When it comes to caring for the elderly, hygiene issues are surprisingly common. Determining why their bathing habits have changed is the best way to devise a successful strategy for getting a senior to shower regularly and wear clean clothes. There are many possible culprits, and several factors often combine to form a perfectly unhygienic storm.
At best, poor hygiene can result in minor body odor and an unkempt appearance. However, extreme changes in bathing habits can border on self-neglect, affect a senior’s social life (and quality of life by extension), and even jeopardize their health. Frustrated family caregivers often struggle to convince aging loved ones to bathe more often. The solution seems simple, but there is often much more to this issue than meets the eye.
Why Do the Elderly Not Want to Bathe?
Depression
If a loved one who used to wear makeup, bathe regularly, or insist on crisply pressed clothes suddenly stops taking care of themselves, it’s wise to rule out depression first. A simple checkup with a doctor is a good idea, especially if low energy or lack of interest seems to be part of this change in behavior. Depression isn’t always obvious to an observer, so keep an eye out for the warning signs.
Respect and Control
As people age, they often feel as if they’re losing control over their lives. One thing that seniors tend to keep a tight grip on for as long as possible is their own personal hygiene. Caregivers and family members can nag all they want, but the more you pester them about something, the more they tend to resist. They may react with a remark like, “This younger generation is trying to take over everything. Well, they aren’t telling me when to shower, that’s for sure!”
Dulling Senses
Your nose may easily pick up on the odors of urine, old sweat, and feces, but elders may not even notice these stomach-turning scents. They are especially “nose blind” to their own smell and that of their home. This is because their senses are not as keen as they once were. With the aging process comes a weakening of the senses, especially one’s sense of smell. Many seniors begin showering and changing less frequently because it is harder for them to notice the tell-tale scent of body odor or see stains on their clothing that indicate it’s time for a wash-up and a load of laundry.
Read: Loss of Smell in the Elderly
Boredom
Sadly, many seniors’ days aren’t marked with tons of activities like when they were younger. If there isn’t something special about Wednesday, well, it might as well be Tuesday or Thursday. It can be easy to simply lose track of time and not realize how long it’s been since they last showered. (This can be compounded by actual memory loss, but more about that in a moment.) Furthermore, if there isn’t company coming over or an outing coming up, then what’s the point of exerting the energy to get all gussied up and just sit around the house?
Fear and Discomfort
The bathroom can be a scary place for many older adults. After all, it is entirely composed of slick, hard and often monochromatic surfaces—the perfect setting for a fall. Taking a shower or a bath was once a regular part of their routine that they didn’t think twice about. Now, this basic act carries significant risks. The possibility of a bruised ego, a broken hip, or even a permanent change in mobility is enough to deter anyone from stepping into the tub.
Discomfort is another very common culprit. Seniors get cold much more easily. They may tire out quickly and no longer have the sense of balance and range of motion they once had. If someone must help them bathe, there is a loss of dignity involved. Joint pain and lower energy levels can make simple tasks like doing laundry and changing clothes a real hassle.
One study published in the Journal of the American Geriatrics Society found that “some participants restricted their mode or frequency of bathing in anticipation of future disability instead of seeking out and implementing strategies to maintain or enhance their full bathing ability.” Essentially, these seniors modified their personal hygiene routines out of fear and expectation of a disability that hadn’t even occurred yet!
Furthermore, the ways in which seniors modify their established bathing routines don’t necessarily equate to good or even adequate personal hygiene. A secondary fear of losing independence and dignity causes many older adults to rely on sink baths, baby wipes and other stopgap measures that are not intended to replace a regular bath or shower. Although negative expectations surrounding aging and functional decline are to blame in these cases, seniors’ insufficient adaptations and reluctance to accept help may actually create a self-fulfilling prophecy regarding age-related decline and bathing disability in particular.
Cognitive Impairment
Poor personal hygiene is an incredibly common symptom of Alzheimer’s disease and other types of dementia. Convincing a resistant elder with all their faculties to bathe is difficult enough, but getting dementia patients to shower can seem downright impossible. Conditions that cause cognitive impairment are often accompanied by depression, difficult behavioral changes, sensitivity to stimuli, and/or an inability to keep track of time. When these things combine, it can cause a loved one to refuse to bathe or mistakenly think that they have already bathed for days, weeks or months on end.
