Difficult Behavior: Poor Hygiene

As far as difficult behavior is concerned, poor hygiene is one of the more difficult subjects to broach. You don’t want to hurt their feelings or seem insensitive, yet something needs to be done.

The signs of this problem are fairly obvious to everyone it seems, except perhaps to the offending parties:

  • Unpleasant odor
  • Greasy hair
  • Bad breath
  • Dirty and/or food-stained clothes
  • Long finger/toe nails
  • Disheveled appearance
  • Open sores

You might wonder how anyone can stand living like that. Actually there are several possible underlying causes.  Here are some of the more common ones:

Depression  Someone who is severely depressed doesn’t care about their appearance.  They don’t have the energy or motivation to take care of themselves.  Reasoning and trying to ‘talk’ a person out of a clinical depression is not going to work. They will need professional help and possibly medication.

Dementia  This condition often brings other difficult behaviors along with it, such as aggressiveness, paranoia, hallucinations, unwillingness to cooperate, and more.  In this case, you may need assistance from another family member or a professional caregiver to carry out the tasks associated with hygiene.

Sense of Sight and Smell is Failing  The person may have no sense that anything is amiss.  They’re used to the smell or their sense of smell may be failing.  If their vision is also failing, they don’t notice stains on their clothes, or uncombed hair, etc.  In this case, it’s best to politely let them know about the problem and take steps to assist them with their grooming needs.

Memory Problems  It could be they simply don’t remember that bathing, brushing teeth, washing hair, etc. needs to be done routinely.  This is where a care plan, in which they’ve had input, can add structure to their daily routine.  A daily list may be helpful as each item can be checked off as completed.  This could be especially appropriate for someone who is living semi-independently, but is forgetful.

Inability to Keep Track of Time  Most of us live by the clock and calendar to ensure we meet deadlines, remember appointments, and such.  This gives us a clear picture of where we are in our life’s timeline.  However, for young children, those with dementia, and elderly people who have no set schedule, time has less meaning; everything just flows together.  For example, it may have been a week since they brushed their teeth, but to them it seems it was yesterday or perhaps only a few hours ago. 

It may help to have what I call ‘markers’ during the day.  For example, do they watch the news or a cartoon first thing in the morning?  Make it routine that when the program ends, grooming begins.  Or it could be right after breakfast.  Whatever ‘marker’ you choose, be consistent so that it becomes habit.  This structure will also add to their sense of well-being.

Fear of Falling, Vulnerability, Embarrassment, Discomfort  No one likes to feel exposed and vulnerable.  Those with disabilities or the elderly have a definite fear of falling, and may also find they chill easily.  It’s understandable that showering or bathing in these instances is something they dread and want to put off as long as possible.

Regression  This is especially true for someone with Alzheimer’s.  They may need someone to take the initiative for their hygiene as they are not able to handle it themselves.  If you think about how their life was ‘in the olden days’ you’ll realize they probably only bathed once a week.  That was the norm in those days and they don’t understand why it needs to be done so often now.

Control  This is a means of claiming independence.  They don’t want to be told what to do or when to do it, so they go to the extreme just to prove that they are still in control of their life.  This can happen at any age.  It’s a passive temper tantrum without the kicking and screaming.

Medical  Many medical conditions, and sometimes medications, can cause loss off muscle control leading to incontinence, involuntary bowel movements, drooling, and spilling food.  This causes embarrassment for them and they may try to hide it.

This is one serious aspect of poor hygiene that cannot be ignored as it can lead to skin ulcerations and bladder infections, as well as contaminated furniture, clothes and bed linens. In a worst case scenario, this could result in septicemia, a life threatening infection. Refusing a cleanup is not an option in this case.  

What Can Be Done in General:

  • Try to determine the reason for the behavior; speak with their doctor about it.
  • You may need to lower your standards. Bathing 1- 2x per week may be adequate, with spot cleanups as needed.
  • Prepare a bowl of warm water, soap, and wash cloth/towel for a “bird bath” if they’re fearful of the tub or shower.
  • Provide a shower chair, non-slip mat, and hand rail if they have a fear of falling when bathing.
  • Offer to assist them. Move slowly and explain what you’re doing as you proceed, and for your own protection, wear disposable gloves. Be gentle and speak in a soothing tone. Keep their private parts covered with a towel and ensure that no one else is going to walk in. Dry each area before proceeding to the next to prevent chills.  There are also packaged disposable towelettes available for quick cleanups; just carefully warm them in the microwave  before use.
  • Help them brush their teeth, or offer to clean their dentures for them.
  • Keep their hair short. Use a dry shampoo if necessary or run a wet wash cloth with shampoo through their hair, rinse with a wet wash cloth, dry, and comb into place.
  • Help them shave.
  • Use pads or diapers if they have problems with bladder or bowel control. Keep bedding, clothes, and furniture clean and dry to avoid sores, odors, and infections.

Providing hygiene to another is distasteful to some people.  This is nothing to be ashamed of.  Keep in mind, your discomfort will be transferred to them, so it might be better to find someone else to handle it, or hire a home health aide.

Other difficult behaviors a family caregiver may face can be found by clicking here.


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