Dementia and personal hygiene

As dementia progresses, many people struggle with their personal hygiene. Changes in memory, mobility, mood and judgement can affect a person’s ability to wash, dress and care for themselves. Helping someone with these intimate tasks can be challenging for carers and family members too.

Poor personal hygiene can lead to an increased risk of infection and skin damage. It can also be embarrassing for the person with dementia and those around them.

Understanding why these difficulties arise and approaching them with sensitivity can make a real difference to the wellbeing of both the person with dementia and those supporting them.

How can dementia impact personal hygiene?

Problems with memory, confusion, anxiety and mobility are among many things that can cause dementia to impact personal hygiene. For example, a person with dementia may forget to wash or brush their teeth. Or some personal hygiene tasks may cause pain or anxiety, meaning the person avoids them. As a person’s dementia progresses, they may need more assistance with their personal care.

Why might someone with dementia not look after their personal hygiene?

Many symptoms of dementia can stop a person from being able to look after their personal hygiene. These include memory loss and confusion, physical difficulties, mental health issues and loss of inhibition and judgement.

Memory loss and confusion

A person with dementia might forget to carry out everyday personal hygiene tasks like washing, brushing their teeth or brushing their hair. They may also forget how to do these things. For example, they might go to have a shower, but not be able to remember how to turn it on. Similarly, they might get confused trying to carry out personal hygiene.

Confusion can also cause issues like a person not wanting to change their clothes as they do not understand the need. They may not understand why a carer wants them to undress or wash, especially if the person is not a family member.

Physical difficulties and pain

Physical difficulties like arthritis, frailty or injury might mean a person with dementia cannot do the movements needed for some personal hygiene tasks. Or if they are experiencing pain in a certain area, they might avoid touching it. For example, if they have mouth pain caused by gum disease or tooth ache, they might avoid cleaning their teeth.

Fear and anxiety

A person with dementia may experience anxiety and fear, including around personal hygiene. This can be caused by many things, including:

• past traumas
• sensitivity to heat, cold and other sensations
• fear of water
• physical discomfort
• feeling overwhelmed

It is important to look out for signs of fear and anxiety, understand where these feelings may come from and support the person to feel more relaxed.

Depression and lack of motivation

Depression is common in people with dementia. Depression can cause a lack of energy and motivation, which can make it difficult to carry out everyday tasks like washing, cleaning your teeth and brushing your hair.

Loss of inhibition and judgement

Sometimes people with dementia experience a lack of inhibition and judgement – this is particularly common in frontotemporal dementia. It means they can do or say things that are not considered appropriate. This may include not washing because they do not realise they need to.

Is a lack of personal hygiene a sign of dementia in someone elderly?

Lack of personal hygiene in an older person is not necessarily a sign of dementia. Pain, depression or mobility issues are examples of other reasons a person might struggle with personal hygiene.

However, if they are also showing other signs and symptoms of dementia then talk to the person’s GP, who may refer you to a memory clinic if they think the person may have dementia.

Practical advice to maintain personal hygiene

Maintaining hygiene is usually a very private and personal activity. Helping someone with such intimate tasks can cause distress for both the person with dementia and their carer. Everyone will have their own challenges, but understanding why these changes are occurring and making some adjustments can make things less stressful for everyone.

It is important to recognise that a younger person may have different routines and expectations around their personal care and grooming to older people, for example around hairstyle and colour, makeup choices, facial hair and hair removal.

Always try to respect these preferences and support the person to continue with them — for instance, you could help them put on makeup, colour their hair, trim their beard or remove body hair. Being able to express themselves through their clothes and personal appearance will help them maintain their sense of identity and self-esteem.

Washing and bathing with dementia

People with dementia may struggle with washing their hands, body or hair. These tips may help you support a person with dementia to wash.

Break down tasks

Prompting the person may be helpful, giving one instruction at a time. For example, when helping them wash their hands, you could ask them to:

• turn on the tap
• open their hands
• put the soap onto their hands
• rub their hands together
• rinse their hands
• dry their hands

If this proves difficult, you could encourage the person to use hand sanitiser or antibacterial wipes instead. Involve the person in the process as much as possible — you could wash, wipe or sanitise your own hands to demonstrate what to do.

Respect the person’s preferences

When supporting a person to have a bath or shower, be respectful of their usual preferences — if they have always preferred a bath, they may be reluctant to use the shower. If using a shower, they may feel more comfortable and safer using a shower seat.

Let the person test the water first

Sometimes, difficulties with spatial awareness and depth perception can affect personal hygiene. Allowing the person to feel the water and its depth in a bath, or running the shower over their hands before they get in, may help them prepare for what to expect. The person may prefer to use a handheld shower rather than stand under a powerful shower stream.

Create familiarity and consistency

Try to use the person’s usual toiletries to provide familiarity and consistency. Make sure everything you need is to hand and offer prompts throughout the process — this gives them a task to focus on and promotes independence.

