Thursday, January 29, 2009

Poor hygiene in elderly, seniors who will not bathe or shower

As individuals begin to age and their health starts to deteriorate family members may see a dramatic change in hygiene habits. Things like changing their clothes on a regular basis, bathing, combing or fixing their hair, lack of make up for the ladies who always fixed themselves up may start to show up in little ways. It starts with the notice that grandmom or mom didn’t put her lipstick on today or her hair is not fixed well. When you ask about it, the answer you may receive is oh I just didn’t feel like it today. If that answer seems odd to you, it should, there may be something going on that the person is not sharing.
Things like eye sight worsening, arthritis acting up, a physical pain in the body or possibly the beginning stages of memory impairment may be occurring. Often what happens is the person starts to rationaliz their behavior or lack there of by making excuses that are in general terms such as just didn’t feel like, didn’t have enough time, etc.
Like anyone who would say that to you, you want to give the person the benefit of the doubt but you should keep an eye to see if it happens again, the frequency of how often and if there is a pattern to it. Maybe it is only on rainy days when the person’s arthiritis is acting up and causing the person much pain. The person may not tell you how bad the pain is. The key to identifying if patterns of behavior are changing is to watch, listen and document. Keep a little note on your calendar at home or in your wallet, this date, saw mom and hair not done, said didn’t feel like it. This documentation may come in hand later to show a doctor the patterns or to determine how and when possible memory impairments began.
Reference is made to the start of memory impairments because often people who begin to suffer from dementia can lose the sequencing or patterning of how to do a certain behavior. He or she may not remember the steps of how to put lipsticks on, throw a possible eye sight problem on top of that and the person will just stop putting the lipstick on completely. It is much easier to just generalize and say oh I don’t feel like it than to verbalize they are scared that something is wrong and they can’t remember the steps of how to do it or see it.
Bathing is often a behavior that memory impaired individuals will not do. They resist the bathing or showering completely, often becoming angry or aggressive if you bring it up. This can be a combination of many reasons why. Again they can forget how to do it, be ashamed to let anyone see them without clothes, not be able to see the depth of the water in the tub, as a clear water against a white tub bottom and poor eye sight is a dangerous combo, if you can’t see how deep, you won’t get in, thinking you might drown, putting a color on the white bottom like dark blue mat sometimes helps if it is an eyesight problem, getting in and out of the tub physically can be a major problem for people so they stop doing it because it hurts too much and causes them pain. There are many reasons why people will not bathe. Sometimes we want people to bathe on our schedule in the morning when in fact they bathe all their life in the afternoon or evening and for memory impaired individuals who are actively reliving the past, they know they bathe in the evening. If you force them to do it at another time, they will resist. Sometimes sponge bathing is your best answer and showering with a shower chair, safety bars and a hand held shower piece can be done once a week.
Changing clothes often becomes an overwhelming experience for people as well. They will wear the same clothes for several days or wear only like 3 outfits when they have tons of clothes to choose from. We need to remember the goal is to keep people clean and healthy. If we can get a sponge bath and clean clothes whether it is one of the 3 outfits they always wear, they are bathed and clean. Keep your expectations low. They don’t have to wear all the clothes in their closet, they just need to be clean and healthy. Let them wear what they want as long as it is clean.
When you find yourself getting overwhelmed and frustrated, it may be time to bring in outside help. Often people respond to the aide who comes in to bathe them and they will do it for the aide because she is coming specifically to do it and leave. Sometimes the person sees the aide as an authority figure and will comply with the request of the aide to bathe. It is worth a try to see if it works. We need to be creative with our elderly folks not manipulative. Try different things to help them stay healthy and clean. Keep your goal and expectations for them low. They do not live their lives like younger people. Poor eyesight, aging, pain, physical disablity can make anyone feel like why bother putting the lipstick on. It is easy to rationalize it away. Aging is a process and we need to go through the process with them on their terms not ours. For more information, go to www.comfortkeepers.com

1 comment:

Robert Joe Young said...

this was very helpful thank you.