January/February 2010 Print - Debra Levy Eldercare Associates

Bathing and dementia

Loss of interest in bathing is one of the most common and most confounding symptoms of dementia (memory loss). This change can seem a shocking reversal of personality, especially when a typically quiet person screams or hits.

What’s the problem?

Individuals with dementia may not remember why bathing is important. Instead, what stands out for them is the discomfort and the difficulty of the task.

Emotional discomfort. Bathing is private and intimate. Being watched or undressed and bathed by someone else can feel embarrassing, scary, or downright “wrong,” especially if you’re not sure you know the person.
Physical discomfort. It’s easy to get cold when bathing, especially if the water or the room isn’t comfortably heated.
Difficulty. Bathing is complicated! It involves planning and carrying out multiple steps, in the correct order, and with the appropriate products. Getting in/out of the bath or shower also requires strength and flexibility.

Suggested solutions

Reduce frequency. A bath twice a week may be plenty. Clean genital areas more often if there is incontinence.
Establish routines tailored to the person. Stick with what’s familiar. Consider your loved one’s preferences for time of day, bath versus shower, type of soap, after-bath lotion, etc.
Guide, but avoid taking over. Let your loved one do as much as possible. Respect his or her pace. When directly assisting, describe each step: “Now I’m going to clean your hands.”
Preserve dignity. Allow modesty in whatever ways possible. Close doors and curtains. Place a washcloth or towel over private parts and lift to wash. Have towels and clothing ready.
Ensure safety. Check the water temperature. Install grab bars and make sure tub/shower and floor surfaces are not slippery. Never leave your loved one alone.
Consider alternatives. If resistance or distress continues, look at options such as a sponge bath, a towel bath, or some of the other creative bathing techniques recommended by the University of North Carolina Institute on Aging.

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Can Mom live safely on her own?

Has your family member said, “I want to stay home no matter what”? That’s a common wish. No doubt, you’d love to oblige. But if home care tasks are starting to pose problems, you may be wondering what’s realistic. The Independent Living Assessment makes it easy to get an unbiased appraisal of your loved one’s need for assistance.

The survey was developed by Boston University’s School of Public Health. It takes only about 10 minutes to complete. It assesses an older adult’s ability to accomplish typical activities by:

Asking about an individual’s difficulty with walking, lifting, and bending; daily personal tasks such as bathing, dressing, eating; and life tasks such as socializing and managing money
Identifying problem areas
Suggesting the level of assistance needed
Delivering a downloadable report (a pdf) personalized to your loved one’s situation

To keep abreast of changes in your loved one’s abilities, use the free online tool as often as once a month. You won’t be answering the same questions each time. The assessment questions change in response to changes in your loved one’s abilities.

If memory loss is a concern, check out the Alzheimer’s Association’s CareFinder interactive tool. On the basis of your input, it will suggest the key questions to ask service providers to ensure your loved one’s needs are met.

If it looks like help is needed, you can use these tools as an objective starting point for a family meeting.

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Reducing salt in Dad's diet

Has your family member been advised to reduce the salt in his or her diet? Do you have doubts about your loved one’s ability to follow through? Food, after all, is one of life’s pleasures. And salt (sodium) is a key flavor enhancer. The simplest solution is to remove the main sources of salt, add new flavors in its place, and eliminate commercially prepared foods.

Remove the main sources of salt. (These two steps reduce salt intake by 30%!)

Take the saltshaker off the table.
Remove the salt supply from the kitchen.

Add flavor with herbs and spices. Experiment.

At the table: nonsalt dried herb blends, lemon juice, balsamic vinegar, freshly ground pepper, toasted sesame oil.
In cooking : fresh or dried savory herbs (basil, thyme, sage), exotic spices (curry, ginger, chipotle pepper), citrus juice, and grated citrus rind.
Do not provide a commercial “salt substitute” without the doctor’s permission.

Eliminate commercially prepared foods. An entire day’s “salt budget” can be blown in a single serving of prepared dinners, luncheon meats, quick breads/cereals, and common condiments and marinades. But you don’t have to spend hours in the kitchen, cooking from scratch. Consider instead:

Cooking in bulk. Roast a whole chicken, pork roast, or meatloaf. Leave the leftovers for sandwiches. Save the bones and bits for a savory soup base.
Cooking slowly. A slow cooker allows flavors to develop in stews and casseroles. Put the ingredients together when it’s convenient for you. Use fresh, frozen, or low-sodium foods.
Creating toppings. Sautéed mushrooms, browned onions, homemade pesto or chutney. Freeze in small portions that are easy to grab and warm at mealtime.
Making mixes. Make your own mixes for pancakes, cornbread, and muffins with low-sodium baking powder.

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