Maintain the person’s dignity

If the person is embarrassed about showing their body or being washed, you could put a towel over their lap or shoulders to help them maintain some dignity, washing one part of their body at a time.

Try a sponge bath

If the person is very resistant to having a bath or shower, a sponge bath may be less stressful. You can also buy toiletries designed for people who find bathing and showering difficult, such as dry shampoo and body wash.

Cutting and cleaning nails with dementia

It can be challenging to help a person living with dementia cut and clean their fingernails and toenails. You could try these tips:

• Clean and cut nails after a bath or shower — as well as removing dirt, the water will soften the nails so they are easier to cut. Alternatively, you could encourage the person to soak their hands and feet first
• Give the person a gentle hand massage to help them relax
• Some people enjoy choosing and wearing nail varnish, so you may be able to make cleaning and cutting nails part of a manicure
• If the person is becoming stressed, take a break then try again
• Look for a local chiropodist or podiatrist, who has experience in working with people with dementia, to help with nailcare

Washing and cutting hair with dementia

Some people with dementia enjoy having their hair washed, cut and styled, but others find it stressful. Keep in mind that hair usually does not need washing as frequently as the body — once a week may be sufficient.

Encourage the person to be as independent as possible when washing their hair. Give step-by-step instructions and let them do as much as they can themselves – for example, they may be able to shampoo their hair but need you to help rinse it out.

The person may prefer to wash their hair in the bath rather than in the shower. If they do not like water on their face, you could use a shampoo shield or they could hold a dry flannel over their face. Using a handheld shower or a large plastic jug to rinse the person’s hair could reduce discomfort.

Dry shampoo can be a good option for keeping hair cleaner between washes. It is sprayed into the hair, massaged in and brushed out, absorbing and removing some oil and sweat. It can let you leave a longer gap between hair washes if they are stressful for the person with dementia.

If the person is reluctant to have their hair cut, going with them and having your hair cut too may make the experience more positive and can be seen as a ‘treat’ or part of a day out together.

Alternatively, having a mobile hairdresser visit the person at home may reduce stress. Some care homes have their own hairdresser or salon specialising in working with people with dementia.

Always make sure you respect the person’s preferences with their hair. If they have long hair, for example, it may be tempting to cut it short so it needs less upkeep, but keeping their usual hairstyle and colour is an important part of maintaining self-esteem.

Shaving with dementia

These tips may make shaving and hair removal easier for a person with dementia:

• Encourage the person with dementia to use an electric razor — this is safer than using a traditional razor and can help them maintain their independence for longer. If the person is used to shaving with a traditional razor, they may need help with this
• Make sure you have everything prepared in advance and if necessary, talk the person through the process step by step
• If you need to shave the person, asking for their help with a certain aspect (eg, “Can you hold the towel for me?”) can make them feel included and respected. You can buy razors that are specially designed for carers to use on the person they care for
• People who use wax, hair removal cream or devices like epilators can continue to use these for as long as possible, with support where necessary
• If they go to a salon for hair removal, they can continue to do so for as long as they are comfortable. Keeping to their usual routines will provide familiarity and maintain self-esteem

Dressing and cleanliness with dementia

People with dementia may find it hard to accept help with dressing and cleanliness, so it is important to take the time to make them feel comfortable and encourage independence. These tips may help with choosing clothes and dressing:

• Too many choices may overwhelm a person living with dementia — however, it is important that they are allowed to make their own decisions about what to wear. Try offering a choice of two outfits so they can decide which to wear
• Label drawers and wardrobes with pictures of what is inside to help the person find what they need
• It may be helpful to lay the person’s clothing out in the order they would put the items on
• Some people with dementia like to wear the same clothes all the time. If so, you could buy several identical sets of clothes — when they are in the bath or in bed, you can swap the dirty outfit for a clean one
• New or gifted clothing can be used to encourage someone to change, for example, “I would love to see you wearing the new trousers we bought you”
• Encouraging the person to wear a particular outfit for a visit or outing could prompt them to change their clothing
• Look for clothing that is easy to put on and take off — drawstring waists and Velcro fastenings may be easier than zips and buttons

Periods and dementia

If a person with young onset dementia is still having periods, this can present additional challenges with personal care. While it is important to respect their wishes around sanitary protection, you may need to rethink which products to use. For example, if you need to help them change their protection, pads may be more appropriate than tampons.

Using a smartphone app to track the person’s cycle so they know roughly when to expect their period can be helpful. Setting reminders to change protection may also be useful.

Bear in mind that periods usually change during perimenopause – for example becoming lighter, heavier or less regular. The person may need your help to understand what is happening and how to manage the changes.

