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Personal care

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Helping someone with dementia with their personal care can be extremely time consuming and emotionally exhausting. You will very much be in each other’s personal space, and that can take some adjustment – for both of you.


While it’s important that people with dementia are encouraged to do as much for themselves as possible for as long as possible, there will come a time when they just aren’t able to care for themselves, or will forget what needs to be done.

There are many reasons why a person with dementia might have difficulties carrying out their personal care. Dementia affects each person differently, and you also will react to the situation in a different way to someone else, so you will need to find an approach that suits you both.

Here are some of the things they – and you – may find challenging while bathing and dressing, and some possible solutions to those challenges.

 

Challenges when washing and dressing:

 

 A lack of privacy

Possible reasons

Possible solutions

Washing and dressing are intimate, private activities. Many people may have never undressed in front of others before so may feel embarrassed or humiliated.
  • Pull down the blinds or close curtains and doors to create a feeling of privacy.
  • Cover mirrors if the person with dementia doesn’t recognise themself.
  • Give them a lot of reassurance and be patient.
  • If they are able to manage most of the task, help them only when necessary.

 A fear of bathing

Possible reasons

Possible solutions

Some older people, and especially those with dementia, have different temperature needs and might be reluctant to undress.

Make sure the room is warm and inviting for the person with dementia.

Noise, people, bright lights and clutter in the room can be distracting.

Have enough lighting and make sure it’s the same brightness in all rooms. Soft background music may help create a calming and relaxing atmosphere.

They may not be used to bathing or showering daily.

Try to stick with the person’s previous bathing routine, and/or time their bath or shower for the time of day they are most relaxed.

 A fear of water

Possible reasons

Possible solutions

They may be unable to gauge the depth or temperature of the water and be frightened to step into it, or may be worried they will fall.
  • Some people prefer smaller or deeper baths – check what the person with dementia prefers.
  • Allow plenty of time for the bath and encourage

them to do as much as they can for themselves.

  • Prepare the bath ahead of time.
  • Install a hand-held shower and rails.

They may fear drowning, particularly if water is being poured over their head.

 
  • Try separating hair washing from bathing. Some people with dementia associate bathing with having their hair washed and become upset because it frightens them to have water poured over their head.
  • Washing their hair in a basin rather than a bath or shower may be a better option.

 Physical or medical causes

Possible reasons

Possible solutions

Depression or a physical illness can cause a loss of interest in personal hygiene. They may now have problems with balance or walking, or with their eyesight, or have trouble fastening buttons or closing a zip. The side effects of some drugs can also cause dizziness or stiff joints.

Organise for them to have:

  • a thorough medical examination to find out any possible physical or medical reasons for any challenges dressing.
  • their vision or glasses prescription checked.
  • an evaluation for depression.

 Wearing too many layers of clothing

Possible reasons

Possible solutions

Some people with dementia find it hard to judge hot and cold weather.
  • If the extra clothes aren’t causing them any problems then it may be easier to leave them on.
  • Pack away extra clothing so that it’s not visible and only put out what’s appropriate to wear.

 Choosing new clothing or footwear

Possible reasons

Possible solutions

It’s important to maintain the person’s individual style as much as possible. Everyone has their own style of dressing and buying new clothes that are very different from how they used to dress may cause problems.

 
  • Choose clothing that’s easily washable and doesn’t need ironing.
  • For some people, buttons, snaps, hooks, zippers and belt buckles are too difficult to manage, so maybe replace them with Velcro tape.
  • Busy, bright patterns on clothes can be distracting – choose clothes with simple patterns and with solid contrasting colours because these tend to be easier to see.
  • Slip-on shoes are easier to put on – make sure shoes have non-skid soles.

 Wearing the same outfit everyday

Possible reasons

Possible solutions

In the past, many people didn’t change their clothes as often as we tend to today and the person you are caring for may want to wear their clothes beyond the time you believe they should be in the wash.

 
  • Rather than arguing, think about buying a couple of the same outfits so they still have the comfort of wearing familiar clothes.
  • Tactfully take the dirty clothes at the end of the day and put down clean clothes in their place.
  • Being reminded to change your clothes can be an embarrassing and humiliating experience, so choose your words carefully when suggesting they change.
  • Compliment them on their appearance when they are wearing clean clothes.
  • Even if they do want to wear the same clothes, encourage them to dress themselves as much as possible, as keeping their independence builds up their pride and self-esteem.

 

 Deciding what to wear

Possible reasons

Possible solutions

It’s important to encourage a person with dementia to choose their own clothes, although it might be difficult for them to make even simple decisions.
  • Simplify the number of choices – offer two outfits to choose between ie. “a white or blue shirt”.
  • Take inappropriate or out-of-season clothes away from the dressing area.

 The task is too confusing or complicated

Possible reasons                 

Possible solutions

Getting undressed, having a wash and brushing teeth can be very complex tasks because of the many steps involved.
  • Break down the tasks into simple steps and gently explain each step.
  • Use simple, respectful language – try offering limited choices, such as, “Would you like to have a bath or a shower?”
  • Encourage the person to do as much as possible themselves.
  • Lay out the soap, washcloth, towel and clean clothes in the sequence you will need them, making sure they are all within easy reach.

