As your parents get older, you may be finding that they aren’t seeming to bathe very often, or that their clothes are, well, a bit wiffy. Or, perhaps you are their caregiver, and you know that they are bathing less, or are really resisting bathing very regularly.
A lack of personal hygiene can be one of the signs of dementia, but there are lots of other reasons why your elderly loved one may have a lack of personal hygiene.
Contents Overview & Quicklinks
What is personal hygiene ?
In general, personal hygiene will cover these areas –
- bathing and showering
- washing and cutting hair
- hand and foot care – pedicure and manicure
- mouth and teeth
- washing and changing of dirty clothes
- handling of food – washing of hands
How often should an elderly person bathe ?
There is no exact number, but an elderly person should bathe at least once or twice a week to avoid any skin breaks or infections.
This can be a sponge bath, so long as they get washed everywhere, particularly under their arms, areas with folds in their skin and most importantly their private parts.
It is important to wash the folds in the skin, and to dry them properly as well so that bacteria doesn’t build up and cause skin infections.
On the days that your loved ones don’t take a bath, you should get them to at least wash their faces, under their arms, their feet and their private parts with a wet cloth.
In hot weather you may want to make an effort to make sure that your parents wash more frequently, but at the same time you want to be careful that your loved ones don’t overwash, as their skin is thinner and more sensitive than a younger person’s.
As a person ages, their skin thins and produces fewer oils, becoming somewhat prone to tearing and bruising – you may have noticed how many elderly people often have bruises on their arms.
You may want to suggest to your loved one that they use milder products as they get older, as they will be gentler on the skin, and hopefully won’t dry it out so much.
After bathing, another tip is to use a good moisturizer to get some oils back into the skin, which will help to keep it supple and prevent some of those skin tears and breaks.
Women need to take a more care with cleaning their private parts than men, as they are more susceptible to urinary tract infections, which can have serious consequences.
Women who have been to the toilet should always be wiped from front to back to help avoid urinary tract infections.
Why do the elderly not want to bathe ? Elderly hygiene issues
Bathing and doing frequent laundries may be too expensive for elderly parents with a small budget, so they may have to cut back on how frequently they do both to reduce their expenses.
Only so many hours in the day
Our loved ones slow down a lot as they age, and it becomes very hard to do all the things that need to be done.
Our parents have to prioritize what they feel needs to be done first, and personal hygiene may not be as important to them, as some other pressing jobs, so it gets put off for a day or so.
I hear my 90 yr old mom sighing about once every 30 seconds, and when I ask what’s wrong, she always says that she has no energy. And with the loss of energy comes a lack of motivation.
If your loved one lives alone, is mostly sedentary, and possibly suffering from mobility issues, they may have even less energy to spend on their personal hygiene.
This lack of energy means that, again, only so many things can get done.
Disturbed sleeping patterns
Sleep patterns change as people age. It can be harder for seniors to get to sleep, and then they may wake up more frequently during the night, as their sleep is not as deep as when they were younger.
To compound the problem further, seniors frequently need to get up to urinate, suffer from conditions which cause pain and anxiety, and may be taking medications which can play with their sleep as well.
My 90 yr old mom had a very bad hip, which before her hip replacement, would wake her about 5 times a night in pain.
This coupled with Nocturia (waking because of the need to urinate) meant that she was waking 6-8 times a night.
As you can imagine, my mom was shattered the next day, and motivating her to do anything was nigh on impossible.
Our elderly parents feel the cold much more easily than we do, and they may not be bathing so much as they catch cold when they get wet.
The bathroom is the most dangerous place in the house for falls, so if you have mobility issues, are unsteady on your feet, and in pain, the bathroom is a scary place.
If you have noticed that your mom, or dad, is getting wary of an accident in the bathroom, you may benefit from taking a look at my article about making the bathroom a safer place –
Loss of dignity
Your loved one may know that they require assistance with bathing and other aspects of their personal hygiene, but they can’t bring themselves to ask you, as they feel it is undignified to have to be helped.
Pain and Loss of mobility
Any conditions which cause pain and a loss of mobility, such as arthritis, osteoporosis, knee and hip complaints, will make washing, getting in and out of the bathtub or the shower very difficult.
