By Annette Thompson, OTR/L
In my years of experience as an Occupational Therapist working with individuals with severe mental illness and more recently in the elderly with dementia¸ I have found that bathing or showering is often the primary activity of daily living (ADL) where people are having difficulty. There may be many reasons why someone does not want to shower or bathe and many things to consider. Sometimes the reason may be very clear to the patient and the caregiver and other times it may not be as clear and may take some investigating to figure out. Two common reasons are fear of falling and being uncomfortably cold in the shower or bath.
If fear of falling is a reason there are several things that can be done to decrease the fear. An Occupational Therapist can make recommendations of ways to make the bathroom safer with grab bars, non-slip mats, shower chairs or tub benches, changing shower doors if necessary, use of hand held shower head, use of long handled sponge to improve ease of reach and other possible adaptations. The Occupational Therapist can then practice transfers in/out of the shower or tub until the person feels more safe and comfortable. If the individual’s balance is poor then Occupational and Physical Therapy can help improve the person’s balance and this may improve their confidence and decrease fear as well.
Other considerations are sensory in nature such as temperature, smell of the bathroom, making experience more sensory appealing. If temperature is an issue, make the bathroom the warmest place in the house, have the person wear a warm robe until ready to get wet, make sure water is warm before touching the person’s skin, have the towels ready so they can be dried quickly. Other ideas to make the environment more sensory appealing is to make sure room smells nicely, there are many fragrance options available from plug in smells to essential oil burners, nice smelling bath products are just some ideas. Think of the lighting it must be adequate but not overly bright. Maybe playing soft music or soothing sounds of nature would help decrease anxiety.
Social/emotional factors may be coming into play as well. The person may be embarrassed to have help with bathing and showering, and we may need to consider who they feel the most comfortable with in helping them. If there is no choice, think about ways to decrease embarrassment such as them doing their private areas and what they can by themselves as much as possible, covering areas of body once washed with towel if necessary, if person only needs help in and out use curtain for privacy until they need help. Make sure the bath or shower is being given at a time that works well for the individual as well as the caregiver, making sure it is not rushed to decrease anxiety.
Again, there are many possible reasons an elderly person may not desire to bath or shower any longer. If this is difficult to figure out, an Occupational Therapist is the right person to assist with assessing why the person may be having difficulty and making recommendations on how to assist the individual and the caregiver with improving the ease of showering or bathing. This is an individualized process and, as stated above, there are many factors to consider and many possible ideas of improving the situation.