Dementia is a progressive condition, in which those living with moderate or advanced dementia will require support in carrying out activities of daily living (ADLs) such as bathing, dressing, grooming, toileting, walking, and eating.
For many, bathing and showering are activities that are rather private and intimate. The same applies to persons living with dementia. Thus, it is understandable that they may feel uncomfortable receiving assistance and may find it difficult to adjust to this change. These feelings of uncertainty are also felt by caregivers, who often have trouble convincing their loved ones to have a bath, or making the process a calm and comfortable one for everyone involved.
However, it is crucial that caregivers like yourself approach these activities with understanding and compassion as this will go a long way toward reducing feelings of anxiety and frustration, hence improving the quality of life for both you and your loved one with dementia.
How Does Dementia Affect Bathing and Showering?
Dementia affects every individual differently. This includes their experience of the symptoms, the rate at which the condition progresses, as well as the type and level of support required.
Find out how the symptoms affect persons living with dementia and develop gradually throughout the mild, moderate, and advanced stages of the condition here.
In the context of personal hygiene, persons living with moderate (and in some cases, mild) dementia may find it challenging to carry out a sequence of activities in the correct order, such as the steps required to take a shower. They may also have difficulty with perception, recognition and understanding the objects around them, which can make bathing and showering distressing. Conversely, persons living with advanced dementia are likely to depend completely on their caregivers to perform their ADLs.
Tips to Improve the Shower and Bath Experience:
1. My loved one refuses to shower when I tell them to. What do I do?
In moments like this, it is important to understand why your loved one does not want to take a shower. Here are a few things to consider:
- Does my loved one think they have already taken a shower?
- Does my loved one feel anxious or embarrassed about taking a shower with other people around?
- Are there any physical problems that may make showering difficult or painful for them?
- Do they feel uncomfortable using the showerhead in the shower?
- Would they prefer to shower slightly later? Before they were diagnosed with dementia, when did they prefer to take a shower?
- Does my loved one feel unsafe taking a shower in the bathroom? Were there incidents of falls or near-falls in the bathroom before?
It is important to take into consideration your loved one’s preferences for shower or bath, products, time of day, etc.
It is also useful to make sure that showers happen at the same time every day, so that it becomes part of the normal flow of their day. This predictability will reduce their stress and anxiety which might make them more willing to bathe.
Additionally, you may further encourage your loved one to take a shower by giving them reasons to. For instance, you may mention that you may be expecting visitors or have made plans to go out later in the day, or mention that they can have a warm cup of tea and do something fun after the shower. Remember to keep the conversation generally positive and avoid discussing or arguing about the shower.
2. My loved one is often stressed and agitated when they have to take a shower. What can I do to make them feel more relaxed?
Before going about the bath or shower, it is important to ensure that your loved one’s surrounding environment is relaxing and ideal for the activity.
- Ensure that the bathroom or the place in which the bath will take place is properly illuminated.
- Organise the shower or bathing essentials. You may consider labelling the items to make it easier for your loved one to identify them.
- Ensure that the bathroom is clutter-free so that your loved one has enough space to find what they need.
- If your loved one finds physical activities more difficult, you may wish to prepare a shower commode so that they can have a less tiring experience whilst showering. In the absence of a shower commode, you may place a plastic chair with a backrest against the wall to ensure that the chair is stable. You may also install grab bars that your loved one can hold on to or place non-slip mats for added safety.
- Some persons living with dementia may feel distracted, confused or agitated when they see themselves in the mirror. It is advised to cover the mirrors in the bathroom with a towel to reduce feelings of discomfort and displeasure in your loved one.
- Test the temperature of the water to ensure that it is not too hot or too cold. You may also use a hand-held shower head with a milder spray or a pail so that it is more comfortable on the skin.
- Play relaxing music during the activity to create a sense of calm.
- Communicate clearly, gently, and encouragingly with your loved one while assisting them in the showering process.
