Dementia and Hygiene

How to Solve Hygiene Problems Common to People With Dementia

Odd or frustrating behaviors around clean clothes, bathing, oral care, hairstyling, and shaving seldom come "out of nowhere." Usually there's a trigger, and ways to work around it.

Dementia Hygiene Problem: Wears Same Dirty Clothes Over and Over

Possible causes
The person:

  • Forgets the clothes are dirty after they're removed (so they never go in the hamper or wash).
  • Has impaired ability to make judgments.
  • Likes the familiarity.
  • Is overwhelmed by too many choices while dressing.
  • Prefers solid colors over busy patterns, which can be distracting or annoying.

What to do

  • Avoid pointing out that clothes being worn are dirty, which puts the person on the defensive and sets up an argument she doesn't understand.
  • Ask yourself if you're bothered by the repetition of the outfit or by actual dirt or odor. (A couple of generations ago, people didn't change clothes every day.)
  • Pare down the closet to fewer options. Stock solids in favorite colors instead of patterns.
  • Buy an identical replacement for favorite outfits (same color, style) so you can wash one while the other is being worn.
  • Remove soiled clothing from the room at night once the person is sound asleep. She'll forget about it the next morning if there's something else handy to put on.

Dementia Hygiene Problem: Forgets to Bathe

Possible causes
The person:

  • Has memory loss that makes her unable to keep track of or care about bathing.
  • Feels confusion about the sequence of steps involved.
  • Feels juvenile, anxious, or defensive when asked or reminded about bathing.

What to do

  • Stick to a consistent bathing routine. Make it the same time the person previously bathed (first thing in the morning, right before bed).
  • Don't remind or even mention how long it's been since the last cleanup. Instead of arguing, proceed with bath preparations.
  • Don't ask, "Did you shower?" or "Would you like to shower now?" Get everything ready and invite the person in: "Look, your bath is ready. I know how you love your evening bath."
  • Try leading the person to the bath unexpectedly, on your way to doing something else. Or lead the way to the bathroom but without talking about a bath.
  • Have everything ready so you don't leave the person alone, as she may abandon the idea.
  • Don't worry about a full daily bath or shower. Bathe weekly and "top and tail" (face, genitals) as best you can the other days.

Dementia Hygiene Problem: Refuses to Bathe

Possible causes
The person:

  • Has depression.
  • Is embarrassed being seen naked.
  • Had a previous upsetting experience (slipped, the water was too hot, it took too long, she got chilled).
  • Has fears (of falling or drowning).
  • Dislikes being told what to do.
  • Feels rushed and out of control.
  • Can't remember the complex sequence of activities involved.

What to do

  • Build positive associations with bathing: Precede the bath with a pleasant activity (listening to a favorite radio program) and follow up with another one (a dish of ice cream).
  • Build pleasant associations with the bathroom, such as hanging favorite pictures there. Keep the door closed for privacy. Buy the person's favorite brands or scents.
  • Stick to a consistent routine for bathing, which becomes soothing. When you find an approach that works, try to replicate it exactly the next time.
  • Keep the room and water warm. Feeling chilled may be what upsets the bather. Pour a little water on her open hand to show her it feels nice before she gets in.
  • Use as little water as necessary in a bath; a few inches is fine. The tactile sensation of entering water can cause fear or confusion.
  • Cover the mirror if the person talks about other people watching; she may perceive your reflections as other individuals, adding to her fright.
  • Put water in the tub before the person enters the room; the loud pouring of water can cause distress and your loud voice over it can be interpreted as angry shouting. Showers are also noisy and may be more frightening than a bath.
  • Place a brightly colored, nonskid bath mat in the tub or shower to help the person judge depth; put a colored carpet on the floor outside the shower or bath, for focus.
  • Use distractions in the room to take the person's mind off the washing: Play favorite music, install a lava lamp on a shelf opposite the tub or hang favorite pictures, keep up a conversation about a pleasant topic (antics of a dog or child, old family stories). Give the person a washcloth or wash mitt to occupy her hands.
  • Act as if you have all the time in the world.
  • Simplify the process so there are as few steps as possible:
    • To wash, use a combination bodywash-shampoo, ideally in a pump-style bottle.
    • If washing hair is too difficult, skip it for a separate time out of the bath and/or use dry shampoo.
    • To rinse, use a handheld shower head or a pitcher of water.
    • To dry, use a terrycloth robe as a towel instead of toweling off first and then putting on a robe. If the person is becoming impatient, don't worry about a little moisture. Exception: Cornstarch powder is handy to absorb lingering moisture, especially in people with many skin folds or sensitive skin prone to irritations.
  • Never force or intimidate (nudge the person into the shower, lift her foot into the tub, threaten "or else!"). You can set off a contest of wills or catastrophic panic.
  • Be respectful but matter-of-fact about cleaning genitalia. If you're squeamish, offer a warm washcloth and prompt the person to do it during bathing. But if she can't, you should do so yourself at least every few days, to keep the area clean and watch for lesions or rashes.
  • Know when to quit trying to persuade. If you're heading to a stand-off after five minutes of negotiations, drop the subject of bathing. Distract the person with another activity and then try again 15 or 20 minutes later. Make it sound like a fresh new idea.
  • Try alternatives. A gentle, handheld shower while seated on a shower chair helps some people feel more secure and therefore willing. A spouse might follow his or her mate into a shower. Suggest a warm sponge bath "just to wipe off the day" before dressing into pajamas. Use warm, damp washcloths (store several in a plastic bag before you begin) and no-rinse soap. Keep the person covered and warm with an oversized towel.

