Caregiver SOS: Bath time can frighten some seniors

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My mom is a nightmare about her bath. She refuses, giving every excuse in the book. She used to be meticulous. I hate to see her unclean. Any ideas on getting her to bathe again?

Signed, Looking for suds

Bath time is a very common battleground for people with dementia. For some, it is about the physical issue of getting in and out safely, while others simply stop wanting to enter the bath and resist help. Remember, this is part of the changing brain. It is not malicious.

It is important to recognize that this activity may be overwhelming for your mom. The sequence of events may be too much to manage. Some people feel insecure in the potentially slippery, hard environment. Many don’t relish the intrusion into what was a private activity that now requires supervision.

Some dementias result in not being able to gauge the depth of a tub. Outlining the bath or floor with contrasting tape may help. Good lighting is always important.

A proper assessment by an occupational therapist or other professional familiar with these challenges may help. A simple environmental solution such as a grab bar, telephone handle shower or chair may make things less stressful.

For many with dementia, modifications like these make it safe (and that is key) but this is not the end of the challenge. One technique you may want to consider is looking at what time of day the bath happens. Some people find it challenging in the morning and shifting the time can help. Be creative. Bathing in the afternoon may work. Try giving one prior to a nap or walk.

Also, make this event as pleasurable as possible. Think “spa.” Heat the room to a comfortable warm temperature (especially in winter, when taking off clothes is not pleasant). Prepare nice soaps and try playing soothing music in the background.

If assistance is needed, it is important that the environment does not feel rushed and overbearing. The verbal and non-verbal cues of “get going and get this done” can create a negative environment. Provide step-by-step instructions and present pleasant choices — such as a variety of scents to choose from — that may engage the bather.

Remember that dignity is key and putting the person in control helps. Cover their shoulders so they feel less exposed. Talk about something pleasant as a distraction (e.g., “The grandkids are coming!” or discussing dinner plans.) Some do better if they can hold a cloth, sponge or something to manipulate.

For older people, it is not always necessary to shower daily, as many are not as active and don’t get as dirty. If incontinence is an issue, more regular bathing is ideal, but sponge-bathe genitals, if needed. A trip to a hairdresser may elicit a positive memory and sometimes people do better in a social context. If needed, purchase dry powder shampoos to comb through hair for cleanliness.

Arguing and getting upset with a combative person will not help. Leave it and try again later. In some circumstances, medication may be warranted. But everything else should be tried prior to opting for medicine. Do your best to manage this challenge and remember: this is just another manifestation of the illness. It is not personal.

Nira Rittenberg is an occupational therapist who specializes in geriatrics and dementia care at Baycrest Health Sciences and in private practice. She is co-author of Dementia: A Caregiver’s Guide available at www.baycrest.org/dacg Email questions to caregivingwithnira@baycrest.org This article first appeared in the Toronto Star. It is reprinted with permission.

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