How to Handle 5 Common Dementia-Related Hygiene Problems

Among the behavioral changes you’re likely to encounter as a caregiver for a loved one with dementia, many are hygiene-related. As the condition progresses, it becomes harder for someone with dementia to maintain their personal hygiene whether it’s because they mentally or physically struggle to do so.

Helping your loved one maintain personal hygiene is important for their overall health and to prevent infection, but it can be challenging to get your loved one to cooperate. To help, we outlined some of the situations you’re likely to encounter as a caregiver for someone with dementia and what you can do to help. You should also bring up any hygiene issues with your loved one’s doctor, and consider hiring an in-home caregiver to assist.

This behavior may occur because your loved one:

• Forgets that their clothes are dirty after they’re removed (so they never wash)
• Has impaired ability to make judgments, like whether or not it’s a good idea to wear something that may be dirty
• Likes the familiarity of wearing the same clothes frequently
• Is overwhelmed by too many choices while dressing

• Pare down the closet to fewer options. Stock solids in favorite colors instead of patterns.
• Buy an identical replacement for your loved one’s favorite outfits (same color, style) so you can wash one while the other is being worn.
• Avoid pointing out that the clothes being worn are dirty, which can create shame and put the person on the defensive and lead to arguments.

This behavior may occur because your loved one:

• Has memory loss that prevents them from keeping track of or caring about bathing
• Feels confused about the sequence of steps involved
• Feels juvenile, anxious, or defensive when asked or reminded about bathing
• Feels ashamed asking for help

• Stick to a consistent bathing routine, such as bathing first thing in the morning or 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.”
• Break things down into smaller steps, for example, saying “Here is the shampoo, I will put some in your hand. Can you take the shampoo and rub it into your hair?” versus presenting the bath as one larger task.
• Modify the bathing routine to make it work better for your loved one. This may include cutting down the frequency of bathing to 2-3 timems per week or doing “sink wash ups” in between baths.

This behavior may occur because your loved one:

• Is experiencing depression, which can make it challenging to do things like bathe or shower
• Feels ashamed or embarrassed about not being able to do a simple task they used to be able to complete
• Is embarrassed being seen naked
• Has had a previous upsetting experience bathing (slipped, the water was too hot, it took too long, they got chilled)
• Is worried about falling or drowning
• Dislikes being told what to do

• Build positive associations with bathing: Precede the bath with a pleasant activity (such as listening to a favorite radio program) and follow up with another one (such as a dish of ice cream).
• Create a pleasant environment in the bathroom, such as hanging favorite pictures or buying their favorite brands or scents for soap and bath products.
• Stick to a consistent bathing routine, which becomes soothing. When you find an approach that works, try to replicate it exactly the next time and share what works with other caregivers involved in your loved one’s care.

This behavior may occur because your loved one:

• Feels diminished by loss of independence
• Has had an unpleasant experience with someone helping them bathe
• Is modest or embarrassed to be seen without clothes on

• See if a substitute caregiver works better. A father may refuse a daughter’s help, for example, but accept that of a son or an in-home care aide.
• Use an ample robe or let the person disrobe in the bathroom to avoid a situation where your loved one has to walk from changing room to bathroom naked or wrapped in a small towel. This can build embarrassment or resentment.
• Use a distraction while helping the person undress, such as singing or telling a happy story unrelated to bathing.

This behavior may occur because your loved one:

• Forgets about dental hygiene due to their memory loss
• Has dexterity problems that makes brushing and flossing teeth difficult
• Finds the sensation of brushing or flossing and/or taste of toothpaste or mouthwash unpleasant
• Has mouth pain that they cannot articulate

• Stay up-to-date with your loved one’s twice-yearly dentist visits to check for cavities, gum infections, dangerously cracked teeth, ill-fitting dentures, and the like. Make sure the office knows the patient has dementia, or better yet, ask for a referral to a geriatric dentist who has experience working with dementia patients.
• Incorporate toothbrushing into the daily routine. If it becomes a battle, pick your loved one’s most cooperative time of day. Try brushing your teeth at the same time- modeling and task breakdown is very helpful.
• Use the same brand of toothpaste the person has always used, if you can and apply it to the brush for them.