Coping with personal hygiene

A person with dementia can appear to lose interest in how they look, even if they used to take great pride in their appearance. It can be upsetting for family members and loved ones of the person to see their appearance slide, and observe them walking around with dirty clothes or unruly hair.

It’s a sensitive subject of course, and not an easy one to bring up with the person. Firstly, consider why it might be happening. It could be for a variety of reasons. The person might be depressed (and need to see their GP), or find it hard to get washed and dressed. Alternatively, they may not even realise they are putting dirty clothes on.

Appropriate clothing
My mother lost interest in her appearance during the mid-stages of her dementia. It was a shock to see her wearing the same clothes repeatedly. She stopped washing her hair. I didn’t know how to broach the subject. At first, I put it down to depression, as she did appear to be depressed, but it turned out to be more than that. She had lost the ability to judge what clothing was appropriate. This is not uncommon. A person may not know what clothing to wear and different climates may also confuse them. When it comes to getting dressed, they may have no concept of winter or summer. You may find the person wearing a thin t-shirt without a coat in the winter, or a thick coat in the summer. And they may not understand how to put clothing on in the first place.

I once bought my mum a thick winter fleece, thinking it would nice and warm for her during the cold months. It was a half-zip top. One day I found it at the bottom of the cupboard, with the front of it cut up. She had found it difficult to get it on and off, as the zip only went halfway down the front of the top before you had to pull it over your head. Tops like this, or cardigans with small or fiddly buttons may simply be too awkward. It might be better to buy cardigans with large buttons, or an open cardigan that doesn’t even need to be fastened. Similarly, avoid trousers with awkward zips or buttons. Stretchy pull-on trousers, or tracksuit bottoms may be more suitable.

If the person doesn’t know what clothing to wear, then you or a carer will need to lay the right clothing out on their bed, from top to toe so that they can tell what item of clothing goes where (e.g. blouse at the top, trousers below). If the person needs help with washing or dressing, they may still not appreciate you helping them, so the best thing to do is encourage them to be as independent as possible. Only help them when they need it, and use small prompts. When helping them, try to:

• Give them space – allow them extra time to get washed and dressed and don’t hurry them along. Patience is a virtue.

• Use distraction techniques if you are helping them – rather than focusing on the fact that they clearly need someone to help them get washed and dressed, distract them by talking about a topic they enjoy.

• Put yourself in the person’s shoes – it’s easy to focus on the practical issues – i.e. tasks that need to be done – but think about the effect that washing or dressing is having on the person with dementia. They may feel embarrassed that someone needs to help them. Be sensitive.

Is it really necessary?
Getting washed or dressed may be a physical struggle, so a person may feel less inclined to do it if they aren’t going anywhere. Maybe it’s too much of an ordeal to get in and out of a bath, or stand up in the shower. A shower stool may be a simple solution, but even then, you’ve got to consider any struggles they may be having with getting dressed.

If a person with dementia refuses to get washed or change their clothes, think about whether it needs to be done there and then. Are they staying in all day? Is it a real problem for them to stay in their nightclothes if they aren’t going out? If you’re taking them out, then maybe a quick wash will suffice. Choose the simplest outfit you can find.

If the person is refusing to wash their hair, then it may be because they find it an awkward task. My mother used to kneel down and wash her hair over the shower in the bath. As she got older, it became harder for her to do this, so I would help her by washing it while she sat on a shower stool. If a person refuses this kind of help, then a weekly visit to the local hairdresser can be presented to the person as an outing or a treat, which it is, but it’s also serving a purpose.

Most of us feel fresher and more alert when we’ve had a daily bath or a shower, but for a person with dementia this may be distressing and even tiring. Respect this, and encourage them to have a quick wash if it’s too much for them to get in and out of the bath. Ask yourself if it’s really important for them to be washed at a certain time. If it isn’t, go back in a few hours and try again later, when they may be more amenable to the idea. Work with their changing moods – pick a time when they are in a good mood – and you are more likely to get a better result with less stress for all concerned.