Dementia bathing issues or just seniors and cleanliness…
Father in law (FIL) says that “since he never goes anywhere or does anything anymore, he doesn’t get dirty”, so he doesn’t “feel the need to mess up more clothes” by changing into clean clothes every day… or even every other day, or every week.
Mother in law (MIL) says that showers hurt her now, so she’s been refusing them; and it’s just too much effort to get up and change her underwear and pajamas, and anyway, all she does is lie in bed, so she “never gets dirty”.
Their reasons for not bathing or changing their clothes and underwear sound reasonable, sound like good reasons – to them. But they are not.
FIL has long had an issue with bowel incontinence. Medications in the past year have finally calmed that situation down a lot, but not completely. Bowel and bladder incontinence are invariably issues in later stages of Alzheimer’s, so we’re very aware this will be a problem again in the future.
MIL has never mentioned any issues with me before, but over the past year that I’ve been doing her laundry, well, let’s just say that the state of her underwear indicates that urinary incontinence is a growing problem. Recently, there are also laundry indications that her frequent use of Milk of Magnesia (ugh!) have affected her bowel control.
Since MIL lies in bed all the time, and FIL sits in his recliner all the time, skin breakdown is a serious possibility. Wearing dirty underwear can actually exacerbate the situation, and not only cause the skin to break down more quickly, it can lead to infections in the wounds. Pressure sores have 5 different stages; stages I through IV are not pretty, but the fifth stage, which is actually called “Unstagable”, is horrible. At its worst, a pressure sore can affect the very deepest tissues, turning the surrounding skin and tissues black, and causing unremitting, excruciating pain. If you’ve ever seen this, you will do anything it takes to avoid it, either in yourself or a loved one. I have; it’s not something I ever want to see again, in anyone.
Last week, FIL’s laundry consisted of 1 pull-over shirt and his sheets. That was all. MIL’s laundry was one pair of underwear and her sheets. She didn’t even change her pajamas. The week before was the same, except that there was one set of pjs. So we got up early this morning to make it to the ALF in time to catch the nurse-practitioner before her monthly appointment to see my in-laws. We felt it was time to consult with the nurse, as well as with the director, about our options to get my in-laws’ clothes changed regularly.
The nurse did lecture both MIL and FIL on the necessity to be clean and to change their clothes regularly; I followed up with my own observations, including what I remembered of the treatment for my uncle’s unstagable pressure sores, and how scary and painful they were. I hope it got through, but only time will tell. In the meantime, we’ve arranged with the ALF management for an aide to ensure every day that FIL, at least, does change his clothes; I’ve also addressed this with the hospice care manager for MIL. We’ll just have to wait and see if this works!