Fear and discomfort are often magnified by dementia as well. A loved one may not understand why there is water running on them or become afraid of it. They may hallucinate that the shower drain will suck them down. When it comes to bathing, dementia patients just don’t understand what you are trying to “do to them.” It can be a traumatic experience for everyone involved.
Furthermore, we take daily bathing for granted in this country, but when our elders were growing up, a weekly bath was likely the norm. Your loved one probably adopted more frequent bathing habits as they grew in popularity, but damage to their brain may cause old habits to reemerge. A weekly shower may sound like a godsend for some caregivers, but it’s difficult for dementia patients to actually stick to this schedule when they cannot recall when their last bath day was.
A Caregiver’s Experience With Elderly Hygiene Issues
When my mother-in-law was still living independently in her apartment, she began forgetting to bathe and change her clothes. She would look me in the eye and say she had because she truly believed it. Some of this was due to her memory issues. She thought she must have taken a bath at some point recently, so she said she did. However, I believe fear was a contributor as well.
Finding a workable solution to this problem proved difficult. My mother-in-law was an exceptionally modest woman, even for her generation. I knew that she didn’t want a family member helping her bathe; It was far too intimate. So, we decided to hire a professional caregiver through an in-home care company to come to her apartment and give her a bath on a regular basis.
On the first bath visit, she reluctantly let “the girl” give her a shower. To help ease her mind, I stayed in the apartment but waited in another room. On the second bath visit, a different bathing aide showed up and my mother-in-law refused to let this woman in the house. She slammed the door and that was that. From there, bath visits were touch and go. Some days she would concede, and others she would flat out refuse.
Her apprehension is completely understandable. I wouldn’t want a stranger coming to my home to bathe me, especially if it is a new person each time. But caregivers need to do something to help their loved ones maintain their personal hygiene. The health implications of not doing so can be great. Urinary tract infections (UTIs) and nasty skin conditions can present serious setbacks for an aging loved one.
How to Convince an Elderly Person to Bathe and Wear Clean Clothes
There are many different approaches you can try once you’ve figured out why a loved one isn’t taking proper care of themselves. It’ll take some trial and error to find what works best for you both, but it is crucial to put in the time and effort.
Use Their Doctor as a Resource
In some cases, a loved one’s doctor can be a powerful ally. For example, a doctor can determine if depression is a factor and whether antidepressants may lift their spirits, give them more energy, and help resolve the self-care issue. A renewed interest in life may make a senior more aware of needing (or wanting) to shower/bathe and wear clean clothes.
Medical professionals can also rule out other factors that may be affecting their ability and/or willingness to care for themselves and recommend next steps. Keep in mind that our elders often place doctors on a pedestal and may take their “official” recommendations more seriously than a family member’s pleading and nagging.
Overcome the Poor Hygiene Power Struggle
If you find yourself in a power struggle with an elder who refuses to be “bossed around,” a little well-intended trickery can come in handy. See if you can get a close friend to call and extend an invitation out to lunch or some other gathering that requires a bit of primping. A reason to get cleaned up for someone besides family can sometimes do the trick. Bribery may seem childish, but the promise of a special treat, such as dinner at their favorite restaurant on their weekly bath day, can also be a powerful motivator.
Use the Right Bathing Aids and Products to Maximize Comfort
Specially designed senior bathing aids and products can be a game changer as well. For example, if you can still get a loved one in the shower, but they aren’t steady on their feet or tire easily, there are many types of shower chairs available. This is a wise choice for anyone who is getting older, because it can significantly decrease the risk of falling while bathing.
A hand-held shower head can be useful for bathing a loved one who is afraid of or overwhelmed by water. It allows them (or a helper) to direct the stream only where they want it and when.
Grab bars are another must-have for those who are afraid of falling. Simply having extra points of support can help a senior navigate getting into and out of the shower safely and confidently.