Coupled with enhancements to the physical environment, it is important for caregivers to tailor interactions with their loved ones to their specific needs in order to make the most of each conversation. Find out how to best communicate with your loved one here.
Additionally, do not rush the activity. Allow plenty of time for the shower or bath to take place so that your loved one does not feel rushed. They may take a longer time to process information, which affects their ability to make certain decisions. You may wish to remind your loved one of the steps they need to take and support them in identifying the correct shower essential. It might take slightly more time, but your loved one will have a sense of control over what is happening, which will reduce anxiety and increase their level of confidence.
In instances where showers may be too distressing for your loved one, remember that there are alternative ways of maintaining their personal hygiene. For instance, you may give them a sponge or towel bath while they are sitting or lying down on their bed. Body wipes are good alternatives as well.
3. My loved one feels embarrassed when I assist them with their shower/bath in the washroom. What can I do to protect their modesty during the process?
It is important to respect their privacy as far as you can, especially during activities that are rather personal and intimate like showering and bathing. You can do so by:
- Ensuring that nobody will walk in while they are washing or getting dressed
- Closing the blinds, windows or shower curtain for privacy
- Uncovering only the part of their body that you/they are washing. A towel can be useful for this. You may also wish to start with the extremities of the body like their hands and legs to slowly ease your loved one into the showering process.
Ask The Expert: Episode 4 – Living With Dementia (Daily Activities)
Source: Agency for Integrated Care
In this episode, Ms Low Mui Lang, Executive Director of Peacehaven Nursing Homes and Peacehaven Day Centres, answers questions related to managing the daily activities for persons living with dementia, such as how to respect a loved one’s privacy during the shower process.
Your loved one may also prefer someone in the family (or otherwise) who is of the same gender as them. They may also prefer a certain person to assist them in the shower over another.
Should someone new (i.e. domestic helper, care professional, family member who is not as close to your loved one) be assigned to assist them in the washroom, priority should be to build rapport and familiarise themselves with the newly assigned person. Remember to allow some time for your loved one to become more comfortable with being assisted by the new person.
It is important that you empower your loved one to make these decisions and to consider their preferences so that they feel comfortable during the activity.
4. I’m new to this. How do I even begin to assist my loved one with showering?
Activities of Daily Living – Resource Guide for Caregivers
Source: Agency for Integrated Care
This resource by AIC is a step-by-step guide on how to support your loved one with their personal hygiene needs. These may include bathing, shampooing, mouth care, shaving, foot care and various other ways of washing.
5. I think I need additional support. Who can I reach out to for help with my loved one’s ADLs?
It is perfectly alright to seek help, especially if you are new to this and are feeling unsure. Home Personal Care service is provided by trained care professionals to assist clients and their caregivers with ADLs, medication, mind stimulating activities, elder-sitting and other care tasks.
Prior to the start of the Home Care service, a registered nurse, therapist or doctor will assess the cognitive and functional skills of your loved one before coming up with a care plan that is best suited for them.
For other services near your home, refer to the Agency for Integrated Care (AIC) E-locator.
You may also wish to enrol in courses or training programmes to gain a better understanding of how to support your loved one in their daily activities. Refer to the AIC Caregiver Training Courses E-Calendar to view available caregiving training courses surrounding home personal care.
Additional Resources
Caregiving for Seniors – A Practical Guide
Source: Caregiving Welfare Association
This handbook was developed to provide a deeper perspective on the common issues faced by caregivers. It features:
- Various practical approaches to challenges that caregivers face during their journey of caregiving
- Step-by-step guide on how caregivers can support their loved one with activities of daily living, plan for the future, and engage in self-care.
Ask the Expert: Episode 3 – Living With Dementia (Communication)
Source: Agency for Integrated Care
How do the changes brought about by dementia impact communication? What are some words to avoid? Does talking speed, words you use and body language matter when speaking to a person living with dementia?
In this episode, Ms Michelle Ong and Mr Anjang Rosli answer questions related to communicating with person living with dementia.
