Q: Dear Regina, I work in a place where I care for many older persons. Most do not give me a problem with bathing. This one person will trouble me with screaming scratching and sometimes kicking/hitting me when it comes to bathing. I must admit that we don’t like to bathe this patient as it is too much struggle. My colleagues and I feel we have tried everything to get this person to bathe. We are calm, we speak nicely, and still the patient doesn’t want the bath. What else can we do?
A: Bathing or showers are important to keep skin from infections, reduces UTI’s and avoids bad body odour. For people with Alzheimer’s showers can be scary for many reasons. Most fears are related to not having a good experience during the process. So we as caregivers need to identify or consider possibilities of what the discomfort can be. You and your team collectively put together the steps you use to approach the person and note the response and see if you can come up with a possible reason for not liking the shower. Call the family and ask what the routine used to be and go from there. Think about how you would feel if someone approached you to take your clothes off and bathe? What would make things more enjoyable to you and less embarrassing?
Any time the kicking, yelling starts you should back off and evaluate what happened, your actions before the combative behaviour. Did you have their full attention?
You mentioned that you are calm and kind and you also stated that most of you do not like to give the shower. People living with dementia have the ability to sense your discomfort about the shower as well. Your body language may be speaking louder than your kind words.
Understand that some fear may be vision and they are not able to see the water well and all of a sudden, have splashes of water hitting their head or face can frighten them. Try installing a hand-held shower head so you can control where the water hits. Start by asking them to feel with their hands, then point water towards their feet. Talk to them about what area needs to be washed and allow them to do as much for themselves as they can. Then, say “ok, let’s rinse the soap off.”
Distracting them with positive things they will receive after the shower like their favourite cookies or ice-cream or an outing will keep their focus on the fun things when you are bathing them. My favourite is to get them to sing their favourite song while walking to the bathroom. With the song you can tell them each step of what you want them to do in their favourite tune. Also make sure the shower or baths are very comfortable for them and provide dignity.
Be mindful of the words you use that comfort them. Have them feeling you are doing it together not to them. Saying things like “You need a bath, it’s time for your shower, you smell badly,” only upsets them. Use the word “we” instead of “you.” The whole experience should make them feel like they have had some control and feel good about doing it and they are not alone. Remember, we help them help themselves; we are not there to do it for them. When we take over, it belittles them and they are not children. (Children do not like being belittled) They can feel humiliation the same as you and me. They are still someone’s mom, dad, brother, sister or friend.
Q: Dear Regina, What can be the reason my mom does not want to eat regularly? Sometimes she thinks she ate already but I tell her she has not. She still will not eat.
A: People living with Alzheimers or related dementia’s sometimes lose interest in eating for many reasons including things like thinking they already ate, loss of taste, loss of smell and not being able to see the food on their plate. The usual taste they can recognize is salt and sweet. Anything in between becomes bland to them. Medications are another reason that can affect appetite.
A few ideas to help by using extra natural flavourings, checking for visual changes, check her mouth to see if sores or teeth are hurting. Observe if she spits some food out, then adjust the texture for her. Another study I read suggested that patients eat 25 percent more on red plates than white plates. Try small meals during the day. Depending on the level of dementia your mom is at, it may be challenging to multitask during meal time. So don’t talk, allow her to focus on the meal.
People with Alzheimer’s move slowly and they are usually on a different time clock than we are. Get on their time and slow down.
Brainy quote: Train your mind to see the good in every situation
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