Dementia Hygiene Problem: Dislikes Being Helped While Bathing (But Needs It)

Possible causes
The person:

  • Is modest.
  • Feels diminished by loss of independence.
  • Had an unpleasant experience with someone helping.

What to do

  • See if a substitute helper works better. A father may refuse a daughter's help, for example, but accept that of a son or an aide.
  • Avoid a situation where the person has to walk from changing room to bathroom naked or wrapped in a small towel. This can build embarrassment or resentment. Use an ample robe or let the person disrobe in the bathroom.
  • Use distraction while helping the person undress, such as singing or a telling a happy story unrelated to bathing.
  • Consider providing a light robe to wear in the tub. It's more cumbersome to wash around but can provide a sense of privacy. Have a thicker, dry robe at the ready to change into when the bath is done. Alternative: Cover genitals and breasts with washcloths.
  • Someone who doesn't mind a full tub of water may feel more modest if it's full of bubbles.
  • If she can handle it, don't actually bathe the person, but hand her the washcloth and let her do it. Issue repeated gentle prompts: "Now wipe your neck. Next the arms. Now the other arm."
  • Don't towel the person off yourself, but let her do it. While helping her dress, try to make a quick check for missed areas. Have a small towel handy to dry those areas surreptitiously. Apply cornstarch if necessary.
  • Try a warm sponge bath out of the tub, given while a robe is worn. But take care to clean the genitals and under breasts or folds of skin.

Dementia Hygiene Problem: Doesn't Take Care of Teeth

Possible causes
The person:

  • Suffers memory loss (a common hygiene problem).
  • May dislike help because she feels she's being treated like an infant or out of control.
  • May have dexterity problems.

What to do

  • Have professional backup: Visit a dentist twice a year to check for cavities, gum infections, dangerously cracked teeth, ill-fitting dentures, and the like. Make sure the office knows the person has dementia, to book adequate time. For tough cases, ask for a referral to a geriatric dentist who has experience working with Alzheimer's patients.
  • Incorporate toothbrushing into the daily routine, such as when getting dressed or ready for bed (ideally both). If it becomes a battle, pick the person's most cooperative time of day. Try brushing your teeth at the same time.
  • Use the same brand of toothpaste the person has always used, if you can. Apply it to the brush for him.
  • Provide a thick-handled, easy-to-grip toothbrush. The noise of an electric toothbrush may cause distress.
  • If the person doesn't recognize a toothbrush, slowly insert your own toothbrush in your mouth to model how it's done.
  • If the person clenches her teeth and won't open them, brush what you can see.
  • Dentists recommend flossing, but unless the person is cooperative about oral care, it's not worth the battle or risk of being bitten.
  • Clean dentures daily. Don't leave it up to her. Ask her dentist the correct way if you're unsure.
  • Minimize the number of products in the bathroom. People with dementia may use shaving cream for toothpaste, for example. Avoid mouthwash, which may be swallowed.

Dementia Hygiene Problem: Trouble Grooming (Hairstyling and Shaving)

Possible causes
The person:

  • Forgets the task entirely.
  • Forgets the complicated steps involved.
  • Can no longer identify tools involved (comb, razor).
  • May be embarrassed.

