Wednesday, September 19, 2012

Alzheimer's and the Dreaded Shower


The dreaded shower it is a problem for the majority of Alzheimer's caregivers. Often a big problem.

By Bob DeMarco
+Alzheimer's Reading Room 


Alzheimer's and the Dreaded Shower

This happened in February, 2010.

I wrote about the "shower". After writing that article I really started working hard on the shower. As a result, I can now say that the shower is rarely a problem.

I successfully incorporated the shower into our day in a way that makes it happen - with ease of effort.


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Now I know some of you are going to laugh. I believe the Alzheimer's patient should take a shower every day. I think if you do it every day it is easier. In other words, it becomes part of the routine of the day, a habit. I can visualize many of you thinking, this guy is nuts.

I know that many of you think once or twice a week is good enough. Well, I don't disagree with you. However, I believe it could be harder to get an Alzheimer's patient to take a shower every once in a while, than it is to get them to take one "like clockwork".

I really need to get going on the Google Hangout so I could write articles like this one and then have you come in and ask me questions, laugh at me, and the like, and see me react live and in person. That would be great fun.

Another issue that comes up is me, the man, giving my mother a shower. It is not a problem for me. You just have to think of your mother as some kind of giant baby. It works.

Some of you recall, that when Dotty gets sick and too weak to take a shower, I have to give her the shower. As it turned out, I now give her a shower once a week.

Let me tell you, when I get done with Dotty she looks like a freshly washed and waxed car. She is squeaky clean. I also condition her hair and give her chin a shave. Note, there is still one tiny part of Dotty's body that I don't clean, she has to do it. The butt does not bother me, by the way.

Are you cringing? This falls under the category of medical science so its okay to be vivid. Are you laughing?

Dotty gets a least five showers a week. Sometimes she is not feeling well and on those days I let her "slide".
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I wrote this part on February 20, 2010.

Almost every single day my mother will resist when it comes time to take a shower. When she occasionally says something other than NO, I look to the heavens as if it is a reward.

My answer to the question about how do I get my mother to bathe is rather difficult to describe. I'll do my best. If you have questions, put them in the comments box and you will likely bring more information out of my head. It will likely improve this article.

Step one, constant positive reinforcement about the positive effects of being clean.

I always reinforce how great it feels to be nice and clean. This might be around 8 or 9 in the morning. This is how I start to set the stage for what is coming later in the day -- Dotty's shower.

I make a big deal about the shower. I am tying to establish a pattern. Establishing patterns is one of the only ways I know that works well to establish consistent behavior with someone suffering from Alzheimer's disease. I am convinced that trying to do the same thing, at the same time, every day is very helpful in Alzheimer's caregiving.

I try and make sure my mother is in some bright light before and during the period directly before her shower. It helps if it is sunny outside. Then we have bright light inside. Bright like effects my mother's overall behavior. Of this I am certain. Bright light, bright mom.

My mother usually gets her shower around 3 - 4 in the afternoon. I gave up trying to do it in the morning. Why? Because it was easier for me to establish the "morning pattern" and then slot the shower into the late afternoon. Obviously, we have doctor's appointments etc that throw us off our schedule from time to time.

Right before shower time, I start talking to my mother. About the weather, or what is going on in the world, or whatever could be on my mind at the time. Communication and dialog. I don't sneak up on her and tell her she needs a shower, or has to take a shower.

No matter what, when I say time to take a shower mom almost always says the same thing. NO. Of course there are variations on this theme. I don't need a shower. I already took a shower.

I already took a shower. This one is pretty funny since mom is still in her pajamas. I learned a long time ago, trying to explain to mom that she could not have taken a shower because she is still in her pajamas is a mistake. All it does is lead to confusion, consternation, and those famous words, kiss my ass Bobby.

Instead of saying you are still in your pajamas, I usually envision something like me solving the world hunger crisis. I have a better chance of solving the world hunger crisis than I do of convincing my mother she could not have showered.

Here is one simple way to get someone suffering from Alzheimer's to take a shower in my opinion. I learned this as a freshman in college in Psychology 101. Let's call this Pavlov's dog and the shower.

