Caregiving Challenges, Refusal to Bathe Due to Fear of Water

The fear of water phenomenon occurs in many with advanced dementia and is often accompanied by a refusal to bathe.

Helpful Highlights

  • Fear of water in some persons with advanced dementia is a curious and unexplained phenomenon. (Not all persons with dementia will develop this fear.)

  • Oftentimes this fear is accompanied by a refusal to bathe, which can be incredibly challenging for caregivers.

  • Handling bathing with your loved one who fears water requires understanding, gentleness, and a lot of patience. It is the disease, it is not intentional.

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Dementia and the fear of water

Although research cannot pinpoint exactly why this curious phenomenon happens, it is well documented that fear of running water (showering) and/or submerging in water (bathtub or pool) occurs for many with advanced dementia.

The onset of fear of water is usually sudden. One day, your loved one may start to scream or become physically agitated (even combative) when the shower is turned on them, or when you want them to step into a filled tub. Researchers speculate that water itself may not be the whole of the problem and that persons with advanced dementia resist because they may:

  • Have difficulty with depth perception, making it scary to step into the water.

  • Get upset because they do not feel the need to bathe.

  • Feel too physically or emotionally vulnerable being nude.

  • Have altered sensory perception, so they feel that it is a cold, uncomfortable experience, no matter how pleasant the water temperature.

  • Perceive that the water is too hot or too cold, despite a consistent temperature.

  • Recall past traumatic events associated with water or bathing that resurface with dementia.

  • They no longer understand what water is or its purpose, and therefore it is a danger to them.

What do I need to know?

Foremost, it is unlikely that you will be able to get your loved one comfortable with water again once fear develops, and trying to force it will only make you both more anxious and agitated.

Developing a fear of water doesn't necessarily mean the dementia is getting worse. Again, this is a curious phenomenon that occurs because of the disease but seems independent of its progression. It simply shows up, unaccompanied by other worsening symptoms.

Understand that their fear of water, and more importantly any refusal to bathe, is a result of the disease and is not intentional. Your loved one is not consciously trying to be difficult or make things harder for you. Take several breaths before you get upset.

How do I get them clean?

First is determining how many times per week your loved one needs to bathe. Their health is unlikely to suffer if they do not bathe every day. Provided that they have good toileting hygiene, and a fresh change of clothes daily, bathing twice a week is usually enough for most seniors.

Beyond that, there are a couple of ways to approach bathing. You can determine what their tolerance level is, for example, will they still stand or sit on a shower chair in the tub or shower? If so, will they accept a handheld showerhead being used on them, or a pitcher of water? Or you can go straight to using a small tub of soapy water and washcloths (called a "sponge bath" or "bed bath" but doesn't have to be performed in a bed). You can also use prepackaged bathing wipes, though these can get expensive. When providing a "sponge/bed" bath, ensure that the parts you are not washing are dry and covered to prevent discomfort and chills.

Note: When using soapy water and washcloths, be sure to go back over washed areas with plain water washcloths to remove soap residue. Leaving soap on the skin can cause dryness and irritation.

For hair, consider using no-rinse shampoo caps, especially if your loved one has difficulty with water on their head. These are also useful for times when their hair and scalp may need cleaning but their body doesn't.

It's also very important to talk to your loved one while bathing them. Let them know what you're doing before you do it, and be sure you have their attention and are face-to-face while speaking.

A couple of final tips... Giving them something to hold while bathing can be helpful; a washcloth, sponge, or bottle. If, during bathing, your loved one becomes agitated, distract them for a few moments and then try again. If they become outright resistant, stop the bathing process altogether and come back to it later. Otherwise, you could both end up hurt, physically and emotionally.

RESOURCES

Aging Care - Dementia Bathing

Alzheimer's Association - Bathing

Aziz, V.M., & Roufael, R. (2019). Water and dementia, learning from clinical experience. Neurology and Neurosurgery, 2(1-2). doi: 10.15761/NNS.1000114

Fletcher P.D., Downey L.E., Golden H.L., Clark C.N., Slattery C.F., et al. (2015). Pain and temperature processing in dementia: A clinical and neuroanatomical analysis. Brain, 138(Pt 11), 3360-3372. DOI: 10.1093/brain/awv276

Khundakar A.A., Hanson P.S., Erskine D., Lax N.Z., Roscamp J., et al. (2016). Analysis of primary visual cortex in dementia with Lewy bodies indicates GABAergic involvement associated with recurrent complex visual hallucinations. Acta Neuropathologica Communications, 4(1), 66. DOI: 10.1186/s40478-016-0334-3

No content in this app, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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