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5 ways to spot if someone with dementia is struggling with their hygiene

Ensuring that someone with dementia maintains good hygiene is essential for their wellbeing.   Therefore we have produced this article to help you identify those that may need help and how you can help them.

 The impact of this is that someone that may have struggled in the past will now be able to take pride in their hygiene and in themselves.  

In the article we will give you 5 ways on how to spot if someone with dementia is struggling with their hygiene.  These include:

  1. Forgetting to change clothes or wearing dirty clothing
  2. Forgetting to wash and bathe
  3. Refusal to wash or bathe
  4. Failing to take care of teeth
  5. Problems with grooming

The background

Dementia slowly prevents an individual from taking care of everyday tasks as their cognitive abilities fade. This often leads to poor hygiene – even for individuals who were previously very proud of their appearance.  The more common types of dementia are lewy body dementia and vascular dementia.  

Over time frustrating and challenging behaviours can emerge around washing, oral care and clean clothes. These issues can be difficult to navigate for caregivers, family and friends – as without good hygiene and cleanliness the person’s wellbeing can suffer.

Despite this, it can be difficult to encourage them to continue with basic hygiene tasks – and tackling personal care can become a full-time job for carers.

The good news is that forgetfulness, confusion and refusal surrounding hygiene activities usually have triggers that can be combatted and managed effectively when approached in the right way. In this article we explore the common issues surrounding cleanliness, hygiene, grooming and personal care – with hints and tips for carers to help you to keep your loved one healthy and happy.

1 – Forgetting to change clothes or wearing dirty clothing

One prominent issue caregivers looking after a person with dementia face is dealing with dirty clothing worn day after day without being washed or recognised as being soiled. There are a number of reasons why individuals with dementia wear dirty clothing for days or even weeks on end.

Often they forget or don’t realise that the clothes aren’t clean – they believe that they have just clean them, or have put them on fresh each morning. There are a few other motives behind dementia sufferers wearing dirty clothing, including:

– Impaired ability to make judgments

– Favouring familiarity

– Overwhelmed by choice when deciding what to wear

– A preference for solid colours.

It can be difficult to know what to do in these situations as pointing out that a person is wearing dirty clothes can humiliate and upset them, causing a futile argument since they are unlikely to understand what you are saying. Instead, put several measures in place to help the person you are caring for to maintain a routine around clothing, encouraging them to wear clean clothes on a more regular basis

Start by decluttering, selecting a ‘capsule wardrobe’ of clothes so that the person you are caring for has fewer option to choose from. You may like to leave an outfit ready for them to wear each day, removing dirty clothes from their room at night ready for washing.

If your loved one prefers one favourite outfit, buy duplicates so that they can wear similar things each day without issue.

2 – Forgetting to wash and bathe

Regular washing and bathing to maintain good hygiene is important for everyone – and it becomes especially difficult as dementia progresses and daily routines are harder to keep on top of. Failure to wash and bathe regularly is common and can occur for a number of reasons, including:

Memory loss – the person forgets that they have or haven’t washed recently

Confusion or forgetfulness regarding the steps involved in running a bath, using a shower etc.

– Frustration or embarrassment over inability to wash or bathe leading to denial or inaction.

A consistent bathing routine can help you to keep on top of things and ensure that your loved one is always clean and well presented. Stick to the same time each day or every other day to alleviate confusion and maintain regular good hygiene. People with dementia often thrive on routine, so fitting this in around other activities will help them to feel secure and happier day to day.

Instead of trying to remind them, scold them or ask them to shower or bathe, simply get everything ready then invite them in. Say ‘Look, your bath is ready.

It will be nice to have a bath won’t it?’ or remind them how much they enjoy their morning shower or favourite bubble bath. To make life easier for you as a carer focus on organising a ‘full’ bath or shower every other day or every few days, with a ‘top and tail’ daily wash in-between.

3 – Refusal to wash or bathe

Forgetfulness surrounding washing and bathing can be difficult to overcome, but once a routine has been established it can become an enjoyable and easy aspect of daily life once more. Cleanliness is very important – especially for older persons leading more sedentary lifestyles. Refusal therefore is particularly challenging for caregivers who want the best for their loved one, but at the same time would prefer not to upset or force them to bathe or shower.

Reasons for a person with dementia to refuse to wash include:

Depression and low mood – lack of interest in taking care of themselves

– Embarrassment and/or modesty – they don’t want to be seen naked or are too proud to accept help

– A previous upsetting or scary experience such as a slip or fall in the shower

– Stubbornness – the person dislikes being told what to do

– Loss of control

– An unpleasant experience previously with people helping

– Feelings of embarrassment/shame due to loss of independence

– Forgetfulness – unable to remember complex sequence of activities involved.

Although refusal to wash can be difficult to deal with, there are some easy steps you can take to break down barriers and encourage your loved one to work with you to maintain good dementia hygiene on a regular basis.

Start by building positive associations with bathing – preceding the bath or shower with a pleasant activity (listening to a favourite radio show together or going for a walk), then following up with another one (a nice dessert or cup of tea).

