One of the most common problems caregivers of persons living with dementia including Alzheimer’s disease face is getting their carereceivers into the shower or bath.
It seemed to come on suddenly for Helen. One day she simply refused to go into the shower. Her family set up a shower chair, offered to stay with her while she showered, and even changed the shower door to a curtain thinking those were the issues.
She adamantly refused all options, becoming agitated and angry.
This is a fairly common problem for dementia caregivers. Water, including the shower and bathing can quickly become an issue. Nancy Mace MA and Peter Rabins MD call it “Overeacting or a Catastrophic Reaction” in The 36-Hour Day.
They explain that the refusal to take a bath or shower is because of the complexity of the task. Think about all the steps involved in getting a shower or bath, and you’ll see what they mean. It starts with deciding to get a bath, getting towels, soap, clean clothes and continues until getting dressed after the shower.
Dr. Rabins and Ms. Mace believe it becomes overwhelming because of the steps involved, which the carereceiver often can’t recall, and due to other issues like loss of independence and privacy. The person living with dementia simply cannot cope with the situation, and her solution is to refuse the shower or bath.
Another explanation comes from Bob DeMarco in his article Water Is Invisible and Disconcerting To Dementia Patients. He believes it’s a perception problem. He wrote that water is invisible to those living with dementia, and their reactions are understandable when something they can’t see hits them in the head or body, often where they can’t see what’s happening. He further explains that often drinking water is also an issue for the same reasons.
Or could there be another reason?
Well, in Helen’s case, she was fine with washing at the sink with her caregivers. And she drank plenty of water, so it didn’t seem to be a problem of the fear of water itself. Her family and caregivers thought it was more like a fear of falling. And she had in the bathroom, just not in the shower.
Or it may have been a feeling of claustrophobia in the shower. Or perhaps because for most of her life she had taken baths and refused to use the shower except to wash her hair, and maybe she just didn’t like the shower.
Maybe, it was a combination of all or some of the above explanations.
While the why is interesting, most caregivers are more interested in the solution. Just like there is no one size fits all pantyhose, one solution may not work for all in dementia caregiving. After all, Alzheimer’s disease is the most common form of dementia, yet not the only one. And each individual has his or her own unique challenges. So it’s not surprising the solution may need to be adjusted to fit the level of dementia or physical impairment.
Possible solutions include:
- Take a complex procedure like showering one step at a time, calmly and slowly explaining each step as you go. Allow extra time, and watch carefully for signs of agitation or stress. If present, stop and figure out what is causing it before proceeding to the next step.
- Sometimes what the carereceiver needs is another person in the shower with them, helping each step of the way. This may require the caregiver changing into a bathing suit or scrubs that can be changed for dry clothes when done.
- Installing equipment like a hand held showerhead; a shower chair; grab bars for safety; maybe even changing the colors of mats, shower curtains and even towels to bright primary colors. Changing to red plates has shown to improve the appetites of dementia patients, so maybe changing colors would work in some cases.
- Avoid the shower and give a sponge bath in a chair or bed, or a combination of both. This may take some practice or even additional assistance, Cleaning delicate private tissues can take some extra time and may need to be done with the carereceiver standing or in bed rather than sitting.
- For some people, the time of day may make a difference. I know one person who loves the water in the morning, even going lake fishing. By mid-afternoon he describes himself as being unable to process even small puddles and finding them scary. Showering and fishing in the morning solve his water issues, at least for now.
Seek professional help of an experienced trained caregiver or your carereceiver’s medical team to help you find solutions that work in your specific situation.
It may take some deductive reasoning and maybe even some trial and error to find the solution that works for you. When you look at it as a puzzle or a challenge, often finding the solution becomes a game and may even come easily.
What is your solution to the challenge of showering and dementia?
Leave a comment with your solution.
To your Happy & Healthy Caregiving,
Ina Gilmore MD
Purple Angel Dementia Ambassador
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