Before Turning on the Faucet: Alzheimer’s Disease and Bathing

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It may be at the beginning when an Aging Life Care Manager® does an initial assessment of the person with Alzheimer’s disease; or it may come up as the dementia progresses; or it may never come up. The task is bathing, and for reasons discussed below, it is an undertaking that has its unique challenges.

For some, a bath or a shower is uneventful. But for others in the early stages of Alzheimer’s disease, he or she may be accustomed to bathing independently. Now that independence is disrupted. There may be an aide or family member standing in the bathroom or right outside the door. Privacy is compromised and the need for safety trumps a long history of modesty. It can be especially challenging when the aide is female and her client a male.  If this new bathing protocol were not enough, the cognitively impaired person may not recognize that anything is wrong, so she becomes verbally and physically abusive as she staves off the invasion of helpers and disruption to her customary routine.

With the progression of the dementia, the senses are the triggers for the challenge to bathing. Seeing the water rush out of the spout or shower head may be anxiety provoking; the sound of the water may illicit a similar response. Multiple mirrors in the bathroom may give a “house of mirrors” effect. Good in an amusement park, but not the bathroom. If it is a bath the person is taking, he may view the tub and water as bottomless and be afraid to enter it.

While the explanations are as varied as the person partaking of the bath or shower, the following five strategies can be helpful in reducing the stress for the caregiver and family member:

  1. Choose the right time of day. If a person is experiencing sundowning, a shower in the late afternoon or evening may not be the right time.
  2. Assess the level of help needed by the individual and then coach the person accordingly. A strength-based approach will help the person to have a greater feeling of security and independence.
  3. As the caregiver, be aware of how you are feeling as you approach bathing. People with dementia are sensitive to the moods of others. If you are tired after a long day, put off the bath or shower for another time.
  4. If there is resistance, use a reward-based approach: “We’ll take a very short shower and then we’re going to have coffee and those chocolate chip cookies you like.”
  5. If these strategies prove unsuccessful, try a sponge bath or use a non-rinse body soap and shampoo. These items are available in drug stores and online.

As Aging Life Care Managers®, we suggest approaches that will insure minimum stress for the caregiver and the desired hygiene outcome for the cognitively impaired person. It is a customized approach that recognizes the unique needs of each family member.


Written by Miriam Zucker, LMSW, ACSW, C-ASWCM

Categories: Aging Life Care Management