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    Dementia Symptoms & Caregiver Strategies: Making Bath Time Easier for Cognitively Impaired Adults

    Bathing is often the most difficult personal care activity that caregivers face. Because it is such an intimate experience, people with cognitive challenges may perceive it as unpleasant or threatening.

    Behaviors during bathing

    People with cognitive impairment may become resistant to bathing. Such behavior often occurs because the person doesn't realize what bathing is for or doesn't have the patience to endure lack of modesty, being cold or other discomforts. In addition, loss of independence and privacy can be very difficult for the person. He or she may also have increased sensitivity to water temperature or pressure. Do not take disruptive behaviors personally. Remaining flexible, patient and calm will serve you best as you try the following tips.

    Before you begin

    When bathing a person with cognitive difficulties, allow the person to do as much as possible. Be ready to assist when needed, but try to offer only the level of help necessary. With milder forms, your loved one may only need a reminder to bathe. With increased impairment, he or she will require more assistance.

    Prepare the bathroom in advance by:

    • Gathering bathing supplies.
      Have large towels (that you can completely wrap around the person for privacy and warmth), shampoo and soap ready before you tell the person that it's time to bathe.
    • Making the room comfortable. 
      Pad the shower seat and other cold or uncomfortable surfaces with towels. Check that the room temperature is pleasant. Having calming music playing can also help.
    • Placing soap, shampoo and other supplies within reach. 
      Try using hotel-sized plastic containers of shampoo, and have a washcloth ready to cover the person's eyes to prevent stinging.
    • Monitoring water temperature.
      The person may not sense when the water is dangerously hot or may resist bathing if the water is too cool. Always check the water temperature, even if the person draws his or her own bath.
    Making the Bathroom Safe

    It's important to make the bathroom as safe and comfortable as possible. Install grab bars, place non-skid mats on floors, watch for puddles and lower the thermostat on your hot-water heater to prevent scalding injuries. Also, take care to never leave the person with severe cognitive impairment alone in the bathroom, use products made of non-breakable materials, and keep sharp objects (i.e. tweezers, scissors) out of reach.

    Helping the person feel in control

    You may need to experiment to determine if the individual prefers showers or tub baths.
    • Give the person choices.
      Sometimes it's better to ask: "Would you like to take a bath or a shower?" rather than "Let's take a bath" or "You need to take a shower."
    • Fill the tub with 2 to 3 inches of water.
      Then assess the person's reaction to getting in. It may be better to fill the tub after they're seated.
    • Be sure the person has a role.
      Have your loved one hold a washcloth or shampoo bottle.
    • Be aware that the person may perceive bathing to be threatening.
      Have activities ready in case he or she becomes agitated. For example, play soothing music or sing together. If your loved one resists bathing you can always try again later.
    • Always protect your loved one's dignity and privacy.
      Try to help the person feel less vulnerable by covering him or her with a bath blanket while undressing.
    • Have a familiar person of the same sex help, if possible.
      Cover or remove the mirrors if a reflection leads the person to believe there's a stranger in the room.
    • Be flexible.
      If necessary, allow the person to get into the tub or shower with clothes on. He or she may want to undress once clothes are wet.
    Adapting the bathing process
    • Set a regular time for bathing.
      If your loved one usually bathes in the morning, it may confuse him or her to bathe at night. Determine what time of day is best for them. Then set a routine.
    • Be gentle.
      The person's skin may be very sensitive. Avoid scrubbing. Check the spray on the shower head to make sure the water pressure isn't too intense.
    • Simplify the bathing process.
      Try different approaches to make bathing easier. For example, sew pockets into washcloths to help the person hold on to the soap, or use soap that washes both hair and body.
    • You may experience the most difficulty when attempting to wash the person's hair.
      Try using a washcloth to soap and rinse hair in the sink to reduce the amount of water on the person's face.
    • Coach your loved one through each step.
      For example: "Put your feet in the tub." "Sit down." "Here is the soap." "Wash your arm."
    • Use other cues to remind them what to do.
      Try using a "watch me" technique or lead by example. Put your hand over their hand, gently guiding the washing actions.
    • Use a tub bench or bath chair.
      Having the person sit while showering may be easier and safer. Look for a chair that can be adjusted to different heights.
    • Be sure to cleanse hard-to-reach areas.
      Wash between folds of skin and under the breasts. It is important that genital areas are cleansed, especially if incontinence is a problem.
    • "Sponge bathe" as an alternative.
      Don't worry about the frequency of bathing. "Sponge baths" with a washcloth can be effective between showers. You may want to try non-rinse soap products, which can be used with warm towels and applied under the guise of providing a "massage."
    After-bath care
    • Check for rashes and sores, especially if the person is incontinent or unable to move around.
    • If possible, have him or her seated while drying off skin and putting on fresh clothes.
    • Be gentle on the skin. Pat skin dry instead of rubbing. Apply lotion to keep skin soft.
    • Use cornstarch or talcum powder under the breasts and in the creases and folds of skin.

    You can find more helpful tips at:

    *The information above was compiled by Howard Hahn, MSW thorough personal clinical experience and commonly available published materials.

    Cognitive Impairment can have many causes. The patient’s doctor should be consulted to determine a specific diagnosis and treatment options. But whatever the cause, the symptoms are often alike, and the Caregiver Strategies are often similar.

    The information in the resources listed above was compiled by the Ray Dolby Brain Health Center through clinical experience and commonly available published materials. For information on additional Caregiver Strategies, go to: