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Helping Your Elder with Grooming and Hygiene

Seeing that doctors' appointments are kept, meals are cooked, and bills are paid is only part of your job description as a caregiver. Your main job — and most important work — is helping your older person get the best out of her remaining years, even with the seemingly simple tasks that involve personal grooming.

For most elders, depending on others to help them clean and groom their bodies is painful and embarrassing at best — especially when the person performing the service is a son or daughter.

Bathing made easy

Preparing the bath and standing nearby for emergencies may be all that's required to help with personal care. On the other hand, you may have to do everything, including toweling dry an embarrassed elderly parent or cajoling a confused spouse into the shower.

Above all, act casual — even if you don't feel it. A laid-back attitude helps relax your elder in what may be a disconcerting situation for both of you. Calmness is infectious. Remain unruffled if they say they don't need a bath (despite the fact that potatoes are growing out of their ears).

Resistant bathers will frequently submit to the "power of the prescription pad." When all else fails, work with the doctor to get him or her to write a prescription to take a shower.

Have a frank discussion about bathing. Does your older person prefer a family member to assist, or would she like it better if a stranger did it? How about someone of the same sex, or opposite sex? (Many choose to hire a trained person to come in regularly to do personal hygiene like bathing and shaving.)

Good practices

A long, hot bath or a brisk shower and quick rub down with a spa towel may be ideal for some people, but the older person's needs are different.

It's good practice to:

  • Ask about usual bathing routines (morning or night, shower or bath, washcloth versus sponge). Incorporate as many preferences as possible.
  • Suggest a tub bath. Tubs are less dangerous than showers (unless it's a stall shower) and are easier on the caregiver. But don't insist on the tub if she's a shower person.
  • Get everything — towels, sponges, soap, and shampoo — for a smoother process. Liquid soaps are more convenient than slippery bars of soap.
  • Clean under every skin fold and wrinkle — including breasts, neck, and genitalia. Dry these hard to reach places well to avoid fungal infections.
  • Allow modest elders to hold a towel around their bodies while they're being showered. Admittedly, this practice seems awkward, but experienced caregivers say this technique works. But what about cleaning those private parts? You decide.
  • Use a hand-held shower attachment for rinsing. Protect your clothing with a plastic apron, unless you want a shower, too.
  • Install nonslip adhesives or the floor and grab bars in the bathtub. Most medical-supply stores stock a variety of shower stools and bathtub benches for safer bathing.
  • Pat dry —don't rub — sensitive, fragile skin. Applying a moisturizer (one without drying alcohol) after a shower or bath helps to prevent furthering drying.
  • Sponge-bathe your elder on some days. Daily baths aren't usually necessary, and they tend to draw moisture from the skin, especially if the water is hot and the bath or shower is long.

When they become angry or confused . . .

Bathing a confused older adult may become more difficult because the person may have forgotten what bathing is for and perceives the whole experience as distressing. She may feel threatened, get angry, and react with resistance, screaming or even hitting.

For confused elders:

  • Increase the room temperature. Being cold sometimes ignites a strong emotional reaction.
  • Test the water temperature. The elder may be unable to tell you that it's too hot or too cold.
  • Don't get bent out of shape if personal care provokes an inappropriate sexual behavior. Behaviors such as public masturbation, disrobing, and sexual comments are examples of a symptom that sometimes results from a dementing illness. Try distraction or counter with a firm but gentle "no."

Dressing challenges

Determine whether your elder prefers to be "dressed to the nines," comfy in sweat suits, or something in between, and help him maintain his style as long as possible by:

  • Encouraging self-dressing and assisting only when needed.
  • Laying out all clothing in the order it should be put on.
  • Buying duplicates if they insist on wearing the same thing every day.
  • Replacing tricky buttons, snaps, and zippers with Velcro.
  • Maintaining dignity by providing a couple of clothing choices.
  • Complimenting his or her appearance, but only when the flattering remark is genuine.

For disabled elderly, put the painful or weak arm or leg into the clothing first, minimizing stress on the weaker side. When removing clothes, take the stronger arm or leg out first.

As women age, their tummies protrude, and their behinds flatten. Finding pants to fit becomes a chore. An easy solution, especially with elastic-waist pull-up pants, is to wear them backwards so that the extra seat room now covers the tummy.

In addition, if your elder's underwear is uncomfortable, substitute a camisole or undershirt for a bra, or boxers for briefs. Swap pantyhose for knee-highs or socks, but only if your elder lady agrees.

Look out for tight clothes. Advanced age affects the ability to detect the discomfort associated with tight belts and binding sleeves that can interfere with circulation.

Keeping smiles bright and mouths healthy

Old age, illness, and dentures don't diminish the need for oral hygiene and regular dental checkups. The amount of saliva (which cleans teeth) decreases with age, leaving the mouth more vulnerable to tooth decay and infection. Pair that with the inability to brush and floss, and the risk soars.

Dentures should be checked regularly for proper fit. Long-living people are also at high risk for oral cancer — another reason for regular dental visits.

When your elder's loss of dexterity or lack of a firm grip makes holding a toothbrush akin to holding a greased pig, try to:

  • Attach the brush to the elder's hand with a wide elastic band.
  • Enlarge the brush handle with a sponge, rubber ball, or bicycle handle grip.
  • Wind adhesive tape around the handle.
  • Lengthen the handle with a piece of wood, such as a ruler or tongue depressor.
  • Introduce an electric toothbrush.
  • Brush his or her teeth with a wet toothbrush or an electric toothbrush.
  • Clean her mouth with swabs designed for this purpose; oral swabs can be found in most medical supply stores.
  • Clean his mouth with a damp cloth.

For confused elderly, you can stand by the person and give short several simple instructions: "Hold your brush," "Now put toothpaste on the brush," "Now raise the brush to your teeth," "Now brush your top teeth," or "Now brush your bottom teeth." You can even brush along with him, mirroring what to do.

Skip the toothpaste if the elder is at risk for aspiration pneumonia.

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