Home Helpers Senior Care Services Blog

The Bathing Challenges of Dementia

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If you are caring for a loved one with Alzheimer’s or dementia, you may find it increasingly difficult to keep up with their personal hygiene.  One of the biggest areas of concern that our clients’ loved ones have is the challenge of bathing.

Jumping in the shower may seem routine to you, but for someone with dementia, the experience can be quite the opposite. It’s very common for people with dementia to forget about, or even lose interest in bathing and changing their clothes. Understanding the cause may better help you determine your approach:

Lack Of Privacy
Many seniors were raised to think that washing and dressing should be intimate, private activities. Some have never dressed or undressed in front of others, which may lead to embarrassment or humiliation. They may refuse to change or bathe in front of others so they can hide incontinence issues.

• Pull down blinds, cover mirrors, and make sure the door is closed for added privacy.
• Approach the person with understanding and reassurance.
•  Place a towel over the genitals and simply lift for washing if the person is uncomfortable with nudity.
•  After washing, position towels over the person's lap and on the back of the wet shower chair for comfort and dignity.
• Keep them covered while you dress their top half first.

Environment
Remember that with dementia, your loved one’s depth perceptions may change, making them feel uncomfortable in small, dark places.

• Make sure that the bathroom is warm, well-lit, and inviting.
• Soft music may help make the environment more relaxing.
• Remove unnecessary clutter. Multiple bottles of shampoos and conditioners may be confusing.
• Keep water at a consistent, comfortable temperature.
• The sensation of water hitting your loved one in the shower may be perceived as painful. Try using a handheld shower wand.
•  Spraying the head first can be frightening and cause an aggressive protective response. Start by showering the legs and move upwards to the chest and back.
• 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.

Routine
Remember that your loved one might not bathe as much as you do, nor do they need to. As people age, the body produces less oil, eliminating the need to shower every day. It is important that you do not impose your views about how often your loved one should bathe.

• Try to match your loved one’s bathing routine before the onset of dementia. If they always showered in the evening, set up an evening bathing schedule.
• Consider the time of day when your loved one is most relaxed and not exhausted.

Tasks are too complicated or confusing
Personal care (bathing, dressing, oral care) can be very confusing and complex with all of the steps involved.

• Break down each task into simple steps, while explaining each step. Use simple, respectful language.
• Try offering the person limited choices.
• Let your loved one feel the water before getting into the shower. Saying things like “The water feels nice” or “This feels so good”, can be reassuring and calming.
• Encourage your loved one to do as much as possible.
• Lay out the soap, washcloth, towel and clean clothes in a sequence so your loved one can use them as needed.

Always remember that patience is key. If your loved one shows signs of agitation, take some time to step back and regroup. Move onto another activity for a few minutes, then try again. If all else fails, sponge baths can be an option.

For help and information, contact the Alzheimer’s Association.

Home Helpers’ caregivers are trained and experience with Alzheimer’s and dementia. If you feel that you can no longer care for your loved one on your own, click HERE to learn how we can help.

How Can I Distinguish Between a Senior Moment and a Cause for Concern?

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While most of us have probably lost our keys or misplaced something that was under our nose the whole time, a question many people have is, “Is there a reason to be concerned, or might it just be a Senior Moment?”

A challenge for many families is often determining at what point a change in behavior merits consideration, and when to pursue medical attention.

People often make statements such as “Dad’s going nuts,” or “Mom’s lost her mind,” and don’t recognize that treatments may be available to help a loved one. Dementia, depression and delirium are conditions that cause behavior changes, yet are often undiagnosed and untreated.

The incidence of all three conditions increase as people age. If you sense a change in a loved one’s behavior, encourage your loved one to undergo an assessment by his or her physician. To help health care professionals diagnose and treat a medical condition, it can be helpful to keep a journal of unusual behaviors and report any and all symptoms.

Let’s take a look at each of the three conditions:

DEMENTIA is a term that describes disorders that affect the functioning of one’s brain, and it is characterized by mental decline and impairment. Dementia and Alzheimer’s, a degenerative disorder of the brain, is reported to be the most common cause of dementia in older adults. The Alzheimer’s Association reports that “As many as 10% of all people 65 years of age and older have Alzheimer’s. As many as 50% of all people 85 and older have the disease.”

