Why do some older people become reluctant to take a shower?

Something that many carers and people who work in aged care might have observed is that older people sometimes become reluctant to bathe or take a shower.

Even those who were once very conscious of their appearance and the way they present themselves to the world can become lax about bathing and even putting on clean clothes.

Why is this so?

There can be a number of reasons that older people might ‘give up’ on their personal hygiene.

  • Sometimes older people, especially those with dementia, may fear taking a shower. The person may be afraid of falling, or they may even think their carer is trying to hurt them. By creating a warm, relaxing atmosphere in the bathroom, carers can try to allay some of this fear. It’s also important in these situations to aim to make showering as safe and easy as possible. Ideally bathe in a walk-in shower, use a sturdy shower chair and a hand-held shower head, make sure there are grab bars in place, and non-slip surfaces on the floor.
  • Older people’s senses can become dull. They may not notice that they are beginning to smell. A gentle hint can help in this situation – although you do risk the person being offended!
  • If the person feels isolated and cut off from their community, or depressed about their life or health, they might give up on caring about how they look or how clean they are. If this is the case, we recommend speaking to a doctor about the possibility of the person having depression, and the options surrounding treatment.
  • Sometimes older people may forget they haven’t showered. If this is the case, you can mark on a calendar when showers should be taken.
  • Modesty or shyness can also make some older people reluctant to take a shower. Older people might feel uncomfortable about undressing in front of another person, especially someone they know. Sometimes hiring an extra person, previously unknown to the older person, who can help with showering can remove some of the embarrassment, especially if the person thinks of them simply as a medical practitioner there to help them.

If the reluctance to shower remains – does it really matter?

If the person you are caring for remains reluctant to take a bath, you may have to resort to just sponging them. Do it gently, speak to them kindly and softly, and explain everything you do. Reassure them.

Sponging generally involves using a warm washcloth to wipe armpits, the groin area, genitals, feet and any skin folds. It can help to older people avoid developing body odor between showering.

If person is reluctant to shower, it might also be useful to examine why you are concerned about their hygiene? Are you worried about the person’s wellbeing, or are you more concerned about society’s judgement?

Showering does help older people avoid skin tears and infections, so it does have health benefits.

And of course, our appearance is one way we can present ourselves to the world. If we take pride in our appearance, it usually follows that we have dignity and self respect.

When an older person lets their appearance slip, it can give the impression they have given up on themselves, and have lost some of their dignity.

It’s understandable we might also be concerned about how others might judge the care we are providing.

But does that matter?

So long as the person you are caring for is hygienic enough that they remain healthy, perhaps it’s okay to let showering slip from time to time.

A general rule of thumb is to shower at least twice a week, but even this isn’t set in stone.

You may even find that if you take the pressure off having regular showers, the older person you are caring for might find it easier to bathe and you can find a more relaxed, harmonious equilibrium for you both.

Please note: the image used to illustrate this article does not represent actual people or events.

Image: Young man, Old man – Tom Hussey photographer.

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  1. It may also be… it can be exhausting to be showered ..as I have had csf for 20 yrs I know that to be true. ..so bed bathing or even just sitting in chair being washed and just uncovering each area bit by bit was appreciated by my clients and moisturizing as I went ( and even chatting!!)made my clients feel human not just a body being washed.

  2. Being queued up on a commode chair or stripped naked by a male PCA are good reasons not to shower. If you want people to shower not surprisingly they ask for privacy and dignity. Roughly handling residents in order to do the job more quickly is another reason why people with Dementia might be fearful of showering. I think this article really fails to address a number of issues with Aged Care.

    1. I don’t know about other countries, but in Scotland we (Social Care Workers/Assistants, Homecarers etc) have to abide by Codes of Practice and the Health and Social Care Standards. In fact, we have to register with the SSSC to be able to work in our field, and prove that we have kept up to date with training to be able to renew. If we are accused of not abiding by the CoP and the HSCS then we can be taken to court and prosecuted.

      The description of showering you have given Gian should not and would not be tolerated in our workplace. We are inspected regularly by the Care Inspectorate (unannounced checks) and patients, their families and staff all have the opportunity to feed back to them anonymously about the standard of care received/given.

