to remind the person to clean his or her teeth, or even do it for him or her.
• Fingernails and toenails – a person with dementia may forget about, or have difficulty, cutting their nails. It is important that this is done regularly as uncut nails can lead to problems. It may be useful to enlist the services of a podiatrist. Consider whether the person enjoys having their nails painted and manicured.
• Hair – the carer may need to spend time finding a way to wash hair that is comfortable and acceptable to the person with dementia. Some people can become very distressed by having their hair washed. A visit to the hairdresser or a hairdresser coming to the home maybe a better alternative. Many people with dementia continue to enjoy having their hair cut and styled and this can continue to be a pleasurable experience.

Equipment and support

Dealing with dementia-related behaviours day in and day out is not easy. It is essential that you seek support for yourself from an understanding family member, a friend, a professional or a support group. Remember that you are not alone. Alzheimer’s Australia offers support, information, education and counselling through the National Dementia Helpline.
The Dementia Behaviour Management Advisory Service (DBMAS) is a national telephone advisory service established to support carers and care workers of people with dementia who experience dementia-related behaviours. Telephone advice, assessment, intervention, education and specialised support are available 24 hours a day.

The Independent Living Centre in each State and Territory offers a number of services designed to promote safe living. Information is available on products to assist with personal hygiene including hot water services and temperature regulators. Advice is also available on home modifications and home design. Contact numbers can be obtained from the phone book or by contacting Alzheimer’s Australia.

Where to get help

• Your doctor
• Your local community health service
• Your local council
• National Dementia Helpline Tel. 1800 100 500
• The Independent Living Centre in your State or Territory
• National Dementia Behaviour Management Advisory Service Tel. 1800 699 799 – for telephone advice, assessment, intervention, education and specialised support (24 hours)
• Commonwealth Carer Respite Centres Tel. 1800 059 059
• Carer Resource Centres Tel. 1800 242 636
• Aged Care Information Line Tel. 1800 500 853

Things to remember

• It is quite common for people with dementia to forget about, or lose interest in, bathing and changing their clothes.
• Understanding the cause can help carers decide which strategies may be helpful.
• There are things you can try to help a person with dementia manage their hygiene.
• Approaching the person with reassurance and patience can help overcome obstacles to hygiene.

You might also be interested in:

• Dementia.
  
• Dementia - caring for someone who lives alone.
  
• Dementia - changed behaviours.
  
• Dementia - communication issues.
  
• Dementia - different types.
  
• Dementia - early planning will help.
  
• Dementia - how carers can help with dressing.
  
• Dementia - managing incontinence.
  
• Dementia - safety issues.
  
• Dementia - support services are available.
  
• Dementia - through all its stages.
  
• Incontinence and continence problems.
  
• Personal hygiene.
  

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Alzheimer's Australia Victoria

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Last reviewed: May 2012

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Dementia can cause a change in personal hygiene habits. People may forget to wash or change their clothes, or they may forget how to keep clean. Carers may find this stressful but different strategies can help. A person with dementia may need help with going to the toilet, getting dressed, brushing their teeth and grooming hair and nails.

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your qualified health professional. Content has been prepared for Victorian residence and wider Australian audiences, and was accurate at the time of publication. Readers should note that over time currency and completeness of the information may change. All users are urged to always seek advice from a qualified health care professional for diagnosis and answers to their medical questions.

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