The person with Alzheimer’s Disease will be able to care for themselves in the early stages of the disease but may gradually begin to neglect themselves and may eventually need total help. Problems may arise in getting person to change clothes, bathe, brush teeth and groom self. 1. DRESSING. INAPPROPRIATE CHOICE OF CLOTHING OR LACK OF INTEREST IN DRESSING:
Possible Underlying Causes:
Confusion resulting from multiple choices; reduced ability to distinguish colors; depression/apathy; embarrassment, loss of independence.
Possible Modifications: IMAGE::Clothing arranged in sequence on bed such that the underware and the socks are near each other, followed by the pants, and lastly the shirt.
Reduce choices in color and style and in matching tops and bottoms. Remove clothing that is seldom used.
Arrange clothing by color and in a sequence to make decision-making easier. Provide a mirror in room for person to view self. If the person’s reflection is disturbing to him/her, the mirror should be removed.
2. DRESSlNG. DIFFICULTY WITH THE MECHANICS OF DRESSING:
Possible Underlying Causes:
Memory loss; lack of coordination; difficulty remembering the steps; arthritis.
Possible Modifications:
Provide clothing with velcro closings, front closings, large zippers and with few buttons. The use of pull-on, two-piece exercise suits or loose clothing are easy to handle.
3. BATHING. RESISTANCE TO BATHING:
Problems often arise in getting a person to take a bath because of decreased interest in personal hygiene or increased fears or phobia about water and bathing activity.
Possible Underlying Causes:
Resistance to bathing may come from embarrassment; fear of water; fear of getting in and out of bathtub; lack of interest; inability to remember how long it has been since last bathed; apathy; depression or loss of desire.
Possible Modifications: IMAGE::Picture of woman bathing with bubbles.
Arrange implements in order they are to be used: soap, washcloth and towel can be laid out in sequence.
Check water temperature and depth of water in the tub. (Keep lower than normal levels). Try bathing products like bubble bath, gels.
Remove lock on the bathroom door or deactivate.
Post bathing schedule on calendar of daily events.
4. BATHING. DIFFICULTY WITH MECHANICS OF BATHING:
Possible Underlying Causes:
Reduced strength and balance; fear of falling.
Possible Modifications: IMAGE::Picture of a bath tub with hand rails, a small stool, strips on tub floor to prevent slipping, hand held shower, and no enclosure.
Provide grab bars and skid proof strips on bottom of bathtub or shower. Provide bath bench if difficulty in sitting or standing.
Provide hand-held shower for ease in washing or long handled bathbrush. Place towel on edge of bathtub for slippery hands.
Use “soap on a rope” for ease in handling soap.
If bathtub has a glass enclosure, consider removing it for easier access into tub. Make sure the floor is non-slippery. If a throw rug is being used, it should be firmly secured to the floor.
Consider the use of wall-to-wall carpeting.
5. GROOMING. DIFFICULTY OR RESISTANCE:
Many personal care activities are complex and require a number of steps and therefore should be simplified to support the person’s functioning level. Reduced coordination and/or chronic limitations (e.g., arthritis) may also affect the person’s ability or interest in grooming. Personal care related to putting on makeup, brushing hair, oral hygiene, nail care and shaving may require the assistance of the caregiver as the person may not have the motor skills or memory to carry out these activities.
Possible Underlying Causes:
Lack of motor skills, confusion as to sequence of task; depression; embarrassment.
Possible Modifications:
Keep bathroom area uncluttered and simple with only necessary items left out. Lay out all implements in sequence (e.g., brush, comb, mirror). Place simple instructions next to bathroom mirror outlining steps. You might also put a picture of procedure next to direction (e.g., for brushing hair, a picture of person brushing hair). IMAGE::Telescoping magnifying mirror.
Install telescoping magnifying mirror to make viewing easier. If person has problem gripping or using grooming products because of arthritis or limited strength, there are many aids available that provide a better grip or reduce the need to twist or bend (e.g., comb that bends).
Conditions Affecting Personal Hygiene Maintenance
There are many conditions that can affect the way in which personal hygiene is maintained. These can be physical, psychological, social or as a result of a period in hospi tal. Poor personal hygiene can result in a risk of infection and illnesses and also cause many social issues to arise as a result of odours and appearance.
