Personal hygiene 101: A caregiver's guide to helping loved ones keep clean

Personal hygiene refers to the practice of taking care of our body’s cleanliness. It is an integral part of our well-being to maintain a pleasant appearance, as well as prevent the spread of germs that can bring sickness not only to ourselves but also to others.

Hygiene care is introduced early during childhood through daily training both at home and at school. Once it becomes ingrained as a basic routine, most people have no difficulty in observing their personal hygiene — however, the case is different for our ageing seniors. While this routine serves as a relaxing self-care to us, it can be a nuisance and a real struggle for our loved ones.

Essential aspects of personal hygiene for elderly

Grappling with basic self-care is inevitable once you begin the 60-year old journey. Regardless, with our assistance as caregivers, the following aspects of hygiene can be done more thoroughly:

Physical

Physical hygiene covers the cleaning of the whole body, mainly bathing and toileting. This has proven to be one of the most challenging tasks for older adults due to the danger of wet surfaces.

In addition, they may start to slowly lose bladder and bowel control, also known as incontinence, which requires them to wear adult diapers. For bed-bound seniors or those who suffer from chronic movement-affecting conditions like Parkinson’s, wiping with wet towels or sponges can substitute the typical showering.

Face washing is also required to keep it fresh and clean from food crumbs, especially on the mouth area. We too should often remind them to wash their hands regularly after meals and gardening sessions. This is because they have often made it a habit to wipe dirt off their hands with their wearing garment — which is not ideal for good hygiene.

Aside from cleaning, moisturising is key to long-term skincare. Ageing skin develops cracks more easily — particularly on the ankle and heel — due to the declining ability of the body to retain moisture, hence resulting in dry skin conditions that can be painful if left untreated. Body lotion and moisturisers with sunscreen (SPF) are a great addition to seniors’ hygiene routine.

Oral

Good oral hygiene involves brushing of teeth, tongue, cheeks and roof of our mouth. Aside from usual brushing, use of mouthwash and regular flossing are also encouraged to remove any residues of food.

This aspect of hygiene is unfortunately often neglected among seniors — it is deemed trivial possibly due to the decreasing amount of teeth. On the contrary, the tendency of them to suffer from dental problems such as gum diseases, dry mouth and oral cancer is much higher if thorough care is not observed.

In addition, dentures should be fitted properly from time to time. As we start losing teeth due to ageing, our jaw tends to become loose. If our unfitted dentures constantly slip out of place, the discomfort will cause us to eat less, thus affecting our diet and overall health.

Grooming

Dressing up, getting a haircut, combing hair, and trimming nails are some of the parts of grooming. Amidst keeping up with health check-ups and prescribed medications, appearance care is most likely to hold little priority in a senior’s life. Staying indoors for almost the entire day makes these minor habits appear unessential to the eyes of our loved ones.

Regardless, grooming in the elderly should not be overlooked in order to maintain a neat outward appearance. When they feel good about the way they look, this can consequently boost their self-esteem by sparking a sense of confidence and joy — an incentive to make their monotonous days more fun.

Another purpose of grooming is to make sure none of their body parts gets in the way of their own well-being. If their hair and nails have grown long enough to injure themselves like pricking into their eyes or scratching against their skin, that signals for immediate trimming.

Signs of deteriorating personal hygiene

Spotting the signs of poor personal hygiene helps us to take early preventative steps before they develop into other serious health conditions. Here are the main symptoms in need of our attention:

• Strong foul body odour that gets worse every day
• Bad breath and tooth decay
• Long messy hair that can prick into their eyes
• Long dirty fingernails that can injure their skin when scratching
• The damp smelly fabric of clothing and bedding
• Presence of blood and pus on uncleaned wounds
• Dry flaky skin

Causes of deteriorating personal hygiene

Ageing brings different risk factors leading to a decline in personal hygiene among seniors, including:

Frailty

Older adults are more at risk from frailty, which is a common medical condition when you reach 60 years old and above. Main symptoms include weakened physical strength, being inactive, and reduced ability to grip strongly — all of which increase the chances of fall accidents and hospitalisation.

With the process of ageing, our physical functions naturally deteriorate as a result of the wear and tear of muscles and bones over time.

This significantly affects their motor control and flexibility, causing them to be prone to body aches particularly backaches and joint pains (arthritis), which discourage them from performing any activities that require the slightest amount of physical effort. This condition explains why our loved one tends to slouch, making them unable to stand at the sink or shower for too long with the constant need to grab onto something.

Alzheimer’s disease

Alzheimer’s disease is a brain disorder commonly occurring among ageing seniors which results in dementia — a condition that causes loss or impairment of cognitive functions such as perception, memory, and reasoning.

In other words, they might not be able to remember past hygiene habits and have a difficult time recognising the cues to urinate or defecate. As Alzheimer’s is incurable and gets worse over time, they might gradually stop taking baths, brushing teeth, and dressing up once they no longer understand the relevance.

Fear of slipping and falling

The biggest fear for both seniors and caretakers are the common slip-and-fall incidents—particularly in the bathroom — which can be life-threatening. In fact, about 40 per cent of death-related injuries among adults of 60 years old and above are due to falls. Their weakened muscles and poor vision cause slower reactions in regards to balancing their body and carefully withstanding falls, thus making them more vulnerable to fractures and traumatic brain injuries.

What seems harmless such as floor tiles, rugs, toys and steps can be fatal to your loved one. It is this fear that makes the bathroom a danger zone, thus discouraging them from visiting the bathroom more frequently.

Inconvenience

Everything takes extra minutes for seniors to go about their daily routine. Going to the bathroom alone becomes a hassle and asking for help repetitively may get embarrassing.

