Kate Legg is an Associate Practitioner with Dementia Carers Count. Kate is an Occupational Therapist working in Older Persons Mental Health services in Portsmouth. She has a master’s degree in dementia studies and is particularly interested in supporting people with dementia to do meaningful activities.
What to do if someone with dementia won’t get washed and dressed or change clothes?
This is something which comes up quite a lot when we talk to carers about the difficulties they have when supporting someone with dementia. Confronting difficulties ‘head on’ often leads to further stress, distress and arguments and a more practical approach to these difficulties can be helpful. By thinking about the reasons why the situation is occurring. There may be many reasons why someone is not washing or dressing and putting in practical strategies can often help. We will consider a few reasons and the things that might be helpful.
Possible Difficulty: Remembering where things are kept. Some people find it hard to remember what is in cupboards or drawers or behind closed doors.
Things that might help: Lay out clothes the night before; or have a smaller collection of clothes on display. If possible take off wardrobe doors.
Possible Difficulty: The person is wearing clothes again that they have taken off without realising they are dirty or have been worn before.
Things that might help: Collect up clothes and put in the wash without making it obvious. Lay out clean clothes.
Possible Difficulty: The person realises that they can’t do the task like they used to, and are frustrated, and anxious about it.
Things that might help: If possible make the task simpler by having clothes that are easier to put on, eg no buttons, and try elasticated waists. Be reassuring if you can and make the activity more fun by suggesting a pamper session or doing things together.
Possible Difficulty: The person needs help but won’t accept it from you.
Things that might help: Can someone else help? Often people are more accepting of help from people they are not as close to. Do they need to do the task as often? Would they be able to have a shower every few days instead of every day?
Possible Difficulty: The person is struggling with operating the shower or co-ordinating putting on clothes, or following instructions.
Things that might help: Gentle guidance, turn the shower on for them before they get in. Use lots of non verbal demonstrations and or simple instructions. Allow time for someone to process each stage of the task, don’t rush.
Possible Difficulty: Physically accessing the bath or shower.
Things that might help: Ask for an Occupational Therapy assessment from your memory team or from adult social care. There may be pieces of equipment or adaptations that would help.
We understand that it can be very distressing for carers to see changes in the person they care for. Changes in the persons appearance may lead to negative feelings as these changes can challenge your own moral code. Focussing too much on these changes or excessively ruminating can develop negative thinking patterns and possibly guarded interactions or excessive conflict. This will undermine any positive approach that could help you and the person that you care for and increase the risk of more stress and distress. These are just a few suggestions about what may help, but please ask for advice and support, there is no easy answer and what works one day may not work on another. It’s important that you share your concerns so that you are not overwhelmed and can be reassured that you are doing your best.