How does dementia affect washing and dressing?

As a person’s dementia progresses, they will need more help with everyday activities such as washing, bathing and dressing.

For most adults, these are personal and private activities, so it can be hard for everyone to adjust to this change. You can support a person with dementia to wash and dress in a way that respects their preferences and their dignity.

Personal care activities, including washing and bathing, can be a source of anxiety for people with dementia and their carers. Needing help with something so personal can be difficult to accept, and the person you care for may feel self-conscious or embarrassed. It is important to respect their privacy as far as you can.

Supporting a person with washing and dressing

The way a person dresses and presents themselves can be an important part of their identity. Getting ready each day is a very personal and private activity – and one where a person may be used to privacy, and making their own decisions. As dementia progresses, they will need more help with everyday activities including washing, bathing, dressing and personal grooming.

Understanding the challenges

The person may also need you to make choices on their behalf, such as what to wear, or when to wash their hair. This is because memory loss can affect a person’s ability to remember how to do tasks, as well as whether to do them. They may struggle to carry out a sequence of activities in the right order, such as the steps needed to take a shower.

Dementia can affect a person’s ability to orientate themselves in time and physical place. They may also have difficulty with perception and understanding the objects around them. This can make washing and dressing confusing or distressing – for example, if they do not understand why they need to remove their clothes, or how to remove them.

Getting the right support

Supporting a person with dementia to wash, bathe and dress can be emotionally and physically challenging. Even if you’ve been close to the person for many years, looking after a person’s personal care can be a big step in your caring role. It is common to need extra emotional and practical support at this stage.

You could consider arranging a professional carer to take over this side of their care. You can arrange a needs assessment through your local authority (council) to see what support can be put in place.

Focusing on the person

Many people with dementia have a professional carer come into their home to help them with washing and dressing. This should be thoughtfully planned to make sure the person with dementia is comfortable and can express themselves.

For example, the person may prefer their carer to be the same gender as them, or to have experience working with people of the same cultural or religious background, or the same sexual orientation. If the person with dementia is transgender, they may prefer someone who understands identity issues in dementia care.

As a carer, you should support the person to express themselves. Help them to make their own choices for as long as they can and, if they do need help, offer it tactfully and sensitively. For example, if they like to wear a sari or turban, you will need to know how to put these on.

Understanding which outfits the person feels are appropriate for activities such as prayers or worship should help them to express their faith more comfortably.

A person with dementia should be supported to continue with their personal care routine for as long as possible. This can be reassuring and can help to maintain their skills and independence. Changing their routine, (for example, by asking them to shower when they are used to bathing) can be confusing and uncomfortable.

Allowing enough time

When you’re helping someone with dementia to wash, bathe, dress, or get ready, allow plenty of time so that neither of you feels rushed. They may take longer to process information than they used to, and this may affect their ability to make choices.

They may also find physical activities more difficult. If you can make these an enjoyable activity, and are relaxed yourself, the person you care for will feel more relaxed and confident.

Choose the time of day that works best for the person – try to match what has always been their preferred routine, or find the time of day where they are most relaxed. If the person resists your efforts to help and you are unable to find out why, try leaving them for a while. Sometimes it can be easier if you try again a little later.

Making washing and dressing a positive experience

Washing, bathing and dressing, although personal and private, can be a positive experience for a person who needs support. Focus on what they can still do, rather than what they can’t. This will keep up their confidence, as well as skills.

You may have to simplify some choices so that they can make decisions, but try to support them to choose, rather than choosing for them. For example, instead of deciding what the person will wear, ask them to choose between two tops that you’ve picked out.

Try to keep choices simple, so the person does not feel overwhelmed. You may find that different approaches work depending on the person’s mood or how clearly they can think, which may change throughout the day.

Communicating positively

You may need to communicate in a different way than you’re used to – for example by showing them the two tops and asking them to point to the one they like, rather than relying on only spoken communication.

Making light of any mistakes or awkwardness may help you both to cope better with the situation. If the person is feeling frustrated or embarrassed, think about what might make it a more pleasant and relaxed experience. For example, nice-smelling bubble bath or relaxing music can make washing feel like a luxury, rather than a chore.

Be encouraging about the activity – for instance talking about how nice an item of clothing looks, or how warm the bath water feels.

Being organised can help reduce stress. Consider the following:

• Where does the person prefer to get undressed?
• When do they like to get changed, for example before breakfast or after?
• Do they prefer a bath or a shower?
• What toiletries are they used to?
• What dental care do they need? What is their preferred style of dress and how do they wear their hair and make-up? Are they usually clean-shaven?
• Get everything you need ready to hand before you start (including the clothes they will change into after washing).

Creating the right environment

Creating a relaxed atmosphere and a safe environment will make the person feel more comfortable. You can do this by giving the person as much privacy as you can. The room should be warm before the person undresses. It should also be warm after the person has washed, before they get dressed.

Making sure the room is well lit and clutter free will help the person with dementia find what they need. To create a comfortable environment, try to:

• make sure another person will not walk in while they are washing or getting dressed
• close blinds or curtains for privacy
• cover mirrors before the person enters the bathroom. Some people with dementia find mirrors confusing.