Tips for bathing a patient who has dementia

Caring for older adults
Don’t throw in the towel: Tips for bathing
a patient who has dementia
By First Lieutenant Lori Flori, RN, BS, MN
SOMEONE WHO CARES for a patient
with dementia may consider bathing to
be the most worrisome task he faces.
Not only does dementia affect a person’s
ability to think and function, but it can
change her personality, mood, and behavior. These changes make interactions
during bathing and other personal care
activities potentially difficult, even dangerous. Patients can fall, and they may
injure caregivers.
In this article, I’ll explain how you can
reduce a patient’s agitation and discuss
alternative bathing tips and techniques
that you can use or teach your patient’s
caregiver to minimize future problems.
Focus on the patient
Alternatives for bathing patients with
dementia are the patient-centered bath
or shower and the towel bath. (See
Soothing with a towel bath.) All are safe,
effective ways to reduce agitation and
provide a pleasant bathing experience
for caregivers and patients.1
The patient-centered bath or shower
uses strategies centered on the patient’s
needs and comfort, not on the task of
bathing. Use various techniques to individualize the patient’s bathing experience, such as providing choices, distracting her with food as a special treat or
playing music, using bathing products
suggested by family members, or modifying the type of shower head used to rinse
her—a spray that’s too strong may make
her feel like she’s drowning.
Setting the stage
Start by considering the environment
from your patient’s perspective.2
The towel bath, which focuses on the
relationship rather than the task, can
significantly reduce the patient’s
discomfort and aggressive behavior and
help foster a therapeutic relationship
between caregiver and patient.4 It’s
especially useful for a patient who’s
For a towel bath, keep the patient
covered and warm throughout the
procedure. Cover her with a bath
blanket before undressing her. Then,
taking care that she’s never uncovered,
gradually replace the blanket with a
large towel that’s been soaked with
warm water and no-rinse soap.
Massage the patient with the wet,
soapy bath towel. Then replace the wet
towel with the dry one, and dry her
with it before dressing her.
Someone with dementia has trouble
processing information, and overloading her senses may trigger an aggressive outburst. These outbursts
may in turn make her more anxious,
fueling more aggressive behavior.
Simple modifications that reduce tactile, visual, auditory, and olfactory
stimuli may improve the bathing experience.
To reduce stimuli, turn down the
lights and play soft music to provide a
distraction from other noise in your facility. Other suggestions include warming
the room before taking the patient into it,
speaking calmly to her, and ensuring
continuity of care so she can build a relationship with her caregiver.3
Steps to bathing success
Bathing should be a pleasant experience
for both of you, not just a task to be
performed. Encourage the patient to perform range-of-motion exercises such as
washing her face if she’s able. As an
added benefit, performing a small task
like this will make her feel like an active
participant in the bathing process. Bathe
her at a regular time, preferably when
she would have bathed at home, or
when it’s convenient for her rather than
when it’s convenient for the facility.
Explain the bathing procedure simply
and perform hand hygiene. Respect her
dignity by ensuring privacy throughout
the process.
When you undress the patient, keep
her partially covered for modesty and
warmth or even keep a light gown on
her. Speak softly and calmly; startling her
can cause aggressive behavior. Let her
know what you’re going to do before you
spray her with water or even touch her
with a washcloth.
Rub-a-dub-dub with care
When you bathe a patient with dementia, you may inadvertently provoke aggressive behavior by rushing her,
speaking in an abrupt tone, or touching
her without warning. Try to communicate your actions and intentions at her
level of understanding, using a relaxed
tone of voice and body language.
Be creative. If your patient can’t handle a shower or bath, try bathing one
part of her body each day until you’ve
washed her all over. Although her safety
is your top priority, take her bathing
preferences into consideration as much
as you can.
If your bathing seems to cause pain,
perform a comprehensive pain assessment and manage her pain appropriately.
Teach your patient’s caregiver techniques that he can try at home. For
example, recommend that he be flexible
about bath times and eliminate any negative actions that can provoke aggressive behaviors. For instance, if talking
to her in a loud voice causes her to be
aggressive, he’ll need to be sure to speak
Implementing patient-centered
bathing is one way to maintain high
standards of patient care while reducing
stress and injuries to staff, patient agitation, and aggressive behaviors. This
change in focus should also improve
patient satisfaction. ‹›
1. Sloane PD, et al. Effect of person-centered
showering and the towel bath on bathingassociated aggression, agitation, and discomfort in
nursing home residents with dementia: A randomized, controlled trial. Journal of the American
Geriatrics Society. 52(11):1795-1804, November
2. Rasin J, Barrick AL. Bathing patients with dementia. American Journal of Nursing. 104(3):30-34,
March 2004.
3. Somboontanont W, et al. Assaultive behavior in
Alzheimer’s disease: Identifying immediate antecedents during bathing. Journal of Gerontological
Nursing. 30(9):22-29, September 2004.
4. Rader J, et al. The bathing of older adults with
dementia. American Journal of Nursing. 106(4):4048, April 2006.
Lori Flori, a member of the U.S. Air Force Nurse Corp., is
an emergency department nurse at Elmendorf Air Force
Base near Anchorage, Alaska.
The views expressed in this article are those of the
author and do not reflect the official policy or position
of the U.S. Air Force, Department of Defense, or the U.S.