As dementia progresses, you may find that your loved one’s ability to manage a routine of daily hygiene habits is affected. Understanding why this happens can help caregivers manage the issue with compassion and insight.

Our five senses — sight, sound, smell, taste and touch — help us connect with the world around us, keeping us safe and comfortable in our physical and social surroundings. While healthy brains can recognize, filter and correctly interpret stimuli through these senses, brains affected by dementia struggle to connect stimuli to meaning or prioritize what’s important over what can be ignored.

For example, if your loved one isn’t aware of unpleasant body odor, it’s not because their sense of smell is impaired, but rather because their ability to correctly process that sensory input is affected by changes in the brain.

The Five A’s

These changes are collectively referred to as the five A’s — amnesia, aphasia, agnosia, apraxia and anxiety — and each interferes in its own way and in combination with your loved one’s ability to interpret stimuli and, subsequently, maintain good daily hygiene.

• Amnesia is a partial or total loss of memory. This can affect hygiene by the simple fact that your loved one might forget to maintain hygiene habits, like tooth brushing.
• Aphasia is the inability to express or understand language. This can manifest in difficulty following verbal self-care instructions. A person who has forgotten the importance of tooth brushing may also face difficulty when given instructions on how to do so because of aphasia.
• Agnosia, the inability to recognize objects, persons, sounds, shapes, or smells (while the specific sense is not defective), is perhaps the most disruptive issue when it comes to hygiene. A person with agnosia may not see a toothbrush for what it is, or know what to do with it.
• Apraxia describes the disconnection between brain and body in people living with dementia. With apraxia, your loved one’s brain may be sending the signal to their body to brush their teeth, but the brain is unable to translate that signal into purposeful movement.
• Anxiety is the body’s natural response to stress and can result from the simple fact that your loved one needs help with activities that were once personal and private.

Strategies for Managing Hygiene and Self-Care

As part of the steady decline of changing abilities that characterizes dementia, the five A’s combine to create barriers to your loved one’s capacity to perform activities of daily living (ADLs), a key measurement of functional status in those living with dementia. But you can promote dignity and independence during this process by setting your loved one up for success:

• Create an environment that is safe, friendly, familiar and functional
• Encourage and prolong independence by exercising brain and body
• Develop a manageable daily routine by doing basic self care activities around the same time and in the same order everyday
• Use daily living aids, such as clocks, that show the day and date, as well as the time

As your loved one’s dementia progresses, you will need to increasingly provide instruction to help maintain daily hygiene. This instruction can take the form of:

• Verbal cues: These should be specific and concrete, focused on one thought at a time. Use their name for attention.
• Visual cues: Provide written information or use signs (pictures) throughout the home to help with instruction. Demonstrate an activity for them to imitate. Use gestures; act it out.
• Touch cues: Use touch to gain attention. Get them started, by leading them through an activity once. In the later stages, when a person needs more physical help use hand-under-hand^® guidance and assistance. Using your hand with your loved ones allows them to participate in their selfcare instead of these intimate activities being done to them.

Final Thoughts

• Remember, the five senses are always changing, increasingly affected by brain changes that make the processing of sensory information more and more difficult.
• Privacy and dignity are key
• Provide help, as needed
• Participate together
• Encourage, reassure, compliment and praise
• Maintain routine and rituals
• Be prepared, with everything ready before beginning self-care tasks
• Be flexible and patient, taking your time as needed

Learn more about dementia and caregiving by visiting our blog or calling our dementia care specialists at 817-877-1199.