1 Feb 2009
Dear Mary,
I’m having a very difficult time bathing my mother. She has dementia and absolutely refuses to bathe. I’ve given up on getting her into the shower, but would like to at least sponge bathe her. I know you’ve covered this topic before, but can you please do it again?
Dear Reader,
This is the most common topic I’m asked to address.
It is difficult to elicit from a confused person exactly why she doesn’t want to bathe. Fear of falling, feeling cold, modesty issues, the inability to understand what is expected, the inability to sequence and/or follow directions, and the inability to recognize the difference between hot and cold all come into play. Memory can be so impaired that the person forgets within seconds what she is expected to do and hesitates. This prompts the caregiver to do it for her, an action perceived as an assault that triggers a defensive re-action like yelling or hitting.
I know you’ll groan when I say this, but bathing does not have to be difficult if you keep in mind that confusion and fear are the driving forces for resistance.
Prepare the bathroom in advance: turn up the heat and gather all supplies to within easy reach. The general rule of a dementia-impaired care-receiver is: touch me once; don’t touch me twice - so use no-rinse body wash or body wipes.
The hardest part is getting the person into the bathroom. My experience has been not to ask but to simply state that it is time to “wash-up” or “clean-up” before a meal or snack for instance (food can be a great motivator); then hold out your hand and guide her into the bathroom. Keep the conversation light and talk about anything other than bathing.
Fill the sink with warm water and encourage her to wash her hands. Invite her to sit on the toilet or a chair and hand her a wash cloth for her face. While she is distracted, tell her you want to check her feet and then remove her shoes and socks. Place her feet in a warm basin of water (this can have a calming effect), wash and dry them, and then put on a pair of clean socks and shoes. Never leave her feeling exposed: each time an article of clothing comes off, replace it with a clean.
With instruction, allow her to wash as much of her body as she can. Protect her modesty by holding up a towel. In reality, you will be discreetly looking to check for bruises or skin problems. You can wash specific parts of her body by telling her to hold the towel and then leaning in and doing them. Be thorough but quick using a gentle touch. Her hair can be washed with a no-rinse shampoo cap or dry shampoo.
If you get one part done and she becomes agitated, back off and try again later. Sometimes you have to resort to the seven-day bath: bathing one body part per day. You can also bring a bath-in-a-basin to her in the security of her room which may be less threatening.
Don’t give up. Bathing takes practice and patience. As long as the experience is pleasant it will eventually become a normal routine.
Dear Mary,
My sister was just diagnosed with mixed dementia. What does it mean?
Dear Reader,
Mix-dementia is a double whammy brain disorder caused by vascular disease and Alzheimer’s disease occurring at the same time. According to the Alzheimer’s Association, approximately 45% of all cognitively-impaired people autopsied upon death have this from of dementia. Treatment consists of preventing further vascular injury from stroke and employing behavior management techniques used in Alzheimer’s disease.
| 