These difficulties can be what discourages your loved one from taking more of an interest in their personal hygiene.
People who are depressed will lose interest in activities and hobbies, in which they once engaged with delight, and very often in the own personal hygiene.
Seniors, like us all, are not immune to such health issues, and depression can be a reaction to medications that they may be taking for age related illnesses, or the result of growing older and more isolated.
Lots of seniors will suffer, to some extent, from some memory loss – mostly short term memory – and will simply forget to do those tasks they have always done.
You can easily solve this by making routines and schedules that are put on charts, and your parents can fill them out as they do the tasks.
They will easily be able to see if they have forgotten to wash, shave, or brush their teeth.
Fear of losing control
Some elderly parents, no matter how gently you approach the issue of personal hygiene, will persist in not bathing etc.
Sometimes this can be put down to a fear of losing control.
Your loved one may just feel that their independence is being threatened, and that it’s going to be a pretext to greater losses in their independence.
Sight and hearing difficulties
Problems with sight and hearing can cause your loved one to take so much more time to make their way through their daily tasks, that there isn’t enough time to get everything done.
The bathroom will also become a far more risky environment if your loved one has problems with their vision.
Loss of sense of smell
As our parents get older their senses dull to varying degrees, and some will lose some of their sense of smell, and unfortunately may be unaware that their body odor has become a little over powering.
How do I approach my parent about their lack of personal hygiene ?
You may find discussing personal hygiene with your parents, but can’t be shied away from, and you need to find some tactful way of letting them know that they may need to take care of themselves a bit more.
It is a good idea to not bring attention to stains on their clothes, as this will just embarrass them.
If you are struggling to find a way to broach the subject which won’t embarrass your parent, try going at it indirectly.
You can start by saying you were in the bathroom, and you wondered if your parent still felt okay using the tub or the shower, and if not is there anything you could do to help with that.
You can also just say that you would like to get them a better bathtub, as you think theirs is a bit unsafe for them.
If you know that they have a real mobility issue, you can just say you feel it is time if they agree that some safety equipment was fitted for the shower, bath sink or toilet.
If your mom, or dad, has their washing machine etc. in their basement, you can simply say that you would like to help them with the washing as the stairs may be getting too much for them.
Once you have the broached the subject, as long as you go tactfully, and respectfully you should find out what the barriers are to your parent taking proper care of themselves
If you find that your loved one wants your help with bathing, and other areas of their care, you can try and make it fun. Spoil them a little with some luxurious products and keep it fun.
Just remember that you are there to support them, and try to keep the tone very positive.
Make it very clear that you are there to support them in maintaining their independence in their own home, and not to take control or interfere.
Dementia and bathing
Some dementia sufferers are very afraid of water, even believing they are drowning, so getting them to take a bath, or a shower, can be extremely difficult.
To help with the fear of water, you can –
- rinse free shampoo – without water
- rinse free bath concentrate – without water
- shampoo in a cap – without water
- waterless bathing gloves
- shower visor – these will keep the water out of their face and their eyes
If this is the case, you firstly want to follow the established routines that your loved one has always followed.
Sufferers with dementia may also, at some stage, become unable to recognize themselves in a mirror. If this is the case for you, and you have mirrors in the bathroom, you should cover them so your loved one doesn’t think a stranger is watching them.
Other than this, you should follow the usual steps of helping an elderly person to bathe, preparing the bathroom –
- clearing away clutter
- heating the bathroom
- having any safety equipment necessary
- having good lighting
- making the floor non-slip
- laying everything out, everything in the bathroom
- creating a relaxing atmosphere
- have the bedroom ready for dressing
If you want to know more about how to do help an elderly parent with bathing, I have an article “Why do the elderly not want to bathe ?” which outlines how to approach an elderly parent about their hygiene and bathing, how to help them without taking over.
What are signs of dementia I should look for, other than personal hygiene ?
Your loved one may find it difficult to recall facts that they have just learned.
You may find they are using memory aids to keep track of things.
Most people will, as they age, forget stuff more frequently, but if their memory loss is only age related they should be able to recall them later.
