Helping your loved one with Alzheimer's disease with bathing is arguably the most challenging aspect of Alzheimer's caregiving. Even professional Alzheimer's caregivers struggle with this, and psychiatric medications are sometimes used to treat the anxiety, agitation and aggression that may accompany this critical activity of daily living. The following ideas and strategies are meant to minimize the need for medications and to ensure the bathing process goes smoothly and with minimal discomfort or distress.
Consider Dignity and Modesty First and Foremost
Issues of privacy, modesty and humility don't decline in importance as Alzheimer's progresses, and they play a major role in the bathing process. Self-consciousness is common when a person undresses or is naked in the bath or shower, and for a parent the role-reversal of having a son or daughter bathe them may be very difficult. Starting the bath with some of your loved one's clothes on (such as a t-shirt or undershorts) may help. Allowing your loved one to hold a towel in front of her body may ease anxiety, as may a steady, confident and reassuring approach.
Prepare Ahead of Time
Be sure the bathing area is ready before it is used: there should be enough hot water, bath towels, shampoo and soap within easy reach. The bathing environment should be one with homelike qualities, warmth and safety. Having grab bars in the bathtub and nonslip adhesives on the floor may help prevent falls.
Tub Bath, Bed Bath or Shower?
Knowing your loved one's likes and fears should help you decide whether a tub bath, shower or bed bath is most appropriate. Tub baths are good for skin care needs, and they are generally more relaxing. Showers have the advantage of the option of a hand-held shower to avoid spray hitting the face. Placing a wash cloth or sock over the shower head may reduce the force of the water on sensitive skin. Finally, bed baths are done more often in the later stages of Alzheimer's, when anxiety, agitation and aggression are more severe and easily precipitated by a shower or tub bath. Here it is critical that all the bathing items are ready and that your loved one doesn't need to be left alone at any time. Keeping the body covered with towels or a bath blanket except for the area being washed is helpful, as is the use of distractions such as singing, music, gentle touch and talking about topics pleasant to your loved one.
Keep the Bathing Experience as Calm and Unhurried as Possible
The importance of approach and non-verbal communication is particularly significant here. A calm and undemanding demeanor combined with a relaxed body position and gentle touch are most helpful. Similarly, involving your loved one in the process by having her hold an item such as soap or shampoo may help her feel safe and connected to the process. Finally, being willing to change approaches when what worked yesterday doesn't work today is another essential component of a bathing experience that goes smoothly.
Kovach, Christine R., ed. (1997). Late Stage Dementia Care: A Basic Guide. Washington, D.C.: Taylor and Francis.
Alzheimer's Association. Accessed: September 2, 2010. Bathing