Some people with dementia may have an altered perception of hot and cold water and how water feels.

 
  • Let them feel the water before getting into the bath. Sometimes gently pouring water over their hands reassures them that the water isn’t too hot.
  • Saying something like, “The water feels nice”, or, “This feels good” can also be reassuring and calming.

 Forgetting how to dress

Possible reasons

Possible solutions

Some people with dementia can’t remember whether they are getting dressed or undressed. They may know they are holding a piece of clothing but can’t remember which part of the body it goes on.

 
  • Try using the ‘task breakdown’ technique and break the task into simple, manageable steps and do them one step at a time.
  • You may have to gently remind the person with each step, or do several of the steps yourself.
  • Give them reassurance and praise for each successful step – this will make both of you feel more positive.

They may forget to change their clothes, put them on in the wrong order or put on too many layers.
  • Put out the clothes in a pile with the first item to be put on at the top.
  • Try laying out lightly coloured clothing on a dark bedspread – for someone with problems seeing, contrasting colours may help them see the clothes.
  • Put away distracting things, such as out-of-season clothes.

 

 


Other care challenges

 Using the bathroom / grooming

 Toileting

A person with dementia may need help going to the toilet. If they do soil themselves, make sure their underwear is clean and dry, and change it whenever it’s not. If they are becoming incontinent and do soil themselves, wash them carefully with warm water, then dry thoroughly before putting on clean clothes.

 Shaving

At first a simple reminder to shave may be enough. If they have been using an electric razor, they will probably be able to keep shaving themselves for longer. But if they are using a traditional razor and begin to cut themselves regularly, you will need to help them shave.

 

Ears

Some people can have earwax build up in their ears and this can damage their hearing. Talk to their GP about the best way to deal with earwax.

 

Fingernails and toenails

A person with dementia may forget about cutting their nails or have difficulty doing it. If you can’t do this for them – and nails do harden as we age – you may need to take them to a podiatrist. Or, if you think they would enjoy it and their nails don’t need specialist treatment, maybe take them for a manicure or pedicure.

Hair

Some people get scared having their hair washed – often this is to do with having water poured over their face. You may need to find a way to wash their hair that they’re comfortable with. Using a basin could help, or, if possible, go to the hairdresser or have them visit. Many people with dementia still like having their hair cut and styled.

 dental care

Many people with dementia can’t tell us if their mouths are uncomfortable or in pain, but they might show it in other ways. Maybe they don’t want to eat, are pulling faces, refusing to have their teeth brushed or wear dentures.

Like dressing, it can be hard having someone in right your personal space as they’re trying to take care of your teeth and mouth. That’s why kindness and good communication is needed while you’re brushing their teeth, flossing, or generally taking care of their oral health.

Common dental problems for people with dementia:

  • Some medicines give them a dry mouth
  • Some medicines are sugar based and can cause tooth decay
  • Eating sugary snacks can lead to tooth decay
  • It can get harder for them to brush teeth well or look after false teeth
  • Routine oral care can be forgotten about.

Some solutions might be:

  • Dry mouth – Encourage them to drink plenty of water and talk to their doctor about changing medication, or to the dentist about any products that can help with a dry mouth.
  • Visit the dentist regularly – A thorough dental check should be done in the early stages of dementia, and a simple and flexible preventive dental treatment plan developed with regular visits. You might be eligible for publicly funded dental care, so check your eligibility.

Any worries? Talk to the dentist about what might make the experience easier – maybe that’s making sure the surgery is quiet, that there aren’t too many people around, or that any sedation/medication needs are taken care of. Also, find out if there’s a dentist in your area who specialises in treating people with dementia.

Natural teeth and dentures

Caring for natural teeth is quite different to caring for a person’s dentures.

Tips for natural teeth

  • Use a fluoride toothpaste every day when brushing teeth, preferably twice a day for two minutes each time.
  • Use a small-headed soft toothbrush – electric toothbrushes can be helpful.
  • If the person with dementia can still brush their own teeth, they may find it easier to copy you.
  • When you are brushing another person’s teeth, first explain what you are about to do.
  • Don’t forget to clean the back teeth, front teeth, and the tongue also.
  • If you need to brush for someone else, experiment to find the position that suits you both – it might be easier to sit them down and stand in front, beside or behind them.
  • Talk to your dentist about whether the person you are caring for should be using mouth rinses or gels.
  • Cut down or eliminate sugary foods and drinks to cut the chances of tooth decay.

Tips for false teeth (dentures)

  • Rinse dentures after every meal and brush them using a toothbrush or denture brush – put a facecloth or papertowel in the bottom of the basin so they won’t crack if you drop them while cleaning.
  • Dentures should be taken out at night and soaked in water – you can use cleaning tablets but they’re not necessary.
  • Partial denture clasps can hurt the mouth and tongue and can be more difficult to take out than full dentures.
  • In later stages of dementia, it may not be possible to wear dentures. If so, swab the mouth gently with a soft cloth and water as best you can.

 

 

There is help available for you as you care for someone with dementia, contact your local Alzheimers organisation for more information.

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