People with Alzheimer’s have dementia; however people with dementia don’t necessarily have Alzheimer’s. For example, people with chronic conditions such as Parkinson’s can have dementia. A common form of dementia is a condition referred to as Multi-Infarct, where blood flow is cut off from a certain part of the brain, resulting in permanent damage and loss of mental capacity.

People with dementia often have trouble with their ability to recall information, solve problems and speak. They may also act strange or seem moody. People with dementia often lose the ability to perform everyday tasks necessary to live independently. Another characteristic is an inability to make decisions or respond to questions.

DEPRESSION refers to a mood disorder that can affect both a person’s mind and body. While many people never seek treatment for depression, those who do often experience improvement over time. While everyone occasionally feels depressed or sad, depression is characterized by intense sadness that lasts for a period of two weeks or longer, and impacts a person’s ability to lead a normal life.

DELIRIUM is a cognitive or mental disorder, not a disease. Delirium appears suddenly, often within hours or days, and may come and go throughout the day. A person who is delirious may appear disoriented, exhibit varying levels of consciousness, have disorganized speech, and an inability to comprehend what’s being sad. Delirium can be frightening as a loved one acts unpredictably, is uncooperative and sometimes acts violently. With delirium, there is typically an underlying cause such as infection (commonly UTI’s in older adults), dehydration, physical illness, head injury, trauma, substance abuse, or a reaction to medications (e.g., prescription, over-the-counter, supplements). Once the cause is identified and treatment begins (e.g., changing medications, increasing fluids or treating infections), there is often a quick turn-around.

SEEK MEDICAL ATTENTION
If you notice a change in a loved one’s behavior, regardless if the change is sudden or gradual over time, seek medical attention. Health care professionals are likely to complete an assessment to rule out possible causes, make a diagnosis and determine treatment options. People who receive treatment often enjoy a better quality of life.

My Loved One Was Recently Diagnosed with Alzheimer's, Now What?

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Your loved one was recently diagnosed with Alzheimer’s disease and you’re probably wondering what you’re supposed to do now. 

It’s important to take some time to digest the information. Understand that your loved one’s Alzheimer’s may progress slowly, over time. You may have many good years ahead with your loved one. Take time to discuss what you both want to do to enjoy the time that you have together. 

After you’ve had time to come to terms with the diagnosis, it’s important to consider the following:

• How will relationships change with family, friends, and co-workers?
• How is your loved one coping with memory loss and changes?
• What is the impact of the diagnosis on your loved one’s career, family role, social engagement and/or finances?
• What is the impact of the diagnosis on your loved one’s ability to drive?
• What is the impact of the diagnosis on your loved one’s ability to work?

Do’s & Don’ts:

One of the best things you can do for you and your family is to get legal, financial and care plans in place. Doing so allows you to participate in making decisions and ensures your family won't be forced to make them for you in a crisis situation.

Plan for the future now!

For more information, visit the Alzheimer’s Association.

Click HERE for more information about Home Helpers.

My Loved One Wanders, What Can I do?

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According to the Alzheimer’s Association, 6 out of 10 people with Alzheimer’s disease will wander. As a caregiver, you may have experienced your loved one wondering away from you. Many people with Alzheimer’s disease wander from their caregiver or even their own home. You need to know how to prevent your loved one from wandering, as it may have dangerous and life threatening consequences. By following some important tips, you will help keep your loved one safe and give yourself peace of mind.

• Make sure that your loved one has some kind of identification on them at all times. The Alzheimer’s Association offers MedicAlert® + Safe Return®, which is a 24-hour nationwide emergency response service for individuals with Alzheimer’s or a related dementia who wander or have a medical emergency. For more information, visit www.alz.org/safereturn or call 1-888-572-8566
• Make neighbors and local police aware that your loved one with Alzheimer’s disease wanders.
• Keep an updated picture of your loved one.  Police will need to know what your loved one looks like if they are lost. Out of date driver’s license pictures may not be enough.
• Install door chimes on all doors that lead to an exit. This way, you’ll hear if your loved one leaves the house.
• Consider camouflaging doors. To short-circuit a compulsion to wander into off-limit rooms, you might place curtains over doors or camouflage doors with paint or wallpaper that matches the surrounding walls. A mirror or a stop sign on the door might help, too.
• Plan activities and distractions. If you notice that your loved one wanders at certain times of the day, plan activities around those times. It can be as simple as looking through old pictures, getting them involved with the laundry, or having a snack with them.