Simultaneously help them to associate pleasant associations with the bathroom itself, creating a warm and welcoming environment with soft fluffy towels, favourite trinkets and photos and preferred scents or brands of shampoo and shower gel. Keep the room itself nice and warm during bathing.

Tailor your approach depending on the stage of dementia your loved one is at.

For example, many people in the early stages of dementia are able to bathe alone once prompted, whilst in the later stage fear and confusion can make the process difficult and complex. In this instance use as little water as is necessary in a bath – as the sensory experience of entering water can be frightening or disturbing.

The noise generated by showers and running water can be loud and worrying – so again try to alleviate this by running a bath in their absence and avoiding showers if necessary. Brightly coloured bathmats will help to avoid trips and falls – but you should speak to social services or mobility specialists about adaptations if your loved one is unsteady on their feet.

Distractions whilst bathing can go a long way – their favourite music, ambient lighting, a pleasant conversation about something they love such as their grandchildren or a beloved pet. Give the person a tactile sponge or washcloth to hold as a sensory prompt that keeps their hands occupied. Don’t rush them – instead take things slow and act as though you have all the time in the world.

When washing, keep the process as simple as possible. Use a combination body and hair wash in a pump bottle to make things quicker and easier.

If the person flat-out refuses to get into the bath or shower, it’s important to know when to stop trying to persuade them. If five minutes have passed, simply drop the subject altogether and distract them before coming back to it half an hour later as if nothing has happened.

If refusal continues, consider why the person may be worried about bathing. If they’re uncomfortable with you, a substitute carer may be needed – for example, a father may refuse a daughter’s help, for example, but accept support from his son. Avoid embarrassing situations at all costs and remember that maintaining dignity and respect will help them to feel comfortable. As above, a consistent bathing or showering routine will be key.

Everyone is different of course – so once you find an approach that works, stick with it and repeat.

4 – Failing to take care of teeth

Dental hygiene may sound like a small matter – but failure to keep up with basic daily tasks like brushing and flossing teeth could cause serious issues for the person you care for later down the line.

Without healthy teeth and gums they won’t be able to obtain adequate nutrition, and this can have a significant impact on their quality of life. Reasons for failing to take proper care of teeth include:

Memory loss – they simply forget to brush their teeth each day and lose the habit

– Help may be refused through embarrassment or frustration

– Dexterity issues and cognitive impairment can affect ability to floss and brush teeth

Firstly organise for professional check-ups and cleaning twice a year at least. Explain to the dentist that your loved one has a diagnosis of dementia and make plans for regular appointments accordingly. Bear in mind that you may need Medical Power of Attorney to deal with medical professionals in certain situations.

Some dentists specialise in dental care for the elderly or those with cognitive impairment, so if your loved one is particularly anxious or agitated it may be worth looking into a specialised option for them.

Incorporate dental hygiene into your daily routine at an appropriate time, such as first thing in the morning and last thing at night alongside washing. Use the person’s favourite brand of toothpaste and prepare it ready on the brush for them. Chunkier toothbrushes with easy grip handles are best.

Flossing is recommended, but if the person finds it too difficult or is uncooperative it’s best to leave it and focus on brushing alone you’re your loved one has dentures or false teeth make sure you clean them yourself as it’s unlikely that they will be able to do so themselves.

Remove mouthwash and toothpaste after brushing teeth and leave it out of sight in case they are swallowed mistakenly.

5 – Problems with grooming

Even people who were once meticulously proud of their appearance can let grooming fall by the wayside following a diagnosis of dementia. There are several reasons for this, including:

Forgetting entirely about grooming and why it is important or necessary

– Struggling with the steps involved in common grooming tasks, such as shaving or styling hair

– Being unable to identify the tools involved in grooming tasks (comb, razor).

When broaching the subject of grooming with the person you are caring for, be sensitive and tactful, taking an open and friendly approach. Tell them that you’ve noticed that they are struggling with certain tasks, and would like to help them to look and feel their best.

Often it’s easier to outsource the task of hairstyling or shaving to a trusted professional who understands the diagnosis of dementia and is happy to take guidance from you. Let them know before you arrive

that the person has dementia, and advise that extra time may be needed. Bear in mind that decision-making can be difficult for someone with dementia – so where possible pre-agree what will be done with the stylist to avoid long conversations and any confusion or distress. Ask for a shorter cut where possible, to extend the time between visits. A thorough deep-cleansing shampoo and conditioning treatment will also reinforce your efforts at home.

Salon or barbershop visits can also serve as valuable social outings for a person with dementia. If the person visibly enjoys going regularly (once a week, fortnightly or monthly) keep this on as an activity they will look forward to.

At home, keep routines simple and encourage the person to do things themselves if possible, providing constant verbal prompts and physical reminders. Switch to an electric shaver for men – or see if they are happy to grow a beard, which is easier and safer to maintain. Always acknowledge the result of any aided grooming, telling the person how nice they look. Positive reinforcement will be good for their mental wellbeing and may encourage them subconsciously to co-operate more on subsequent occasions.

For more dementia-friendly articles and hints and tips for carers, take a look at our related pages here.

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