At What Stage Does A Person with Dementia Want to Stop Bathing?
John Trevey on
Dementia and Bathing
At some point, most people who are living with Alzheimer’s disease or another form of dementia will refuse to bathe, forget to bathe, or fight bath time, making it exhausting for caregivers.
This can be confusing. Most adults bathe regularly without thinking about it. We even enjoy that time to decompress and wash off the day. So why do people with dementia seem to throw personal hygiene out the window? And when can you expect your loved one to start her bath rebellion?
First, it helps to understand the stages of dementia and why certain stages and the associated symptoms could lead to trouble at bath time.
What are the stages of dementia?
Every dementia journey is different, but anyone who is living with dementia will progress through five general stages. (The below stages refer to Alzheimer’s disease as that is the most common form of dementia.)
1. Preclinical Alzheimer’s disease
This stage begins before symptoms of Alzheimer’s appear, such as memory loss or changes in personality and behavior. With advanced research, we now know that Alzheimer’s can appear in the brain long before the disease is noticeable to you or others.
2. Mild cognitive impairment due to Alzheimer’s disease
The Mayo Clinic defines mild cognitive impairment (MCI) as “the stage between the expected cognitive decline of normal aging and the more serious decline of dementia.”
MCI can be caused by Alzheimer’s disease or other conditions such as nutritional deficiencies, autoimmune disease, metabolic imbalance, a brain tumor and more. MCI typically causes issues with thinking, reading, learning, remembering, reasoning and attention span but not to the degree that these issues interfere with daily tasks and activities.
3. Mild dementia due to Alzheimer’s disease
This is the stage when Alzheimer’s is most commonly diagnosed because this is typically the stage when symptoms become evident to family members and doctors.
Symptoms of mild dementia due to Alzheimer’s disease include:
- Short-term memory loss
- Poor judgment
- Difficulty with problem-solving or completing tasks
- Misplacing items
- Change in personality
- Getting lost more frequently
4. Moderate dementia due to Alzheimer’s disease
At this stage of Alzheimer’s, the symptoms that began in the mild dementia stage grow more severe. Memory loss and confusion increase. Basic personal details, like important dates, may become difficult to remember.
Personality and behavior changes are more evident at this stage. Many grow suspicious of their caretakers and loved ones or think they are seeing or hearing things.
At this stage, many may need help with activities of daily life (ADLs), such as going to the bathroom, changing clothes and eating.
5. Severe dementia due to Alzheimer’s disease
Throughout every stage of Alzheimer’s disease neurons in the brain are deteriorating, shrinking the brain. During the final stage of Alzheimer’s, the disease has affected every area of the brain needed for daily functioning. This may cause a person to not be able to communicate coherently, to need assistance with all ADLs and not be able to physically move or sit up on his or her own. Eventually, someone with severe dementia due to Alzheimer’s will lose the ability to swallow and control his or her bowels.
When will my loved one start to refuse to bathe?
Once your loved one’s dementia has reached the mild or moderate stage, he may start forgetting or refusing to bathe. This is due to cognitive and physical limitations.
Remember, one of the symptoms of mild dementia is difficulty completing tasks. Any task that requires multiple steps can be challenging for someone who is living with dementia. Think about how many steps are involved in bathing:
That is a lot of steps for someone who is experiencing cognitive decline. In addition, your loved one is likely physically limited. Maybe she has a weak hip, bad knees, or trouble standing up from a seated position—these physical limitations make bathing very difficult.
Poor memory can also interfere with bathing. Your loved one may think he just took a bath yesterday when his last bath was actually a week ago. He may not understand why he needs to bathe. Proper social behavior is difficult to understand when living with dementia.
How to get your loved one to bathe?
If your loved one is in the mild to moderate stages of dementia and refusing to bathe, there are a few things you can do to encourage personal hygiene.
Board-certified geropsychologist Dr. Natali Edmonds suggests trying to following:
1. Create a calming and comfortable environment.
Make your loved one’s bathroom a comfortable and calm place she wants to be in. Light a candle, make sure her towels are soft and her shampoo smells good. Small touches like this can go a long way. Play soothing music.
2. Be mindful of how you are acting around bath time.
If you feel stressed or anxious about bath time, your loved one will pick up on that. Make sure you’re in a good headspace beforehand. Make sure you’re rested and ready to be patient with your loved one as he struggles with bath time too. Don’t make the struggle more difficult than it already is.
3. Make it less awkward.
Dr. Edmonds aptly points out how awkward bath time can be. Your loved one is accustomed to bathing alone. She might be having a hard time adjusting to having someone there with her. Do whatever you can to make it less awkward. Have a conversation topic prepared that you can talk about, provide a washcloth she can use to cover her lap, tell a joke—anything that will make her (and you) feel more comfortable and less awkward.
4. Have everything you need within arm’s reach.
If you have to leave mid-bath to grab more soap or a towel, this could make your loved one more prone to want to end the bath early and leave while you’re not there. Make sure everything he needs is close by so there are no interruptions.
5. Incorporate a post-bath ritual.
Decide on something you and your loved one can do after each bath that she would look forward to. You could play a song, put on perfume or cologne or a comfortable pair of pajamas, or even have a cup of tea together—anything that would help your loved one make positive associations with bath time.
6. Don’t call it a “bath” or “shower.”
If your loved one doesn’t want to take a bath or a shower, don’t call it that! Come up with another name for that time that would encourage your loved one, such as me time, self-care or spa time. Your loved one is far more likely to want some spa time over a shower.
7. Provide some motivation
What would motivate your loved one to bathe? A doctor’s visit? Facetiming with a family member? Going out to dinner? Whatever you know your loved one would want to clean up for, offer that has motivation for his next bath.
8. Use the right bathing tools.
Bathing or showering can be difficult due to physical limitations or discomfort. Does your loved one dislike the feeling of water on her head? Get a hand-held shower attachment. Does he have a hard time standing for long periods? Get a shower stool. Does she feel nervous walking on slippery surfaces? Install a handrail. Baths and showers don’t have to be dangerous or uncomfortable. Talk to your doctor about how you can make your loved one’s bathroom as safe and comfortable as possible.
Dementia and Bathing: Be Patient.
Bath time doesn’t have to be something you dread as a caregiver. If your loved one is starting to rebel against personal hygiene, consider what stage of the disease he is in, what’s making bath time difficult and how you could work together to improve it. He will bathe again! You just might have to be patient until you find what works for both of you.