What to do

  • Let the stylist orbarber know the person has dementia when you book the appointment, to allow for extra time.
  • Don't try to maintain an elaborate women's hairstyle. Ask the stylist to "accidentally" cut it extra-short, so you can go longer between trimmings. Exception: If a woman has a long tradition of a weekly salon visit, she may get pleasure in continuing. But don't keep it up for her out of loyalty once she no longer seems interested.
  • Ask the stylist to shampoo hair first. A professional cleaning and conditioning will feel good and reinforce your efforts.
  • Skip hair products (spray, gel, pomade, dye). Fewer steps make it easier.
  • For shaving, get the razor and lotion ready and give prompts at each step. Some men avoid shaving because they can't remember how.
  • Use an electric razor -- it's less likely to nick.
  • Quit shaving and let a man grow a beard.
  • Acknowledge efforts: "Your hair looks so nice today."

26 days ago, said...

I have been an aide for Alzheimer patients for over 20 years. I have just started a one on one with a new client that is the most resistant to personal care case that I have encounter in my whole carrier. She has only had two other aides work with her and they started when her Alzheimers was not as bad as today. She accepts their help and is very pleasant and affectionate to them. From day one she has been on the negotive tworads me. Her answer always no. She also will cringe when I go to touch her. I managed to get through that and her accepting everything from me except personal care. She even jokes with me and talks pleasantly and lets me touch her hand briefly. But once she is incontinent she shuts down and will not allow me to help her change no matter any of the know approches I use. The amazing thing is yesterday her son came and he pushed for her to let me change her after having a BM in her depends. He got fustrated and left. I was gentle and after he left she let me help her change. For the rest of the day she let me help her with wiping up after toilet use and personal care on her bottom with creams. Changing her clothes and depends too. We had a great day we went for a drive, played cards, walked. She even allowed me to give her a hug for good night. I really felt we had finaly clicked. We went to bed and she slept well through the night. Unfortuanatelly when she woke up this morning she is acting the same way she did the first day I came. Even cringing when I tried to touch her. She woke up with her deppends soaked and refuses to let me help her take them off. She is roaming around the house because she is uncomftorble but leaves when I approach her and for the first time asked me to leave. Please if you have any ideas as how to get through her walls I would appreciate the help.


6 months ago, said...

Hello, I have a question. My patient is now incontinent at night. I clean her up with all the right products but I am finding that she still has a bad order in her personal area with all that hair. I want to shave most of the hair off to keep her from also sweating down there because she can't walk now and sits and I feel if I could shave that area and keep it cleaner she would not have a bad order. Does anyone have any suggestions or have keep them trimmed short in that area and if so how did you do it. Did you shave it or use electric razor etc. I thought about nair but you have to keep it on for 15minutes before washing off and my patient won't sit that long with that stuff on her. Also the other caregiver did it once but said since then she won't let her do it. Could anyone tell me how or if they have had to shave down there for better hyg. thanks Jill


about 1 year ago, said...

Great suggestions! I'll have to try some with my dad - especially on the same clothes and bating. By the way, Depends are the best invention EVER - no leakage and they hold an amazing amount of liquid! I'm kind of surprised dad is not even embarrassed to walk through the store with a big box of his "special underwear."


about 1 year ago, said...

So many comments about difficulty bathing, we have to get our heads together. A radio nearby with classical music, it's a distraction at the same time as being a comfort. Think of how you used a wind up musical stuffed animal for baby's nap. Pretty soon it was an association. Let's use a calendar or Day Board with magnets to indicate when the last shower day was. Hang it in the hallway and make a big deal about doing the entry. My dad came with the warning that he refused female assistance for bathing. Got rid of that rule right away, I guess I did it by assuring I would stay on the other side of the shower curtain, and now I don't even affirm it, he's used to it. I make a solution of shampoo, one part shampoo to five parts water. I squirt where it needs to go, and he rinses. I hold the hand held at the conclusion of the shower while he soaps face and ears, I tell him I'll hold the shower steady while he 'walks in' to the shower spray, he can use both hands while I hold the spray. The whole time I'm assuring him that he's in charge, I can' t see through the curtain, I say, he's the boss, we're almost done. As far as changing clothes, I think the poster who is 'trading' soiled clothes for 'new ones', has the right idea. Best way of handling a two-year-old as well.....trade. Pretty soon the object is the trading and the deal gets done. Oh, and invest in some shower curtains from the dollar store....less expensive than a lot of protective things for the bed, should always have some on hand. As I posted earlier, the motion detecting lights are great for not only lighting the way to the bathroom, but alerting you that the patient is moving about. They're less than twenty dollars each and the batteries last for four or five months. For the hard core parent in hygiene denial, your family will just have to hire somebody to come in an hour a day for bathing assistance and nothing else. Soon she'll be more agreeable to family help, but if not, you deserve a break from a problem like that. Do a round robin with all the siblings, come and help Mom or pay your way out of a turn, it has to be done.


