Just the Facts and More: Bathing

Keeping the Alzheimer patient clean and well-groomed can be a challenge for the caregiver. A depressed person might have lost her desire to bathe while another person might feel embarrassed about getting undressed or might become frightened by running water or mirrors.

For the person who has Alzheimer's, it is easy to feel confused and overwhelmed by simple daily routines such as bathing and grooming. If the person seems afraid, stressed or resistant to bathing, try to determine the reasons why by asking the following questions:


Physical/Psychological Factors

  • Does the person seem depressed?
  • Is there a physical illness or infection?
  • Does the person seem overly sensitive to water or changes in water temperature?

Environmental Factors

  • Is the person sensitive about having someone else in the bathroom?
  • Is the person able to find the bathroom and see clearly once (s)he enters it?
  • Is the room temperature too cold?
  • Is the water temperature too hot or cold?
  • Is the water pressure from the shower too intense?
  • Is the water in the tub too deep?

Special Concerns

  • Is the person afraid of falling, running water, or soap?
  • Is the person confused over such tasks as turning on the water or filling the tub?
Once you have determined the answers to these questions, you will be in a better position to manage the bathing routine.



Action Steps

Have reasonable exceptions.

Keep in mind that frequency of washing and bathing is a personal preference. Some people may not feel the need to shower and/or wash their hair every day. In these cases you might want to alternate a sponge bath with a more complete bath or shower.

Adapt to the patient's needs, routines, and preferences.

If the person is used to taking a shower in the morning or a bath at night, try to maintain that routine. Changing from day to night might distress the person. Also keep in mind that a person may refuse to take a bath for an unfamiliar caregiver of the opposite sex.

Prepare the bathroom in advance.

  • Have the towels ready.
  • Draw the water in the bathtub and test the temperature.
  • Pre-measure the shampoo.
  • Develop a soap pocket in the washcloth so that the person can wash him/herself.
  • Keep the bathroom warm and comfortable.

Gently prepare the patient for the bath.

Be directive at bath time by using such phrases as, "Your bath is ready." In this way, the person will focus on each step of the task instead of whether or not (s)he needs or wants a bath. If the individual continues to resist the idea of bathing, distract him/her for a few moments and then try again.

Make the bathroom safe.

  • Always check the temperature of the water. Keep in mind that the person may not be able to judge the temperature.
  • Avoid using bubble bath or bath and shower oils that would make the tub or shower stall slippery.
  • Keep in mind that showers are often more dangerous and frightening to people with Alzheimer's disease than baths. If you must use a shower, install grab bars and use a tub seat.
  • Never leave a person alone in the bath or shower.
  • Consider using a handheld shower.
  • Use only two to three inches of water in the tub and make sure there are rubber mats or decals on the tub's bottom.
  • Use a non-slip mat and make sure that the bathroom floor is free from puddles. Some caregivers install carpeting in the bathroom.

Take care in giving the bath.

  • Gently coach the person during each step of the bath, reminding him/her of the areas that need washing. Keep in mind that you may need to complete part of the bath or shower yourself.
  • Plan to do a project such as hair washing in the morning when the person is well rested. Get the individual to participate as much as possible.
  • Avoid using harsh deodorant soaps unless there is a serious problem with incontinence, in which case there are special soaps available.
  • Make sure the person washes the genital area -- especially if incontinence is a problem. Also make sure the person washes within folds of flesh and under the breasts.
  • After the bath or shower is completed, check to see that the person is completely dry.
  • Check the person for red areas of skin, rashes and sores. If the problem is serious, consult a physician. Keep in mind that pressure sores and skin ulcers can develop quickly on people who sit or lie down much of the time.
  • Use a body powder, cornstarch, or baby powder under the breasts or in creases or folds of the skin and use a lotion to keep skin soft and flexible. If the individual resists deodorant, try baking soda.

Resources

One of the best places to turn for additional help is the Alzheimer's Association. The Alzheimer's Association has more than 83 Chapters and 1,600 support groups nationwide, where family members of people with Alzheimer's disease or a related disorder share their experiences, provide each other with emotional support, hear practical suggestions and learn to rebuild their lives.

The primary resource for this fact sheet was Mary Barringer, RNC, Partner, Professional Care Management Services, Springfield, Illinois.

Special thanks to the following Chapters of the Alzheimer's Association: Orange County, California; Eastern Massachusetts; East Central Michigan; Greater Kansas City, Missouri; South Central Michigan; and Cleveland, Ohio.

Other Resources include:

  • Miriam Aronson, Ed.D. "Understanding Alzheimer's Disease." New York: Scribner's, 1988.
  • Donna Cohen, Ph.D. and Carl Eisdorfer, Ph.D., M.D. "The Loss of Self." New York: Norton and Company, 1986.
  • Nancy L. Mace and Peter V. Rabins, M.D. "The 36-Hour Day." Baltimore: The Johns Hopkins University Press, 1991.

© 1992 Alzheimer's Disease and Related Disorder Association, Inc. All Rights Reserved.

Compiled by the Lincoln/Greater Nebraska Chapter of the Alzheimer's Association, 1999.