The situation

Getting people with dementia to bathe is a big issue for many caregivers. In the following case, Xiang Shen (a person with dementia) is living with her husband and daughter. Recently, Xiang Shen has often had arguments with her daughter. She would say she had taken a shower when she had not. She also refuses help from her daughter. How would you handle this situation?

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You can utilise your knowledge of behavioural therapy as introduced in Treatments of Dementia > Behavioural Therapy to find out the antecedent, behaviour, and consequences involved.

Antecedent:

Xiang Shen has significant memory decline. She often forgets whether she has taken a shower or changed her clothes. She also believes that she has good hygiene.

Behaviour:

Xiang Shen refuses to bathe and change her clothes.

Consequences:

Xiang Shen gets into arguments with her daughter.

After this, you can identify the needs of the person with dementia using the person-centred care model as introduced in Caregiving Skills > Identify Care Problem.

Personality/Background:

Xiang Shen is a homemaker. She has had the following daily routine since her children were young: Lunch → Nap → Shower → Prepare dinner → Help children to do homework and revision → Dinner → Watch television → Sleep She has lost this routine due to the progression of dementia. If Xiang Shen forgets to bathe, her daughter can only remind her after returning home from work.

Xiang Shen is the eldest daughter in her family. This contributed to her toughness. She is very proud of her son, who has turned into a professional. On the other hand, she is not satisfied with the career achievements of her daughter.

Physical health condition:

The physical condition of Xiang Shen has been very stable. It is not a major reason for her suspiciousness.

Neurological impairment:

Xiang Shen's dementia is still in the early stage. She often forgets whether she has taken a shower or changed her clothes. She also has difficulties noticing her body odour due to sensory loss.

Social psychology:

Xiang Shen is a very tough person. Therefore, she rejects help and reminders from others.

Xiang Shen's daughter hired a domestic helper after Xiang Shen was diagnosed with dementia. This made Xiang Shen very angry. She thinks the domestic helper has taken over her role and that her daughter is looking down on her ability.

You can handle the situation as shown in this video.

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Step-by-step explanations

Relax yourself and adopt suggestions
Relax yourself and remain flexible
Express your care

Our family members and friends often provide us with good suggestions. However, we have to be calm and objective before we can listen to them.

  • We can be flexible no matter what happens if we are in a good emotional and physical state.
  • It is very easy for us to get angry and provoke the person with dementia when we are in a poor emotional and physical state.

Our emotional state, physical state, and behaviour affect us greatly in the caregiving process.

We have suggested a few solutions in the website. You may recall them when you are calm. For example:

  • Environmental modification: Create a dementia-friendly environment
  • Behaviour management: Follow former routines
  • Enhance communication: Provide suitable assistance
  • Enhance communication: Utilise available chances

A caregiver has to pay attention to various things. Two major points are remaining flexible and staying calm.

Caregiving provides an opportunity for us to get along with the person with dementia. It also gives us the last chance to show our love and care.

You can design preventive measures by combining your knowledge and skills in communication, behaviour management, environmental modification, and activity design to fulfil the needs of the person. For example:

Personality/Background:

  1. Behaviour management

    e.g. Arrange for Xiang Shen to bathe in the afternoon to match her former routines.

    Aim: To lower Xiang Shen's resistance.

  2. Enhance communication

    e.g. Have the son ask Xiang Shen to bathe every day.

    Aim: To lower Xiang Shen's resistance.

  3. Activity arrangement

    e.g. Assign simple housework for Xiang Shen.

    Aim: To enhance Xiang Shen's self-esteem.

Neurological impairment:

  1. Enhance communication

    e.g. Provide suitable verbal cues and environmental cues.

    Aim: To assist Xiang Shen to bathe.

  2. Environmental modification

    e.g. Remove unused products in the shower.

    Aim: To prevent Xiang Shen from getting confused.

  3. Activity arrangement

    e.g. Sensory stimulation activity.

    Aim: To enhance Xiang Shen's sense of smell so that she can notice her body odour.

Social psychology:

  1. Enhance communication

    e.g. Utilise every chance to give affirmation when Xiang Shen is willing to bathe.

    Aim: To encourage Xiang Shen to bathe.

  2. Activity arrangement

    e.g. Dressing and makeup games.

    Aim: To promote Xiang Shen's concern about her appearance.

  3. Activity arrangement

    e.g. Bathing the doll games.

    Aim: To help Xiang Shen memorise the steps for bathing.

Physical health condition:

  1. Arrange a sight test for Xiang Shen.

    Aim: To prevent Xiang Shen from getting confused due to visual problems.

  2. Examine if Xiang Shen's skin is too dry.

    Aim: To prevent Xiang Shen from feeling uncomfortable after bathing due to dry skin.

  3. Explore the physical condition of Xiang Shen. Provide a shower chair to help her catch her breath or prevent joint pains that come about from standing for a long time.

    Aim: To help Xiang Shen to bathe.

The suggestions listed above may not be applicable to all cases. However, you can discover other possible solutions by combining behavioural therapy and the person-centred care model. You can also make your life easier by identifying preventive measures for other problems with the help of the person-centred care model.

Summary
You can notice that it is very import for caregivers to stay calm, be relaxed, and remain flexible during the caring process. A family member with dementia will have a sense of dignity when he or she can utilise his or her strength and abilities. He or she will be more cooperative when he or she can feel your care and respect. All of these things will make caring an easier and happier experience.