Agitation and mood swings
Someone who is suffering from dementia can have rapid and unprovoked mood swings, accompanied by pacing around and other agitated behavior.
This is also sometimes accompanied by the person becoming fixated on certain details of something.
Making bad decisions
An early sign of dementia is a display of impaired judgement, and it is particularly apparent when the individual has always shown sound judgement.
They may give away money to sales people, refuse to pay bills without cause, and make decisions which to you seem very irrational.
Problems dealing with money
Dealing with abstract concepts will become more difficult, so dealing with money and numbers may become a very difficult.
Can’t do familiar tasks
All at once, someone with dementia may no longer know how to make their favorite meal, boil some water, or even play a game they love.
Can’t do planning or solve problems
With dementia, planning can become difficult, and a task as simple as writing up a grocery list may no longer be possible.
If you start to regularly find objects in strange places, i.e. the car keys in the fridge, it is usually a good indicator of dementia.
Confusion with time and dates
Getting lost and not knowing where you are, or where you live, losing track of dates, times and seasons are all signs of dementia.
One aspect of this is that the perception of time is different, and the person with dementia may feel 5 minutes to have been 5 hours, and it leads to a lot of confusion.
A person with dementia may stop speaking in mid-sentence because they forget what they were saying, or keep using the wrong words when they speak.
This is one of the classic signs of dementia, where people wander off at any time not knowing where they are, and becoming completely lost.
Repetitive speech or actions
Sufferers from dementia may repeatedly say the same things again, and again, or keep doing the same activities.
It’s believed to be related to boredom or anxiety.
Visual and spatial relationships
Often a person with dementia will not recognize themselves in a mirror.
If they have food on a plate, they may not be able to differentiate between the two, which may be linked to a problem with judging distances and spaces.
Can’t recognize people
Not recognizing family and friends is another common indicator of dementia.
Seemingly purposeless activities
If your loved one keeps engaging in acts which seem to have no purpose, like opening and closing drawings, or filling and emptying suitcases, these may be signs of a form of dementia.
If an individual withdraws from activities with others, this again may be a sign of dementia. Their lack of participation, and showing no interest, may be down to confusion and difficulty with speech.
Loss of motor skills
Very often, as dementia develops the sufferer will lose their motor skills, and tasks such as using eating utensils, buttoning and unbuttoning clothing will either be a struggle, or not possible anymore.
If your loved one is showing a loss of interest, initiative and motivation to do anything, these can be signs of dementia.
With dementia, choosing what to wear can become a problem, and eventually a person may even forget how to dress.
Sufferers may forget to eat their meals altogether, or they may eat, then forgetting they just had a meal, they will eat another. Eventually, they may forget how to eat.
If your loved one exhibits very inappropriate behavior, or starts to act oddly, and not realizing that it’s not appropriate, these may be signs of dementia.
Delusions and paranoia
Often at some stage dementia sufferers may start to hallucinate, to hear and see things that aren’t there, and to become very suspicious of those around them.
People suffering from dementia can get very restless at nighttime and not be able to sleep. There can be confusion between dreams and reality, which can leads to the person becoming anxious, agitated and disorientated.
Some people with dementia, towards the end of the day in particular, latch on to a certain person and start to follow them where ever they go, much like a small child might do.
Source : CBS NEWS – Alzheimer’s: 25 Signs Never To Ignore
Do I need to check with their doctor ?
If you suspect that your loved one may be suffering with dementia, it may be time to consult with their doctor to get some advice on your path forwards.
It may be the case that you are simply not equipped for the task, and that the doctor has other ideas that will help.
The doctor may recommend Extra Care Living, or some other specialized arrangement as being necessary.
Stages of Dementia
While I am not in any way an expert in dementia, my father died for motor neuron disease, which was accompanied in the last year, or so, with some form of dementia, but he also could snap right back to being normal for periods during the day, and then become mildly confused at other times.
My father had a condition – Supra Nuclear Palsy – which slowly robbed him of his voluntary motor functions, at first it was his balance and walking, until even things like swallowing became an issue for him.
So, that to say, I am not claiming clinical expertise, but I have looked after a parent who for several years who was suffering from significant cognitive difficulties, and I am speaking to you from that perspective.