about 1 year ago, said...

I was reading this because we are having bathing issues and trying to confront and deal with my mom in a new assisted living home. She is very combative and rude to the aides and refuses to shower. We are trying to figure this out. I don't know if this is appropriate or not, but I see a few mentions of the elderly driving when they should not. We thought this about my mom for a while and worried that she might hurt someone else. I guess I never really thought the other person would be my father- in the passenger seat- as the victim of us not having the courage to face the driving issue. He was. Please face this issue early on when you need to and avoid tragedy. I wish us all peace and solutions to our problems as caregivers.


about 1 year ago, said...

Thank you for the information it is pratical also truthful and helpful.


over 1 year ago, said...

My mom won't use the bathroom in the middle of the night. She urinates in a container. How ken I get her to use the bathroom again?


over 1 year ago, said...

Thanks for all those tips. I'm at wits end with trying to get my husband to bath. It's funny because he has just been diagnosed. This has been a persistent symtoms for a year now. His memory is still ok. He doesn't communicate much and has thrown hygiene to the wind. I find it so curious as to this being a symptom.


over 1 year ago, said...

Thank you for the suggestions! My dad is late-stage Alzheimer's and has begun resisting things like showering, shaving, and changing his clothes. I'm sharing this article with my mother, who is his main caretaker.


over 1 year ago, said...

Oh and for the shaver recommendation, we got two different types of Norelco. One is the three circular heads, the other one is beard trim straight across single head. They're rechargeable and he seems to like them both. I think the answer is, have the shaver by his t.v. chair. Doing it in the bathroom might be noisy and uncomfortable and long in time. Let him shave in his favorite chair. And as for dressing, folks....remember that you have something that made you feel fat, or pinched or felt too starched. And you avoided that clothing. Find out what the fave article has going for it, and duplicate it in the wardrobe. Research easy accessible clothing on the web, there should be a lot more out there, but at least there's some. I can see my golden years from where I'm standing, I'm glad these helping things are starting to emerge.


over 1 year ago, said...

So many good ideas here...even in the questions!! My 94 year old dad is much improved in this last year. He came here on meds for sleeplessness. When I did a search on tbe web, out went the pills, it's a drug for psychotic behavior, oh and it makes you sleepy. Previous caregivers said they used it only sporadically. I believe getting rid of it is in part responsible for his huge improvement. The doctor said, 'welcome back to the land of the living' when he saw him after eight months and noted his improvement. Everything is great except the hassle bathing, and it's impossible to get him outside in the sun for twenty minutes. The answer to the shower problem lies with an easy to use shower. They are not all that costly, and the family should have thought ahead, shame on you if it wasn't planned for, fix it now. You can't exoect somebody to wobble nakedly into a monster filled with water. Change is needed. If you don't have a place for a nice one-piece fiberglass shower, then remove the existing tub and put it there. A hand held showerhead, a chair that's waterproof, and---make sure you quiet things down, voices reverb....cover mirrors with towels so as not to confuse. Give the patient half a bottle of shampoo to hold as a distraction. I was long into the process, and mind you, the walk-in shower is a dream, easy, comfortable, soothing, temperature-controlled, you can't get scalded...then I realized....it was a tad slippery. I used rubberized shelf roll from the dollar store. Bingo, that solved the problem. Take a good look at what you are asking of the patient....chances are, the tub is scary. Get a good fiberglass shower installation. It would be a medical expense for handicapped, worth twice the price if it eases the problem. Find Light It!, it's a porch light that can be used inside and will light Gram's way to the bathroom, buy a few, you will love this thing because it will alert you to her movement as well as light her path. And, for the indelicate problems mentioned. We solved the odiferous problem within two days. Used Glyco Thymaline which has been around for a hundred years, it's bottled as mouthwash, but the characteristic is that of alkalizing. Objectionable odor gone by 60 percent in day one after a tablespoonful in water, gone in Day Two with the second dose. End of problem. Great ideas here. Like the idea of same time everyday for the shower, don't ask, just start the process ( but please--look at your setup....are you asking this person to go into the belly of a whale? Install a shower with a seat). And the same ritual. The iPad has been an enormous success. I can YouTube Rocky Marciano and Babe Ruth, The Price Is Right, an hour of Frank Sinatra. Shower, IPad and a tea break----life is good. You can put grandkids pictures and the patient can fall in love swiping through all the pics, it's a family album slideshow. With so many apps, you can find soothing sounds or your patient's comfort music. It's now known that the music recognition part of the brain is 'last to go'. We should all be using music instead of pills. And thank you for this page. If we can network and share tips and secrets, we can pass it to the next generation. We owe these people our very world. They fought and won World War Two.....we owe them the best that we can do, and we can do it by networking together.