Physical Conditions
Certain disabilities can prevent the person from maintaining an acceptable level of hygiene that is appropriate for them. If the disability has developed over time, the sufferer may feel a great deal of frustration that their needs are not being met. Any amputation or paralysis can significantly alter a person’s ability and advice and help should be sought from the GP to try and gain help in making any suitable domestic adjustments.
Post-operative patients may find that their physical abilities are restricted, either temporarily or permanently. Plaster casts, surgical incisions etc. can all provide some degree of limitation. Adjustments should be pre-empted and help offered from family and friends even for mundane chores such as laundry and ironing.
Anyone suffering from back problems and arthritis or other mobility affecting conditions may find getting in and out of the bath very difficult. If these problems are expected to be long-term, amendments of domestic appliances may be required. A shower may need fitting, possibly with a chair to help with hygiene needs, the use of a home hair dresser and nail technician may prove very beneficial. Advice should be sought from your GP to find suitable arrangements; social services may be able to advise regarding help with additional costs.
Psychological Conditions
Any mental health problem can affect a person’s ability and motivation for caring for their hygiene needs. Depression, anxiety, schizophrenia, Alzheimer’s and others are all known to have the potential to affect a person’s ability to care for oneself.
Loss of memory, motivation, social isolation and a lack of self-worth are all contributory factors. Carers of these sufferers can help by ensuring there are adequate provisions to be able to carry out these tasks. Making sure the soap, towels and such like are readily available and in view may help the person to remember to bathe or wash.
Oral hygiene and fluid intake are frequently overlooked in mental illness. A simple action such as a thorough cleaning of the teeth can significantly raise a person’s moral and help them to feel better about themselves.
On the other extreme, those suffering with obsessive compulsive disorder can become focussed on repeating hygiene tasks as a symptom of their illness. It is not uncommon for sufferers to bathe far too frequently and use unsuitable cleansing agents. Help from the GP may suggest appropriate treatments to combat this illness.
Social Factors
Unfortunately even in today’s modern society, there are still individuals whom find hot water, soap and towels difficult to gain access to. This lack of resources can result in individuals becoming unkempt and socially isolated.
Poor education and a lack of knowledge are other reasons why people have different ideas on hygiene needs. It is important for young children to understand and be taught how to maintain their own hygiene at as early an age as possible.
Hospitalisation
Many patients in hospital, especially those whom are unconscious, become de pendent on staff and visitors to care for their hygiene needs. If necessary their own products should be brought in from home as the familiarity may help them to recover.Patients often need extra help with bathing and washing, hair care, nail care, pressure area care, toileting needs and oral care.
There are many circumstances that affect the ability to maintain hygiene and often, we as carers, can provide a very useful resource in helping with these needs and helping people overcome their illnesses.
Body Odour
Often thought of as one of the most anti-social occurrences in modern times, having body odour is not necessarily a bad thing. Many women find a masculine scent very attractive, as do men to women; it is part of sexuality and scents that are given off by us is partly what makes us attracted to each other. However, on the whole, suffering from excessive body odour can be a nuisance. Many sufferers are oblivious that they have a problem and live blissfully unaware that they are offending people. Sometimes it may be the duty of the family member or best friend to drop hints to try and raise awareness.
Why Do We Sweat?
Sweating is part of the body’s natural cooling process. We lose fluids through our sweat glands which settles on the skin and cools us as the air reaches it. The fluid lost does not have a strong odour, but when it is left; bacteria can breed which increases the strength of smell.
There are certain areas on our body that contain many more sweat glands that other parts; the groin,
underarms and feet excrete higher amounts of oils through a larger number of glands. These areas are also mainly hidden away from the air so the bacteria have plenty of opportunity to breed. If you are overweight, there is a higher chance of having excess folds of skin and flesh in which bacteria can live quite happily.
Exercising and hot weather all increase the amount of fluid we lose as our body needs to work harder to cool itself therefore increasing the risk of excessive body odour.
Treatments for Body Odour
The cheapest, easiest and fastest way of stopping the smell of body odour is by maintaining personal hygiene and washing frequently. It is also vital that the skin is dried thoroughly so as not to provide a reservoir for bacteria to breed in.
Some people can manage to keep their body odour under control by simply washing once a day, while others may need to bathe two or three times a day. Another easy way of reducing odour is to keep clothes fresh. Clean underwear and socks etc. are essential everyday, not just in the reduction of odour, but to help reduce risks of infection or soreness. A scented detergent and fabric softener that is suitable for your skin is a simple means of giving-off a pleasant aroma instead.