      I would like to think that the person writing the article is presuming a certain standard of care combined with decent human dignity and the old adage, “treat others as you’d want to be treated yourself”.

      1. I think Gian (sort of) raises the point I was trying to make.

        If people refuse to shower, after all you have tried, and they are incontinent, and in fact they do not want to be touched by ANYONE – then, what do you do?

        You have to clean them, as skin breakdown will result from the obvious results of bodily waste and they will be at risk of infection and subsequent delirium.

        In some situations we need to be coercive? No?

      2. In this day and age, it is wonderful that your country still respects the elderly. I am a caregiver myself and it can be difficult at time and as you say, “treat others as you’d want to be treated yourself” says it best! God Bless you for what you do!

  3. The above are all reasons that older people might not wish to shower but don’t forget that often their generation grew up having weekly baths,so with minimal degree of cognitive impairment it may mean that is what they “remember”
    These days too the cost of hot water can be a problem financially for many.

  4. I am my Mama’s caregiver. She gave me a lot of trouble about showering but now has become use to the routine. She still doesn’t want to be bothered but she knows that once a week, I will come into her room and strip her bed to put clean sheets on. That is the signal that clean sheets need a clean body. I also changed the time for her showers until later in the day and that has made a world of difference.
    I am fortunate to have a large shower so she can get in with my help and we shower together, the warm water feels so good to her,she hates to get out. I have settled on once a week showers and sponging thorough out the week, it works for us. I would recommend to just try different approaches and don’t argue, I made that mistake as a new caregiver.

  5. I find all of this really good information and every one is different. I was not given information when I first showered my mum and I know she was embarrassed but luckily we were able to have a laugh about things.I am now a full time carer for my husband and he is a very good man and very cooperative, however I have seen many of the things you spoke of with other aunties of mine.

  6. Not forgetting the stories and experiences of disguised shower before being gassed during the holocaust that some residents can relate to this history and still live in fear today and living the fear and emotions….

  7. It dries the skin out and then we itch ,don’t use soap,and don’t forget to cream afterwards.

    1. All, I have found a wonderful solution to dry skin that I learned from a man who had dermatitis years ago. One you are finished showering the person that you care for, take a towel and blot their skins–don’t rub the skin with the towel as it dries the skin out.

      Next, I take ‘Johnson and Johnson’s’ lavender baby oil gel and put about a quarter-sized amount on my hand and rub each extremity until it is worked into the skin. The moisture that is leftover from blotting the skin gets sealed under the baby oil.

      My husband’s skin used to look awful and now it is soft and not so leathery looking. It takes several applications before a noticeable difference starts showing up but this baby gel is magic in a bottle! It is great for working calluses off over time too!

      I hope this helps!

  8. My mother is quite strong and vigorous, and her shower is quite safe, but she feels bathing more than once a month is unnecessary. She does not need physical help, so sponge bathing by anyone else is out of the question. Reminding her doesn’t help. She is very concerned with her appearance, but not her hygiene. There is no economic barrier, and she lives by the ocean, so that although she has many containers of lotion, she rarely uses them. Her shower is bright and has plenty of natural light, and she has no negative associations with showering. Honestly, I’m not sure she even remembers to shower once a month. Can we just let it go?

  9. All interesting, and valid, comments BTL – but one thing that surely needs addressing is the person with a dementia who refuses to shower or even to wash. And it does happen that you will find a person (who has a dementia) who simply refuses to bathe in any way. And they are doubly incontinent. What then?

    It is hard cases like this that raise some interesting questions. Do you force them to bathe? If not, why not? Of course you have tried everything else; every strategy known to man has been tried, but still the person refuses. What do you do?

    Why is it that if my child, say she is five years old, refuses to bathe then I simply pick her up and put her in the shower – I use force – but if an elderly person with a dementia refuses to bathe I cannot use the same approach and force them to?

    Failure to force my child to bathe will likely result in my being seen as a bad parent, and if this continues and she goes to school dirty and smelling of poo then I am likely to find myself answering to the welfare. I am expected to use force. But if I use force with an elderly person with dementia. Is this wrong? If it is wrong, then why the different standards?

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