There are quite a number of forms of dementia, Alzheimer’s being probably the best known, and is the most common.
Here are a few of the different types of dementia according to the Mayo Clinic –
“Lew body dementia
Parkinson’s disease dementia
Source – MayoClinic.org
According to Alzheimer’s Association at – https://www.alz.org/
Alzheimer’s disease can be divided into three main stages –
- Early (Mild)
- Middle (Moderate)
- Late (Severe)
In the early stages of the disease, an individual may well be able to carry on with normal activities and take part in things as usual.
It may not be obvious to most people other than close friends and family.
The signs that the disease at this stage can be –
- inability to find the correct words or name for something
- remembering names of recent acquaintances
- short term memory loss
- misplacing objects
- having difficulty with planning, organizing and analyzing
This is, in general, the longest of the three stages, and last for years.
In this stage the disease is more apparent with more severe symptoms and greater change to the sufferers’ behavior, patience and cognitive abilities.
At this stage, the person will start to need help to complete routine tasks such as dressing or brushing their teeth.
Signs of the disease at this stage –
- changes in personality and behavior – these can be delusional, paranoid, obsessive and repetitive behaviors
- becoming angry and frustrated easily
- the ability to hold onto memories both short term and long term i.e. events in their lives becomes more pronounced
- in situations which require social interaction or more mental engagement, becoming withdrawn and not participating
- it can become difficult for the person to make appropriate choices for things such as how to dress
- not knowing where a person is, what the date or day is
- the sufferer may no longer know their own address or telephone number
- wandering and becoming lost
- confusion and loss of control of their bladder and bowels
In the final stage, the sufferers become disconnected from their environment and are often unable to respond to others.
As the disease worsens, the care required increases greatly.
At this stage of the disease, the sufferer may –
- need 24/7 care and supervision
- become disconnected from, or unaware of surroundings and recent events
- have trouble communicating
- develop spacial perception difficulties – unable to see if something is deep or shallow, for example
- fail to recognize their own reflection, believing it to be a stranger
- have difficulty with sitting down, standing up, walking and even swallowing
- have little reduced to infections
Elderly bathing services
If you can’t help your loved one, and there can be many reasons why with dementia, you are going to have to consider whether, or not, they need professional carers, or to move into some form of extra care living.
For help with bathing in the home you have –
“Personal Care Attendant Plans” if your loved one is eligible for Medicaid.
These are Medicaid State PCA Plans, which are a form of funding where the beneficiary has need of help with daily living tasks due to some kind of disability or functional impairment.
These programs vary by state, and so does who are eligible, but they can pay for caregivers in the home for daily living tasks.
“Personal Care Services” – these are services provided by private companies and can be called “Bathing Services”, “Home Health Services”, “Senior Home Hygiene Assistance” and so on.
Personal Care Services includes bathing, toileting and daily living activities or “ADL’s” – all services which do not require skilled nursing.
If you type “Elderly Bathing Services near me” into your internet browsing engine i.e. Google Chrome, Safari or Bing, you will get a list of companies who offer home health aides to provide Personal care services.
Unfortunately, you will have to pay for these unless your loved one has some form of disability benefit.
Medicare will not pay for a home health aide if you only require personal care and do not need skilled nursing care.
Medicare will pay for personal care services if you are receiving skilled nursing care at home and require help with personal care as well.
If you want to know more about what exactly Personal Care is, I have an article “What is Personal Care For The Elderly ?” which explains all the different aspects of the subject including bathing, grooming, dressing, foot care, using the toilet, eating and food preparation, manicure, shaving, help with incontinence pads and dental hygiene.
Good luck and remember to take it all slowly.
Go slowly when you try to find out why your loved one isn’t keeping up with their personal hygiene, and let them know that you are supporting them in maintaining their independence, and that you are not trying to take it away from them.
As I have tried to show, there can be very many reasons for a lack of personal hygiene with an elderly parent, and that it can be a sign of many things, as well as one of the signs of dementia.
I’m Gareth, the author and owner of Looking After Mom and Dad.com
I have been a caregiver for over 10 yrs and share all my tips here.