Hygiene: What Changes to Look for & How to Help
Hygiene encompasses many daily activities, from hand washing and brushing teeth to bathing and changing clothes. When someone is living with cognitive changes or early dementia, maintaining personal hygiene can become more challenging for a variety of reasons. Family members and care partners may miss these early changes if they are unaware of what to look for.
Executive functions such as initiation, attention, organization, and sequencing are often affected in the early stages of many dementias. A person who is experiencing short-term memory loss, misplacing items, or forgetting appointments may also be forgetting to complete daily hygiene tasks. Because body odor may not develop quickly—particularly if the person is continent—these changes can be easy to overlook.
What to Look For
Is toothpaste being used regularly?
Is the toothbrush wet or showing signs of use?
Is the shampoo bottle being used, or does it remain full?
Is the shower or bathtub being used regularly?
Are towels being changed and washed?
Are the same clothes being worn for multiple days?
Is hair becoming greasy, uncombed, or unwashed?
Are fingernails becoming long or dirty?
Is there a noticeable decline in overall grooming and appearance?
Why Hygiene Becomes More Difficult
Ch anges in hygiene are often not due to laziness, stubbornness, or a lack ofconcern. Dementia can affect the cognitive and sensory skills needed to complete daily self-care tasks.
Common reasons include:
Forgetting that a task needs to be completed
Difficulty initiating a task without a prompt
Trouble remembering the steps involved in bathing, grooming, or dressing
Feeling overwhelmed by too many choices or products
Reduced awareness of body odor, dirty clothing, or other hygiene needs
Physical limitations such as pain, weakness, or reduced balance
Sensory changes that make bathing uncomfortable or frightening
Sensory changes are often overlooked. The sound of running water may seem unusually loud, water temperature may feel different than expected, reflections in mirrors can be confusing, and concerns about slipping may increase anxiety. Some individuals may also feel vulnerable or disoriented when undressing or entering a shower.
How to Help
Establish a Routine
Create a consistent daily hygiene routine, ideally before significant cognitive changes occur. Familiar habits are often easier to maintain than new ones.
Simplify the Environment
Reduce visual clutter in the bathroom. Keep only the items needed for daily hygiene visible and store other products out of sight to make the process less overwhelming.
Use Visual Reminders
Incorporate hygiene tasks into a daily schedule, checklist, or calendar that can be reviewed and checked off each day.
Provide Set-Up Assistance
If bathing has become difficult, start the shower, adjust the water temperature, and let the person know it is ready. This can reduce the number of steps required to get started.
Address Sensory Concerns
Ensure the bathroom is warm and well lit.
Use non-slip mats and grab bars to increase confidence and safety.
Install a handheld showerhead for increased control of water direction/pressure.
Check that water temperature is comfortable before bathing.
Reduce background noise and distractions.
Consider sponge bathing or bathing at a different time of day if showers create distress.
6. Reduce Decision-Making Demands
Organize the closet with only seasonally appropriate clothing visible. Limiting choices can make dressing easier and less stressful.
Use supportive, matter-of-fact reminders rather than correcting or criticizing. For example: “Let’s get ready for the day.” or “I left the shower running for you.” instead of “You haven’t showered.”
Remember that changes in hygiene are often a result of cognitive and sensory changes associated with dementia. Understanding the reason behind the behavior allows care partners to provide support in a respectful, compassionate, and effective way while helping the person maintain dignity and independence for as long as possible.
Susan Raychard, MOTR/L, CDP