Read: Bathing & Hygiene Top Tips: Promoting Comfort and Cooperation
Frame the Hygiene Conversation Positively
The way you talk about bathing and changing clothing can be very influential. If your loved one requires help in the shower and once enjoyed getting pampered, try referring to bath days as “spa days.” Use a scented body wash and their favorite lotion afterwards to help them focus on the enjoyable aspects and how good they feel afterwards rather than the process itself.
Be gentle when pointing out body odor or soiled clothing. In some cases, a senior simply may not notice and is likely to be embarrassed once it’s brought to their attention. If indifference is the issue, keep in mind that too much nagging is still counterproductive. Caregivers are often beyond frustrated by their loved ones’ apathy regarding their own appearance, but try not to let it show.
While it may not be successful for everyone, positive reinforcement can be helpful. On the rare occasions that you can get an older adult to take a cat bath or put on a fresh shirt, lay on the compliments. Tell them how good they smell and how polished they look. Most elders love getting attention. Again, it may seem elementary, but rewarding their behavior—even minor wins—is very important.
Tread Softly With Loved Ones Who Have Dementia
Dementia care is unlike any other kind of caregiving. Beyond that, it is unique to each family. Some patients merely require reminders and prompting when it comes to bathing and dressing, but others may become agitated or combative at the mere mention of a shower. Furthermore, one never knows when a new behavior or fear may develop or disappear. When it comes to getting dementia patients to shower, proceed slowly and gently. I also recommend scheduling difficult tasks like bathing at the time of day when they are most cooperative.
Don’t insist on a full shower/bath and outfit change all at once. Breaking a task down into smaller pieces over a longer period can make it easier on both of you. Begin with just asking to wipe off your loved one’s face. If they are receptive, gradually move to cleaning their under arms and other parts of the body, all while talking to them and telling them what you are doing as you go. Be soothing. If they fight it or say stop, then stop. You can always try again later. These little victories can function as a stopgap between full baths or showers.
Hire a Bath Aide to Help
While hiring a personal care aide to help my mother-in-law bathe wasn’t totally successful, these bathing visits are a blessing for many families. Most seniors are wholly opposed to the idea at first, but for some, having a stranger assist them is less embarrassing than having a son or daughter do it. Furthermore, in-home caregivers are trained to help people of all physical and cognitive abilities. They know how to knock a shower or bath out quickly, thoroughly and respectfully, all while taking a client’s comfort into consideration. It’s true that some home care companies are better than others about consistently sending the same bath aides, which is why it is important to do your research before hiring.
Read: How to Select a Home Care Company
Consider Long-Term Care Options
Eventually, my mother-in-law’s condition worsened and she began forgetting about her other care needs in addition to bathing. My family saw to her care as best as we could, but the truth was that she could no longer live independently. We were fortunate to find an opening at a nearby nursing home where she settled in very well. My mother-in-law grew comfortable with the staff and her new routine. Surprisingly, bathing was never a problem again.
At some point, many caregivers must face the fact that their loved ones are not going to regain their physical or mental abilities. It may become dangerous for them to continue living independently, or it may be unrealistic to think that one or even two people can meet their increasing need for hands-on care and supervision. Placement in an assisted living facility, memory care unit or nursing home is a difficult choice to make, but many seniors thrive in these environments. Just as a loved one may be more compliant with their doctor or a professional caregiver compared to a family member, staff at a senior living facility may be more successful when it comes to encouraging proper hygiene, getting them to eat, administering medications without hassle, etc.
Compromise Is the Key to Better Senior Hygiene
The hygiene issue is one of many instances in caregiving where compromise is essential. The thing to remember about cleanliness is that you might have to lower your standards. Undoubtedly, it is a difficult and undesirable adjustment, especially if you and your loved one live together.
Caregiving and aging are not glamorous, and there are some changes, such as incontinence, that both parties must simply learn to deal with as best as they can. Do not expect or insist on a pristine appearance. It’s often unrealistic and will only lead to more frustration and tension between you. Taking a loved one to a doctor’s appointment or on an outing looking disheveled and smelling dirty is embarrassing, but do your best to encourage and help your loved one look nice and stay clean. If your current approach isn’t working, then it’s time to consider trying something new.
