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Introduction

The brain is extraordinarily complex. It is made up of several distinct parts, each with its own function. While these parts are separate, they must work together to complete the simplest task.
As Alzheimer’s disease affects each area of the brain, certain functions or abilities can be lost.
One link in the chain of events may be missing and the person will need help or a coping mechanism to complete the task. It is important for caregivers to remember that changes in a person’s behaviour may be related to the disease process.

Where to begin

A dislike of bathing is not uncommon for some people with Alzheimer’s disease. A once peaceful, relaxing activity may be fraught with tension and fear. Start by exploring possible reasons for the person’s behaviour.

Consider the person

• Does the person have the flu or an infection? Is he/she depressed and therefore losing interest in personal hygiene?
• Is the person afraid of stepping into the tub due to his/her inability to judge where the edge is or how deep the tub is?
• Does the person have a fear of bathing as a result of a childhood incident, e.g., near drowning or other unpleasant experience?
• Is there a change in routine? Did the person usually take a shower or a bath, once a week or every day, in the morning or in the evening?
• Is the routine of washing forgotten? Does the person remember what the bathtub is for?
• Is the person uncomfortable with you assisting?
• Are you uncomfortable with your role? Your discomfort may be showing and influencing the person with Alzheimer’s disease.
• Does the person need to wear glasses or a hearing aid to help with communication?

NOTE: If you leave the hearing aid in, watch the amount of water getting into the ear. You may need to remove the hearing aid if you are washing the person’s hair. Keep the person busy with washing and then take out the hearing aid when it is time to wash their hair. Or, use shampoos that don’t require water as suggested under the heading “What to try” below.

Consider the environment

• Is the temperature of the room and water appropriate?
• Is there privacy?
• Is it easy for the person to get in and out of the tub or shower (e.g., are there hand rails)?
• Are you rushed?

What to try

Whether you discover a specific reason for the person’s unease, you can try to make the activity easier and more pleasant.

Here are some suggestions that might help:

• Make the bathroom warm and inviting by playing favourite music and providing adequate lighting.
• Make bathing a positive experience by praising the person’s accomplishments.
• Pull the blinds down and close the door to create a sense of privacy.
• Prepare the bath ahead of time: lay out the soap, wash cloth, shampoo, towels and have the water in the tub.
• Use coloured bubble bath or a coloured bath mat to make it easier to judge the depth of water (avoid a very dark coloured mat - it could give the impression of a hole).
• Simplify the task by giving one instruction at a time.
• Allow the person to do as much of the washing as possible.
• Respect the need for modesty: allow the person to bathe in underwear or a bathing suit or wrapped in a towel.
• Separate hair washing from bath time, if washing hair is part of the problem. Try shampoos that don’t require water.
• Lay a towel or a strip of coloured tape on the tub to distinguish the edge.
• Make sure the person’s hands are occupied by providing a wash cloth.
• If the person regularly refuses to take a bath, escort him/her to the bathroom before raising the subject.
• Try a sponge bath at the sink. This might work if the person has mobility problems.
• Arrange to have another individual, with whom the person with Alzheimer’s disease is comfortable, help with bathing.
• Talk to other caregivers who have faced the same challenge.

For safety’s sake

• Install a railing in the tub to make getting in and out easier.
• Use a tub chair and shower hose if getting into the tub is a problem.
• Use a non-skid bath mat in the bottom of the tub or shower.
• Avoid bath oil that makes the tub or shower slippery.
• Assist the person in and out of the tub.
• Always supervise bathing.

Day to Day

On some days these ideas will make bathing easier. On others you may decide that a sponge bath will be sufficient or even that no bath is best. It’s true most of us like to bathe or shower often and prefer that the person we are caring for does as well. It is important to remember that you are doing the best you can.

In addition…

We are learning more about Alzheimer’s disease and its care everyday – much of it from caregivers like yourself who find solutions to problems and share them with others. You can call your local Alzheimer Society to find resources in your community. You can also exchange ideas by visiting The Care Exchange and Caregiver Forum on the Alzheimer Society of Canada Web site, www.alzheimer.ca. There is information. There is help. You are not alone.

Resources:
The Alzheimer Journey, Module 4, “Understanding Alzheimer Disease: The link between brain and behaviour”, video and workbook series, the Alzheimer Society of Canada, 2002.

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