over 1 year ago, said...

My mother-in-law is 73 years old and has "mild cognitive impairment" according to her neurologist but needs further testing to determine extent and diagnosis (suspect vascular dementia). She is resistant to this further testing, says she doesn't want to know. The problem is she has not bathed more than 2x a week for the last 20 years and in the last 5-10 her showers last approximately 3 minutes. She wears depends and often has accidents but only changes her clothes afterwards and does not wash. Usually it is just urine but occasionally it is bowel incontinence. She smells very badly most of the time, suffers from frequent UTI's, urinates on floor quite often when she does make it to the bathroom and NEVER washes her hands. The infrequent bathing, lack of hand washing and not bathing after accidents has gone on for at least 15-20 years. With frequent falls, car accidents (yes, she is still driving) it became apparent that she and my father-in-law can no longer live on their own. However, mom maintains that she is a perfectly capable adult. When odors get especially bad my husband orders her to take a shower and 3 minutes later she's back out. We simply don't know what to do about this situation. I would be happy if she would bathe 2x a week (provided she also bathes after major accidents) but we don't know how to make this happen. Everything we try to make her do results in arguments and is she gets too upset dad sides with her and we are the bad guys. I don't think her refusal to bathe (or change clothes) is fear based and she is very modest and will not allow assistance. She also has no shame. She has had fecal incontinence in public, used a public restroom to clean up, and has wanted to continue with her shopping plans despite being told she smells of feces. Her pants have fallen down around her ankles on more than one occasion in public and she just pulls them up and continues on her way. She has been told she smells by her children and their spouses, her husband, and her grandchildren multiple times over the last 20 years. I can't believe this is all being called "mild" cognitive impairment. My husband and myself moved in with them 2 weeks ago. We are trying to get things on track. I have been making sure she gets her medications every day and that is going fine, now it's time to tackle hygiene. I am also working on finishing her neurological evaluation but since they relocated to Georgia we have to start over with a new set of doctors. She seems willing to give me medical power of attorney as well. In the meantime, how do you get someone who is convinced they are perfectly capable to bathe? Another factor is that my in-laws are too well off financially to qualify for assistance but not so well off that they won't be destitute before too long if they have to pay out of pocket for care, which is why we are trying to care for them at home for as long as possible. Wow, I just wrote a novel and it's only been 2 weeks!


over 1 year ago, said...

You recommend cornstarch powder to dry folds but that is dangerous because it is able to grow bacteria because it's a food source. Talcum powder is a better option.


almost 2 years ago, said...

my mom is in early dementia and always "puts off " a shower. when she does get in the shower she doesnt use soap[ or shampoo. she just gets wet. i don't know if she thinks she has bathed or what. any ideas?


about 2 years ago, said...

Interesting, my wife truly thinks she showers everyday. I try to get her to shower once a week. The bathtub doesn't work as she has gained a lot of weight and I would not be able to get her out of the tub.


over 2 years ago, said...

I've been the caregiver for my mother in our home since Nov 2011 and the hygiene, or lack there of, is unbearable in our home. Mom always disputes the fact that she can take care of herself because shes a grown woman (of 82) Your advice about bathing and how to go about it sounds wonderful! I will try it all and I thank you in advance!