It is a common feeling for our loved ones to harbour a sense of guilt as they view themselves as a burden to us. Consequently, they would rather let themselves be left unattended than trouble us with more favours.

Ways of helping a senior with deteriorating personal hygiene

Now that we have known why seniors face challenges with personal hygiene, our interventions are necessary to maintain their regular cleanliness. Some useful tips are as follows:

Adhering to a routine

By setting up a routine, it helps to inculcate the practice of habit which trains them to be more alert in accomplishing the same tasks every day. Daily routine should include bathing at least once a day, brushing teeth in the morning and before bedtime, as well as applying body lotion right after bathing for maximum absorption.

Shampooing can be done at least twice a week, while monthly practices can be reserved for hair trimming, nail clipping, and dental appointments.

If there is a sudden change in the schedule, they might express resistance and refuse to follow through. Routine keeps them organised and motivated to fight against sluggishness from little physical activities all day.

Ensure slip-free environment and ease of mobility

In order to encourage overcoming their fear of slip-and-fall incidents that prevent our dearest one from using the washroom more often, the duty lies on us to maintain danger-free surroundings.

The following considerations are viable to minimise hazards around the house by:

• Putting up safety equipment such as armrests, grab bars and bed support rails.
• Providing rubber slippers and non-slip mats to add friction against wet surfaces in the bathroom.
• Encouraging the usage of walking frames for stability.
• Steering clear of any structural obstacles along the way to the bathroom.

Besides having our home equipped with home safety accessories, our body can also be utilised as a support aid, for instance supporting their weight with our arms and hands when preparing for bath time.

In addition, positioning of items also contributes to a safer surrounding for example:

• Placing bed beside the bathroom to avoid accidental urinating and for easy cleaning by caregivers for bed-bound seniors.
• Putting toiletries in one container at a reachable level where they are visible.
• Keeping furniture such as closets and dressing tables closer to our senior’s height.

Do frequent changes

Changing becomes tedious when your body is not as flexible as you were at a younger age. A quick undressing and tossing dirty clothes into the laundry basket slowly turns into a half an hour hassle of being tangled up in clothes.

Since they mostly spend their time staying indoors, it is a common assumption that their body does not get dirty easily—prompting them to reuse the same clothes for several days.

However, such a habit should be discouraged because there is a possibility of bacteria from their sweats trapping in between their skin folds which can be the main source of a foul odour. An advisable practice would be to change their necessities daily especially clothes, undergarments and diapers. Beddings, towels, and knee guards ought to be washed every week.

The frequency surely depends on the condition of our loved ones. For bed-bound seniors, they require even more constant changing as their bed tends to get wet and collect residues easily like food crumbs, hair falls, and sweat.

Handle with much gentleness

As caregivers, we are expected to manage our loved ones with profound care and carefulness in the following manner:

• Do not treat them roughly. Ageing makes you physically more delicate — with your skin becoming highly sensitive to sunlight and scratches due to thinning of the epidermis (outer layer of skin), as well as your limbs getting stiffer. If we are not cautious enough, cuts or bruises may accidentally happen and they might sprain their wrist or ankle. These injuries can worsen their existing discomfort due to the slow rate of healing. This is also why warm water temperature is the best option for our elderly.
• Instruct gently when giving directions as the goal is to guide while keeping them relaxed. A little raise in our voice can instantly hurt their feelings, resulting in aggressive behaviour and rejections.
• Use gentle hygiene products , preferably baby products and those specially formulated for elderly or sensitive skin. The ingredients are essentially milder to reduce skin and hair dryness by using moisturising formulas such as shea butter, aloe vera, and argan oil. Always opt for 2-in-1 shampoo and body wash instead of bar soap, as the latter can easily slip out of their hands and step on. Other hygiene items that are also useful include a soft electric toothbrush and boar-bristle hairbrush.

Be respectful of their preferences

Aside from being physically sensitive, our seniors’ emotions tend to be equally fragile. Taking care of hygiene is one of the most intimate activities for a person — feeling self-conscious of having their full body exposed, even with family members. Being seen in their most vulnerable state may seem to violate their dignity.

This is where consent plays a vital role in establishing trust between you and your loved one. For example, asking for their preference when cleaning their private parts during bathing and toileting.

Some prefer to make their own attempts first before resorting to assistance, no matter how long it takes for them to accomplish. They might request counting to 3 to get themselves ready before standing up hence, communication is crucial in guiding them to reciprocate cooperation.

Forcing should be avoided at all costs. Alternatively, explaining can be an effective way to make sense of things for them. If refusals persist, try our luck another time when they are calmer and in a better mood.

Consider their comfort and convenience

Always think from their perspective when prioritising their likes and dislikes. Perhaps our loved one prefers to use certain hygiene products or clothing today but a different one the next day.

We can also organise their personal items with labels and keep them where it is easily accessible. Replace lid bottles with pump bottles and keep grooming products minimal. Taking note of their convenience can help the care process of personal hygiene go smoothly.

Encouraging independence

While providing assistance is helpful, it is also pertinent to train them to be independent particularly in cases where they have to stay alone at home.

As opposed to the common misunderstanding that caregivers are running away from duty, the main reason is actually to encourage the active movement of limbs, as well as giving our loved one the authority and control over themselves.

Ageing seniors tend to feel frustrated due to being less capable, which can make them succumb to mental health issues like depression. Once they figure out how to practise hygiene on their own, not only can they restore physical strength — their self-esteem and confidence level will also improve.

Getting professional help

Taking care of personal hygiene for our loved ones requires a great deal of patience and perseverance, as we need to follow their slower pace and attend to every need of their demands. There are some elderly who completely refuse the assistance of a family member, which we should not be offended about.

This article was first published in Homage.