People who have Alzheimer's often forget where they are, even inside their own homes. It might help to post descriptive photos on the doors to various rooms, such as the bathroom, bedroom and kitchen. Hang a picture of your loved one on their bedroom door so they that it’s their room.

It only takes a moment for someone to wander away. Even the most diligent caregiver has to sleep, bathe, or talk on the phone. It’s vital that you arm yourself with wandering precautions. 93% of Alzheimer’s patients who wander and are found within 12 hours survive. Seven percent don't. About one in 14 don't make it home alive. Of those lost more than 24 hours, only a third survive. Of those lost more than 72 hours, only 20 percent survive.

For more information about the Alzheimer’s Association, click HERE.

For more information about Home Helpers, click HERE.

Advice to Caregivers: Reassure, Don't Argue

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Dr. Beverly Jones always dispenses this advice to the Alzheimer's caregivers who come through his office: You will never win an argument with an Alzheimer's patient.

"Family members simply cannot recognize how severe the memory loss is," he said. "They see the same person on the outside and just can't comprehend how different they are on the inside."

Winston-Salem doctors specializing in geriatrics and other seniors advocates shared their tips on living day to day with an Alzheimer's patient.

•Set up a no-argue zone. "If you argue with a person with dementia, both people just end up upset, and nothing is accomplished," said Dr. Kaycee Sink, director of the Kulynych Memory Assessment Clinic at Wake Forest University Baptist Medical Center. "With dementia, logic and reasoning are failing, and the person with dementia truly believes that the way they think is correct. If it's a minor issue, just concede. Put on your turtle shell and just let it slide off your back."

•Keep communication short and direct. "If a certain attempt is not working, come back to it later, maybe another way," Jones said. "You must pick your battles, and you must be flexible as a caregiver."

•Don't correct everything, especially if it's inconsequential. "If you try to make a point, it doesn't matter, because two minutes down the road, she won't remember it anyway," said Scott Trotter of Winston-Salem, who takes care of his mother. (See story on previous page .)

But what if the things the Alzheimer's patient says really are untrue and are harmful? One Alzheimer's patient, for example, told everyone she met that her daughter was spreading lies about her.

"You may never be able to convince her of the truth," Sink said. "In this case, for example, the daughter might have to make phone calls privately to the people her mother has spoken to and say, 'This really didn't happen.' But mostly, the people already know that the mother has problems."

•Don't take away what the Alzheimer's patient can do. Pick an activity that is appropriate to the person's level. If she can't cook an entire meal, perhaps she can slice the tomato for the salad.

"Allow them to do as much as possible, even if it's not up to standard," Sink said.

•Do things on a schedule as much as possible, Trotter said. This usually means less hassle.

•Always sit and listen, no matter what the loved one is talking about. Don't say you don't understand what they are saying. "The few times I caught myself saying 'I don't understand,' that would just frustrate her more or make her angry," Trotter said.

•Don't let the person see you get upset. Hide it and vent later with a friend or loved one, Trotter said.

•Don't treat the person like a child, even if some behaviors are childlike.

•Don't push someone to do things he cannot, such as a crossword puzzle that is too difficult.

•If a person with dementia is upset, try to get at the underlying emotion, Sink said.

For example, one man with Alzheimer's routinely worried that his money was going to run out and that he would be left poor. His daughter kept his bank statements nearby, showing them to him again and again. "Look Daddy, here's your money, safe and sound," she would say, and each time he would relax a bit.

Sometimes it almost takes stumbling upon the right words to calm an Alzheimer's patient. Sink told the story of one woman with dementia who worried constantly about her parents, who had long since died. She shouted out again and again, "Where's my mother and father?"

Various people told her, "They are coming for you," but then the woman became worried that her parents were lost.

Finally, someone told her: "Well, I don't know where they are, but they know where you are. And they love you very much." This satisfied and relaxed the woman, at least for a while, Sink said.

•Perhaps most important: Caregivers must give themselves a break.

"Build in some support for yourself, in terms of people who can help," Jones said.

The community offers adult day programs; take advantage of them, he said.

"The biggest problem I see is that caregivers work themselves to death," Jones said. "Literally. I have seen some caregivers who died before the Alzheimer's patient did. Lower your expectations and take it day by day."

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