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When is poor hygiene a health issue for the elder?

by Carol Bradley Bursack, Editor-in-Chief

An often asked question from adult children and caregiving spouses is "how can I get my parents, or spouse, to bathe and change clothes?" I hear this question so much that one thing is certain - you aren't alone in your dilemma. There are several things to look at with hygiene problems, some of which have to do with the caregiver's expectations.

The fact that many elders don't get around to bathing or changing clothes, common as it is, may not be a health issue. It's certainly a social issue, however, and it's one caregivers are acutely aware of.

Personal hygiene is rather subjective to begin with, so when people ask about getting their elders to be "cleaner," I generally ask about past habits. Many people in the older generation were not raised on a daily shower. Many people from Europe, and other parts of the world, think Americans are a bit nutty over the daily bath. So, keep things in perspective. Was your parent or spouse a daily bather? Or did the person just sort of skip around and take a bath once or twice a week? If this was normal behavior though out a life time, it's not going to improve with age. And, likely, just because bathing takes extra effort, you may see some slippage from the routine of the past. That's probably not a big issue.

However, if your parent or spouse was regular with showers or baths and particular about clothes, and now you find that he or she doesn't get around to bathing and runs around in smelly or obviously dirty clothes, then you should consider a few things:

  • Depression can cause people to lose interest in how they look (or smell). If your elders feel isolated or are depressed over life or health issues, they may not care enough to bother with hygiene. If you feel this is the case, the person should see a doctor and the doctor should consider depression. Depression is a much larger issue than cleanliness. If depression is successfully treated, then it's quite likely there will be a renewed interest in hygiene.
  • As we age, our senses often become less acute. We're aware of hearing loss and changes in eyesight. However, we sometimes forget that the sense of smell, and taste for that matter, may have diminished. Have you ever wondered why the elderly lady in the elevator smells as though she, um, bathed in perfume? It could be that she has a diminished sense of smell, so she dumps her scent on like water. This also means that an elder may not be aware of a sweaty smell. Some gentle hints may help here, though it can be a sensitive topic. Be prepared for the elder to be offended.
  • Memory can be an issue with hygiene. Days go by and the elder just doesn't think of a shower or bath. He just took a shower, right? Well, maybe so, but that was several days ago. Again, some gentle reminders may help. A calendar with a note to shower on certain days might be good. Again, however, be aware that some offense may be taken. No one wants to be told they don't smell good.
  • If the elder has dementia, fear may enter the picture. If this is the case, you've got your work cut out for you. It's not a simple matter of reminders. The elder may not know why the water is pouring down on his head. She may be afraid of falling. He may think the person helping him is trying to harm him. Education for the caregiver is important here. Your local Alzheimer's association is a good source. Basically, you'll want to keep the bathroom nice and warm. Soft music may be relaxing. A walk-in shower, with a sturdy shower chair, a hand held shower head and a non-slip rug on the floor are helpful. So are grab bars. Sometimes, you may have to back off and just give a sponge bath. However you do this, tell the person, in a soothing voice, each step you are taking. This warning can keep them from feeling startled or anxious.
  • Third parties can help. My mother-in-law was a very modest person. She allowed me to help her with nearly everything, but she didn't want me to help her with a shower. We lined up an in-home care agency to come in twice a week and give her a shower. She wasn't thrilled, but she looked at this person as a nurse, and therefore she wasn't as embarrassed as she was with family members. Again, safety was an issue, so grab bars, a safe stool and hand held shower head all helped.

With hygiene issues, as with so many others, the caregiver can do well with a little self-examination. Are your worried about your elder's (or spouse's) welfare or are you worried about what other people will think? It's perfectly legitimate to want your elders to look nice for their own sake. We are concerned for their dignity. And it's perfectly human to care if others think you are a good caregiver. One of the ways people judge is by how the elder looks. Even nursing homes are judged by those standards.

We certainly don't want our loved ones to look neglected. However, we do have to take a look at ourselves and our motives so we don't put our elders through emotional pain just because we want pats on the back from the ladies at church.

As I mentioned at the beginning, hygiene is subjective. As with so many issues, balance is important. We want our elders to stay clean enough to be healthy. We want them to retain their dignity. We do our best - and that may mean hiring some in-home help for bathing. But don't make hygiene a driving force in your relationship with the elder. There are many more important issues than whether they are looking sharp that day.

Perhaps a quiet day, with some down time for both of you, is more important - at least on occasion. You may even find that if you let the whole issue go for a bit and stop arguing, the elder or spouse will stop resisting. As with so many other things, they have rights. And they don't like to be bossed around. You may find that a more relaxed approach, with slightly lower standards, gets you farther in the long run.