“Why won’t my mom take a shower or change her clothes.”

People with dementia are often resistant to bathing. They will claim they just showered, or that they will do it later, or outright refuse to shower and change their clothes. Reasons individuals living with dementia no longer participate in hygiene tasks including showers or changing their clothing may include:

• Impaired short-term memory (they believe they already took a shower)
• Sensory changes (sensitivity to water pressure and temperature).
• Impaired executive functioning skills (initiation, sequencing, planning, problem solving).
• Fear of falling.

Understanding what might be causing these changes is important if we are going to have success helping. Trying to force someone with dementia to take a shower will almost always create anger, embarrassment and lack of trust. Instead of forcing or giving ultimatums, try to understand what might be causing them to avoid taking a shower or changing their clothes. Sometimes little changes in the environment can be helpful such as setting up the bathroom to be warm and inviting or creating a “spa” day. Older adults can be more sensitive to cold and need the bathroom to be warm. They may struggle with initiation and sequencing and would benefit from someone turning the shower on and setting the water temperature. Some other helpful tips include:

• Set up the room with only the items they need and remove additional items.

• Have everything ready ahead of time, such as towels, shampoo, a chair to sit on when dressing, and clothes to put on after bathing.
• Use shampoo/conditioner combinations to only rinse hair once. Liquid soap can be easier to apply.
• Adjust shower pressure so it is as soft as possible. People with dementia might feel the “sting” of water as a threat.
• Use pre-existing opportunities to start undressing, such as when someone is sitting on the toilet and has their clothing partly off. Or in the morning when changing out of pajamas.

Unless someone is incontinent, daily bathing may not be necessary. Once or twice a week may be sufficient. Use an activity such as going to the doctor or out to lunch as a reason to complete hygiene tasks. A sponge bath during the week at the sink may be sufficient. You can also use no-rinse soap products to make the process easier.

These are only a few of the strategies that can be helpful. There are many more depending on what your particular situation is and also understanding that each person presents differently. I recommend having an assessment by a trained occupational therapist to determine what might be causing the changes in hygiene and what approach is best for success.