Incontinence and dementia

As dementia progresses, the person may:

• not recognise the urge to use the toilet
• not remember when they last used the toilet, or where it is
• develop mobility problems that make it difficult to get to the toilet in time, sit or stand, or clean themselves afterwards
• hide soiled clothing or not admit to being incontinent because they are embarrassed or do not realise that they are wet or soiled

Going to the toilet is a deeply personal and private matter, which can make it difficult for the person to accept assistance. If you ask them outright if they need the toilet, they may say no. They may be more receptive if you ask them in a more subtle way, such as, “Do you want to use the toilet before we go out?”

If the person needs support with using the toilet, try to provide only as much help as needed and encourage them to do what they can independently. If you need to remain in the bathroom with them, standing to the side or with your back to them rather than directly in front of them will help maintain their dignity.

If the person is having issues with continence, it is worth discussing these with the GP. They may be able to make a referral to the local continence service for advice and support, including around incontinence products.

Overcoming refusal to wash

It is common for a person with dementia to refuse help with personal care. Some people find it easier to accept help from a family member, while others prefer to be supported by a paid carer. They may be more comfortable with someone of the same sex.

A common problem is the person with dementia saying that they have already had a bath or shower and changed their clothes when you know they have not. This typically happens because they truly believe that they have performed these tasks.

Contradicting the person may upset them, and they may feel offended if you point out problems with their personal hygiene. Sometimes taking 10 minutes out, asking for their help with another basic task and then reapproaching the subject can be useful.

Try not to feel guilty if you decide you need professional help. Paid carers are experienced in helping people with personal hygiene, and having someone take over these tasks can reduce stress for both you and the person with dementia.

It may take time and a variety of different approaches to find a personal care routine that works for you and the person with dementia. If you need support, please speak to your GP or social worker. You can also speak to a dementia specialist Admiral Nurse for advice.

Guidance and support for young carers

If a person with dementia is having difficulties with personal hygiene, this can be very challenging for any children or young people in their family. They may be embarrassed to be seen with the person with dementia if they appear scruffy. They may not want to spend time with the person if their standards of hygiene have slipped.

It is important to explain in an age-appropriate way that the changes are the result of the person’s dementia and that they are not neglecting themselves deliberately. If the child finds it upsetting to be around their family member because of poor personal hygiene, you could support the person with dementia to wash and change their clothes before they spend time together.

In some cases — particularly if a parent has young onset dementia — a child or young person may end up helping with personal care. This can be distressing for everyone involved, so think about what tasks are and are not suitable for the child to help with. For example, helping their parent use the toilet may not be appropriate, but they may like to help them choose clothes or brush their hair.

A child or young person who supports a person with dementia is entitled to a young carer’s assessment to establish what help they may need. You can request this from your local social services. Your GP or social worker may also be able to suggest young carers’ groups where the young person can find support.

How Dementia UK can support you

If you need advice on any aspect of dementia, please call the Dementia Helpline on 0800 888 6678 (Monday-Friday 9am-9pm, Saturday and Sunday 9am-5pm, every day except 25th December), email helpline@dementiauk.org or you can also book a phone or virtual appointment with an Admiral Nurse.

Dementia UK resources

• Continence
• Living aids and assistive technology
• Mouth care and oral health
• Perimenopause and menopause
• Caring for a person with a stoma
• Young onset dementia

Other resources

• Independent Living – buyers’ guide to assistive living products
• Living Made Easy – daily living aids database
• NHS: being a young carer – your rights

Frequently asked questions

How often should someone with dementia bathe?

There is no single rule for how often someone with dementia should bathe — it depends on the individual, their preferences, and their level of need. Generally speaking, a full bath or shower once or twice a week is considered sufficient for most people, including those with dementia. In between, a daily wash of the face, hands, underarms and intimate areas can help maintain hygiene and comfort without the stress of a full bath or shower. The most important thing is to find a routine that works for the person — one that keeps them clean and comfortable while minimising distress.

What is the best way to wash someone who is afraid of water?

Fear of water in a person with dementia can stem from a number of causes — difficulty understanding what is happening, sensory sensitivity, a previous negative experience, or changes in spatial awareness that make getting into a bath or shower feel unsafe or disorienting.
Some approaches that might be helpful include:
Reducing the stress of the experience — choosing a time of day when the person is calm and relaxed, keeping the bathroom warm, playing familiar music and using their usual toiletries to create a sense of familiarity and comfort.
Making water feel less threatening — letting the person feel the water temperature before getting in, using a handheld shower head rather than an overhead shower, or filling the bath before they get in rather than running it while they are there can all help reduce anxiety.
Going slowly and explaining each step — giving simple, calm instructions one at a time and allowing the person to be involved as much as possible can help them feel more in control.

Can I use dry shampoo or no-rinse body wash for someone with dementia?

Dry shampoo and no-rinse body wash can be good ways to keep someone with dementia feeling clean and fresh without needing to take a full bath or shower. Dry shampoo can simply be sprayed onto the hair, massaged in and gently brushed out, removing grease. No-rinse body wash comes in foam or liquid form and is massaged in and towel-dried off.