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I’m Not That Dirty

One of the biggest challenges during the early stages of dementia, when personality changes and denial are contributing factors, is the topic of bathing.

One of the most frequent issues is a lack of self-initiated routine bathing, and a resistance to others who suggest that bathing be done more often.

Here are some suggestions to increase bathing compliance and frequency:

  1. Make the shower/tub as safe as possible.  Install grab bars and put a shower chair or tub bench inside to decrease the risk of falls.  If the individual resists the modifications, insisting that he or she does not need the devices, explain that the changes are for the future- if and when that time comes.  Respect his or her opinion, and make it more about your peace of mind than an actual need.
  2. Have a conversation about social norms.  Discuss an appropriate frequency for showering.  The rationale you hear may not be in agreement with your own standards, but you should be able to land on a mutually acceptable frequency (once or twice a week may not be ideal, but it’s a fairly common frequency for someone who is cognitively and/or physically impaired).
  3. Review the procedures for daily “bird baths”.  Many people who will not shower daily claim that they wash at the sink each morning.  Many times, the quality of sink bathing is not good.  Remind them what body parts need the most attention- and educate about the various skin problems that could result from improper care.  If the bathroom sink and floor are dirty and neglected, chances are their skin is too.
  4. Keep a calendar or schedule of the self care routine.  Memory deficits are a leading cause of neglected self care.  The person may actually believe that he or she just bathed this morning, or may not remember that it’s been a week or more since the last shower.  Having a schedule or calendar to “check off” when the task was completed helps to promote compliance.
  5. Get an outsider to do the dirty work.  As much as people in the early stages deny the need for help, they are frequently more cooperative and open to suggestions from outsiders.  An occupational therapist is the ideal professional to broach these topics and figure out a plan.  A personal care aide or home helper is the perfect person to actually assist with the bathing task.  The sooner an outsider is introduced into the situation, the better the acceptance of help will be throughout the course of the disease.

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