I start out like this. Mom its time to take a shower. Sometimes I sit down and pat her hand after she says no, and discuss the merits of being clean. How wonderful it is going to feel, how great she is going to look. I think this to myself and don't say it, my nose will be really happy if you take a shower. I chuckle within.

Then I fire in the zinger. Okay mom lets do this. After you take your shower you will get a nice snack. I usually say potato chips because they are her favorites. Positive reinforcement before the shower, BIG positive enforcement after the shower. For many of you, ice cream or chocolate should do the trick.

I once considered this as a solution to getting mom to take a shower. I would put a potato chip on the end of a string, I would attach the other end of the string to a stick. I would wave the potato chip under mom's nose and then let her follow it all the way into the running shower. I never actually did it. But, I am certain it would work.

When I get mom up for the shower, I hold her hand and walk her toward the bathroom. We get her watch off. The only time mom takes that watch off is when she goes in the shower. She wears her watch to bed and won't allow me to take it off. She has other watches. One looks like a bracelet, so sometimes she has a watch on each wrist. When I was dumb, I use to try and get her to take one watch off. Then I got smart and learned how to laugh. If mom wants to wear 4 watches fine by me, and if will help with the shower she can wear 6.

I think you might be surprised to learn this. I take off mom's robe. She still has her pajamas on. I turn on the shower. I put her bra and panties on the sink. I put her towel on the sink. I hand her the wash cloth. I tell her to make sure she gets all the stinky parts. Then I close the bathroom door, but I leave a crack so I can peak in. We have a glass shower.

It might take 10 minutes before mom gets in. She gets in. I check to see how she is doing. It varies. Most of the time, good enough. She does gets the stinky parts. She is not good at getting her legs and feet. I take care of that.

Carole Larkin asked if I am uptight about seeing my mother nude. The answer is no. Been through too much. I can admit, the first time my mother came marching out into the kitchen nude it did shock me. But between poo poo war, the time my mother woke up and couldn't move her arm and I had to change her, and all the times I have seen her stark nude I am use to it. Life is life, live it to the fullest.

When my mother comes out of the shower, I usually have to dry her back. She usually has her bra and panties on. Her bra straps are usually tangled up. You get use to it. I mean I thought refried beans looked like puke the first time I saw them. Now I love them. Mom looks like a giant nude baby. Maybe that will help the men out there.

My mother dresses herself almost all the time. She does not really know where her cloths are. So, I lay out what she is going to be wearing. I always have extra tops, bottoms, and pajamas right at the bottom of mom's bed -- on the top of the bed at the bottom. If I don't lay out the cloths, Dotty might dress herself like she is getting ready to go to the Crystal Charity Ball.

Carole also asked if my mom is afraid of water. The answer is yes.

Mom won't stand directly under the water when she gets in the shower. I have the shower head set so there is just enough room for her to squeeze in the side. The water is still hitting her but it is not drowning her. I think water is invisible to Alzheimer's patients. This might be why it is so disconcerting. I know water makes my mother feel dizzy. Also, disconcerted.

No doubt water disturbs many people that suffer from Alzheimer's.

I have to tell you this. About three years ago, I thought and believed I would be bathing my mother soon. I thought any day now. Three years. She can still giver herself a decent shower.

This experienced helped me. Just one more good example that they can do more than you think. "More there".

So my advice. Don't get bent out of shape about the simple fact that your loved one doesn't want to take a shower or bath. Accept it. Try and learn how to laugh about it.

Try to come up with a way to positively reinforce the bath experience. Try the snack approach. Or, include something the persons likes to do as an end game. I bet ice cream or chocolate works. Here is the model. Shower leads to snack. Shower leads to ice cream. Shower leads to [you fill in the blank.] The shower should lead to something. Something that is wanted. Something pleasing.

Did you ever consider that if you get uptight you are making them uptight. Make it fun. When they stiffen up about taking the bath or shower, turn the conversation into something that loosens them up. Hold their hand. You will feel the tightness go out of them. Then proceed.

Don't worry you can do it. Be patient. Start looking forward to the day when you can laugh about it.

Original content Bob DeMarco, the Alzheimer's Reading Room