The use of an anti-perspirant deodorant is very useful for keeping excessive sweating of the underarms at bay, there are many varieties to choose from, some un-perfumed, others for sensitive skin; try a variety until you find a brand that is suitable for you.The removal of excess hair helps to reduce the areas on which bacteria can breed; shaving during the summer months can help with feeling refreshed and clean and reduces the event of odours developing.
In the instance of very severe sweating, when all other methods of prevention have been tried is to undergo surgery. Some specialists use a technique called a trans-thoracic sympathectomy, which has a success rate of just under 50% for underarm sweating. The surgeon, through keyhole surgery, permanently damages the nerves responsible for the sweat glands, therefore reducing the amount of fluid produced.
Alternatively and rather radically, would be to remove the sweat glands by using traditional surgical techniques; due to the need for an incision, pain and post-operative infections may result along with
scarring.
Some doctors advocate the use of a skin patch that contains agents that help reduce the glands producing sweat. Any surgery carries risks so this procedure should not be undertaken lightly and should be a last resort.With the development of the use of Botox, doctors have found it to be useful in the treatment of sweating, though it can only be used in the underarm area. The substance is injected int o the areas that have been identified as those that are producing the most sweat.
Body odour is a very personal issue and should be handled delicately. It is nobody’s fault that they may produce excess sweat, but there are steps that can be taken to try and control this issue.
Washing and Bathing
Washing and bathing are the most important ways of maintain good health and protecting ourselves from infections, illnesses and ailments.
Maintaining cleanliness is also important for our self-confidence, physical and emotional well-being. The main purpose of washing is to remove dirt and odours.
The frequency of bathing or showering is very individual and may be dependent on culture; food and water will always take priority over personal hygiene. Skin care and healthcare professionals recommend that the face, underarms and genitals are cleansed once a day and not more often, as this can take essential natural oils away from the skin leading to irritation.Hand-washing should be carried out frequently throughout the day, as they come into contact with many potentially harmful bacteria.
Bathing or Showering?
The choice of whether to use a bath or a shower is very individual and each has its own benefits. Bathing can be an excellent way of relaxing and enjoying some quiet time. Special substances and oils may be added to help relaxation or to improve the quality of our skin. Bathing is a good way for parents to spend some quality time with their children and can be a way of ensuring there is some one -to-one interaction.
The steam created from a bath can help open the pores and loosen the dirt from the tiny glands of the skin, aiding in their removal.
If your body is heavily soiled for example after playing outdoors sports, it may be beneficial to have a shower instead of or before a bath so that residual dirt is not left on the skin.
Showering can be invigorating and increase energy levels. Dirt is washed away immediately and it is generally thought that a shower uses less water than a bath.
Products
Try to use products with a neutral pH to avoid the skin becoming too dry. Moisturise after washing to ensure skin remains hydrated.
Rinse the bath after use, especially if an oil has been added so as to reduce risks of slipping for the next user.
The use of a massaging device can help increase circulation to the surface of the skin, improving the overall health of our external appearance.
Drying
All persons should have their own towel that is washed after each use. Bacteria can multiply on a moist towel and infections can be spread easily.
Skin should be patted dry, not rubbed so as to lessen irritation and so there is some water retention on the skin, decreasing the risk of dry skin occurring.
Health and Safety
Those who are physically or mentally disabled will need assistance with their hygiene needs. Carers should maintain their privacy and dignity at all times and ensure that there are no obvious drafts.
Babies should be bathed as per the techniques taught by the midwife or health-visitor. Always check the temperature of the water before using so as to avoid burns or shock from overly cold water.
Use non-slip mats to avoid accidents especially with young children and the elderly. Wash genitals from front to back, to avoid rectal germs spreading into the vagina.
It is advisable to bath or shower prior to admission to hospital for a surgical procedure to remove potentially harmful bacteria from the skin that may infect a wound.
Avoid dry skin by having warm, not hot water, as this can dehydrate the skin.
Washing with sponges and flannels may be best avoided as these items can transfer bacteria to and from different and unfamiliar areas, causing infection risks to be higher. Sufficient cleansing can be achieved using just the hands. If flannels etc are used, every individual should have their own and these should be replaced regularly.
Washing and bathing is a very individual issue. Daily attention to our body is the best way of avoiding odours, germs and infections. The choice of whether to wash at a sink, use a bath or a shower is down to individual preference.
