Basic Elderly Hygiene
While we are living in a society that bathes daily, it is likely that the senior in your life did not partake in a daily shower growing up. Daily baths are a relatively recent trend. However, regular cleaning is important for a variety of reasons including personal and social comfort.
Frequency of a full bath for a senior will depend on a variety of factors and will vary from person to person – so there is no right answer for all seniors. However, it is generally agreed that while a daily full soak/bath is not necessary, washing of the face, hands, groin and underarm areas on a daily basis is recommended.
Getting Ready to Bathe
Some pre-planning can go a long way toward establishing a good bathing routine. First of all, you may want to involve the senior in this planning to encourage cooperation.
- Decide on a schedule: If you have a routine that you can put on the wall calendar, it minimizes the surprise of the event. It can help a senior predict when it will happen and emotionally prepare if bathing is difficult for him or her. Select days when the house will be free from distractions and times of day when the person is usually most alert and agreeable. Also, be sure to allow a lot more time than you think it may take to ensure that you are not rushing.
- Prepare the area for safety: If you are using the regular bathroom, do you need to install handrails or non-slip stickers to the bathtub? Is there ample lighting? Do you need non-slip area rugs? Do a safety assessment to determine what if any changes you could make to ensure a safe environment. If you will be using assistive devices like hand-held shower heads or bath benches, be sure to have all these in good working order and ready to use.
- Purchase other assistive devices: If your loved one cannot use the regular tub or shower due to mobility issues, you may need to purchase specially designed basins for sponge baths in bed or hair trays to use while seated, etc.
- Simplify products: While we all love fancy soap and fun scrubby devices, it may help to decide on some basic products to use. Because an older person’s skin gets thinner and dryer, it is prone to breakage and infection. Bar soaps usually dry out skin and leave a film that can attract and trap bacteria – only adding to the problems. So, the best soap to use would be a mild liquid anti-bacterial body soap with added moisturizers. You can ask your physician for recommendations. Also, avoid rough “scrubby” bath aids - as the friction can break skin in an elderly person. Opt for soft wash cloths or sponges instead, and use very gentle pressure to avoid breakage.
- Assess if there is resistance and figure out how to address it: Resistance to bathing can be caused by a variety of factors. Sometimes a loss of smell or memory can lower a person’s awareness of the need to bathe. Depression can also be a factor leading to a lack of concern about anything. A common reason for resistance is fear. There are fears that it will be painful and fears of falling or other discomfort like getting chilled. There are often easy ways to address these fears such as installing extra grab bars or heating the room beforehand, etc. Another common fear is embarrassment – which can be helped by the use of a “privacy towel” they can use while you are washing sensitive areas. Chatty small talk about fun topics can also help ease this kind of tension. Most unlikely, it is a rebellion and a desire to keep control over some aspect of a life that may increasingly feel out of a person’s control. In this case, it helps to talk out the person’s feelings and offer as many choices as possible along the way to increase a sense of control. If there is a strong stubbornness, your loved one’s physician may be able to help by “ordering” or “prescribing” a certain number of baths per week. Sometimes this will stop a power issue if that is the case. Again, this type of rebellion is usually not the reason for resistance – so look for basic fears and discomforts first since these are usually the real reason for resistance and are more easily solved.
Many of these steps will apply whether you are just supervising an independent bath or bathing the person entirely. In the event of an independent bath that is private, make sure the person does not lock the door so that if anything happens you will be able to get in the bathroom easily.
- Reduce distractions. Make sure your phone is out of the bathroom and turn off the tv or other noises.
- Prepare: Get all the things you will need in one place before you even start. Heat the room if needed, get all your towels, soaps, etc. in order. Also, it is often a good idea to select and lay out the fresh clothing so that it is ready to go. A large warm blanket is handy in case there is a chill while getting in or out.
- Check your own attitude. If you are calm, happy, and casual – this will help ease any tension, fear or embarrassment. Think of fun topics to chat about beforehand so that you are ready for any awkward moments of silence or need a good distraction.
- Think about comfort. Have your loved one test the water on the back of his or her hand for the right temperature, ask if the lighting is okay, and check in every so often if there is anything you can do to help make more comfortable like adjust the person’s position or turn up the heat in the room, etc.
- Simply and briefly explain each step before you do it. Such as “okay, we are going to take off your shirt first” or “now, I am going to wash your neck.” This helps the person to not be startled by what you are doing and provides some comfort and sense of control.
- Use this time to check the body for sores or rashes. If there are folds of skin, it is important to wash between the folds and dry thoroughly to prevent fungal and bacterial infections.
- Caution: The most stressful time may be just when the bath is over and the person feels chilled. If you have the towel, a blanket and a change of clothes handy, this will go smoothly. In any event, it is the worst time to rush since there are higher chances of slipping or falling then.
- End Well: Dry off completely and get dressed. It may be a good idea to have a snack and/or a small rest after the bath.
Hygiene - Hair, Teeth and Nails
Dental Health: If the person brushes alone but struggles, making the toothbrush longer or easier to grip may help. There are devices and special brushes on the market and you can also modify things yourself. To make a brush longer, you can attach a tongue depressor to the end. To make it fatter, you can wrap a few folded up paper towels around the handle with a rubber band. Remember to change these modifications regularly to avoid breeding germs. Electric toothbrushes do a lot of the work for you. These are typically easy to use for a senior and are great at cleaning teeth with minimal effort. Also, they come in handy if you have to brush for the person.
Nails: Unless your loved one has special concerns like ingrown nails or diabetes, you can usually take care of this yourself with nail clippers. It helps to clip just after bathing as the nails are softer then. Just cut straight across and file gently to soften corners if needed. There is not usually a need to cut cuticles and doing so can increase chance of infections. If you do have diabetic concerns or other problem areas, a podiatrist can often help with this or give proper instructions to avoid any complications.
Hair: There are some great products out there to help with washing hair. Sedentary seniors who are not bathed daily can develop some scalp issues as oils build up. Periodic visits to a salon that specializes in senior hair care can help in many ways. Stylists can do scalp treatments and wash and cut the hair periodically to help bring dignity and a sense of pride for the senior as well as a great excuse to get out of the house. For people confined to bed, they make hair basins for washing. Also, there are hair trays that can be used at the sink to get a better hair wash than you could get during regular baths or showers. There are many “dry” shampoos on the market that can reduce oils and help mostly with appearance and dignity for those “in between shower” days.
The most important things to remember are to stay safe and to not lose your patience with your loved one as bath time can be stressful for both of you. Maintaining dignity and your relationship is important.