Bathroom and people with dementia. Hygiene and comfort versus the struggle of giants

Bathing in people with dementia is one of the most uncomfortable causes of care. The expression of this discomfort is reflected in different forms of agitation that lead to considerable overload for the caregiver. In this text we will try to explain the reasons for this discomfort, offering a series of guidelines that can help to ease the tension that accompanies this type of situation.

Confusion and fear, origin of rejection

In the residential environment, bathing can be a routine, depersonalised task, sometimes harmful to both the resident and the carer. While most people with dementia tend to tolerate this process well, the suggestion to take a shower is not always equally welcome.

As you know, in a few years we have gone from carrying out hygiene in bed to a bathroom with adapted areas, which involves taking the person with dementia to that space, undressing them, soaping them...

The person with dementia may not understand the need for such activity and may be afraid and confused. It is in these cases that, when insisted upon, the feared behavioural disorders (in the form of shouting, physical agitation, psychomotor restlessness...) arise.

For the caregiver, often aware of what awaits him/her, bath time becomes an added stress factor that stirs up his/her fear, anxiety, frustration and conditions the coexistence of both.

Knowing that hygiene is related to uses and customs, intimacy and individual preferences, an approach that could help in these cases would be to know the person's previous hygiene habits, as well as the presence of language alterations (comprehension capacity), sphincter incontinence, inappropriate sexual behaviour, visual or auditory sensory deprivation, etc.

Thus, in the case of Luis, who has been a baker all his life and has the habit of getting up and washing up very early, he may not be comfortable with a schedule that does not suit his usual lifestyle. Similarly, Maria, who has always been very modest, will accept the situation better if another woman helps her in the bathroom.

To our knowledge, pharmacological intervention for the control of this type of disruptive behaviour has been relatively ineffective, to which should be added the high risk of adverse drug reactions. Because of this, it seems logical that the approach should be primarily behavioural, educating and training carers in something that perfectly illustrates the title of Barrick et al.

In addition, we must take into account other aspects such as the number of people, the gender of the carer, the technical aids needed, characteristics of the bath, noise and ambient temperature.

In short, the important thing is not the performance of the activity itself, but to generate the minimum possible discomfort to the person, understanding that bathing is a basic care with hygienic (cleanliness, smell), psychological and emotional effects (feeling of well-being).