Personal Hygiene

Definition

Personal hygiene refers to maintaining cleanliness of one's body and clothing to preserve overall health and well-being. It includes a number of different activities related to the following general areas of self-care: washing or bathing, including cleansing oneself after using the toilet; taking proper care of the mouth; grooming and dressing; and keeping clothing clean. Bathing, dressing and undressing, and using the toilet are considered activities of daily living (ADLs), while doing one's laundry is considered an instrumental activity of daily living or IADL.

Description

Personal hygiene is a preventive health measure that serves a senior's emotional, social, and physical well-being:

• Cleanliness protects against the spread of disease from external parasites (such as body or head lice) or from contact with contaminated feces or other body fluids.
• Proper washing and bathing protects the skin against rashes and sores from contact with urine or fecal matter.
• Oral hygiene lowers the risk of malnutrition, swallowing difficulties, or infections caused by bacteria in the mouth getting into the bloodstream and other body tissues.
• Maintaining personal hygiene lowers the risk of social embarrassment and eventual isolation from others.
• With regard to emotional health, keeping oneself clean and neat improves morale and lowers the risk of depression.

Washing and toileting

Many seniors have difficulty with washing the hair and bathing or showering, although the reasons for the difficulty vary depending on whether the senior's loss of capacity is physical or mental. A senior with arthritis may find it physically awkward or painful to climb into a tub or to open shampoo bottles, whereas a senior with dementia may completely forget to bathe or shower. The caregiver will need to ask several questions to assess whether and what type of help a senior might need in order to keep him- or herself clean:

• Is the disability temporary or permanent?
• Is it likely to get worse over time or stay at the same level?
• What organ systems or parts of the body are affected? For example, a senior who has arthritis in the hands may need different types of household gadgets or assistive devices than one with arthritis in the hips and knees; similarly, a senior with an ostomy will need a different type of bathroom arrangement from one who is sight- or hearing-impaired.
• Can the senior walk or move to the bathroom or are they completely bedridden?

If the senior is incontinent (cannot control the passage of urine or bowel movements), a doctor should examine the patient to determine the cause. There are several different physical causes that may lead to incontinence: the patient may have structural abnormalities or weak muscles in the area of the bladder or anus; diseases that affect the nerves leading to and from the colon or bladder; may be taking medications that interfere with normal patterns of elimination; or may have difficulty reaching the bathroom quickly because of mobility impairments. Urinary incontinence is a particularly important hygienic problem because it is the single most common reason for institutionalizing impaired elderly patients. If a caregiver is helping an incontinent senior with personal hygiene, the caregiver should wash the genital area completely and carefully, and use powder or ointment to protect the skin after washing.

Seniors with dementia have increased difficulties in maintaining cleanliness because they often lose their ability to control their emotions as well as their thought processes. It is not unusual for a senior with dementia to have what is called a catastrophic reaction when they are asked or reminded to take a bath or shower. A catastrophic reaction is an emotional outburst or overreaction to a situation or event. The senior may be upset about bathing because they are embarrassed by having to take off clothing in front of someone else; because they are disoriented and don't remember the location of the bathroom; because they feel rushed, anxious, or cold; or because they cannot remember all the separate steps involved in taking a bath. If the senior is living with a caregiver, it may make things easier if the caregiver coaches the senior through one step at a time in the process and allows him or her to have as much control as possible over the time of day for bathing and the choice of a bath or shower. The Alzheimer's Association recommends keeping a large bath towel nearby to cover the senior while they are undressing so that they feel less vulnerable, and keeping the bathroom at a warm temperature.

Oral hygiene

Proper care of the mouth is important to good nutrition as well as preventing tooth decay and the eventual loss of teeth, because seniors with dental pain or sores in the mouth may stop eating foods that require chewing. The senior should see a dentist twice a year to make sure the teeth, gums, and other tissues in the mouth are in good condition.

If the senior has dementia or some kind of physical impairment that makes it difficult to clean their own teeth or dentures, a caregiver will need to do these things on a daily basis. Some dentists recommend foam applicators instead of brushes for cleaning the teeth of persons with physical impairments. If a brush is used, an electric model may be more efficient than a standard toothbrush. The caregiver should also check the person's mouth and gums for ulcers or irritated areas in between visits to the dentist.

Laundry

Doing one's laundry is an important marker of personal independence as well as a necessary part of physical cleanliness. Unwashed clothing and bed linens can harbor viruses and bacteria as well as body lice, thus increasing the senior's risk of disease. Some seniors may prefer to purchase small apartment-sized washers and dryers that will clean or dry 5- or 10-lb loads of laundry; these machines can be plugged into standard electrical outlets and are light in weight. Seniors living in assisted living facilities can usually arrange for laundry service as needed.

Grooming and personal care

Grooming and personal care concern such matters as shaving, hair care, makeup, and clothing selection as distinct from considerations of cleanliness. Grooming is important, however, because looking one's best is important to the senior's sense of dignity and morale. Clothing that fits properly, looks attractive, and is easy-care can go a long way to lift a senior's spirits, as is attention to hair styling, eyeglass frames, and other items that contribute to appearance. Grooming is also a safety consideration, too, as poorly fitting shoes increase the risk of falls . In addition, clothing that is difficult to unfasten can contribute to incontinence problems when the senior cannot remove the pants or underwear quickly enough to use the toilet properly.

Caregivers should consider the following in regard to grooming:

• Check the senior's clothing periodically to make sure it still fits. This consideration is particularly important if the senior has swallowing problems or is losing weight for other reasons.
• Simplify the wardrobe so that most articles of clothing can be easily mixed or matched with other items. Seniors with dementia can become confused by too many color choices or too many accessories.
• Choose pants, skirts, and shoes with pull-on styling. Shoes with Velcro fasteners are easier for many seniors to put on and remove than shoes with laces or buckles. There are many dresses and blouses for women that are designed to be pulled over the head without the need for buttons or zippers.
• Small accessories can improve morale, too. A man can wear a clip-on tie or bolo if his fingers can no longer manage a conventional tie. A woman's scarf can be tied ahead of time by the caregiver and simply slipped over the head after dressing.
• There is a wide assortment of grooming aids designed for seniors with various impairments, ranging from magnifying mirrors and long-handled sponges for use in the shower to razor holders that attach to the hand, toothpaste and soap dispensers, and many other devices.
• Many barbers and beauticians will make house calls for seniors who are housebound.

For cancer patients, such programs as Look Good … Feel Better offer practical advice about dealing with the effects of cancer treatment on physical appearance like hair loss and weight loss . Although the first program was started in 1989 for women, there is now a program for men too; both are available in Spanish. Seniors who are coping with cancer might want to consider these free programs in order to avoid depression while undergoing cancer therapy.

KEY TERMS

Activities of daily living (ADLs) —Activities considered necessary for adequate self-care.

Catastrophic reaction —An emotional outburst or overreaction to a situation or event. Catastrophic reactions are common in patients with Alzheimer's disease or other dementias.

Geriatric assessment —A comprehensive evaluation of an elderly person's physical health, functional ability, cognitive function, mental health, and social situation.

Incontinence —Inability to control one's urine or feces.

Instrumental activities of daily living (IADLs) —Activities necessary for independent living within one's community.

Ostomy —A surgical procedure that creates an artificial opening in the body for the passage of urine or feces.

Viewpoints

Geriatric assessment

One important measure in evaluating a senior's ability to maintain personal cleanliness and good grooming is a comprehensive geriatric assessment. This type of assessment is carried out by social workers or homemaking assistants as well as doctors and nurses, and involves an evaluation of the senior's living situation as well as his or her physical health and level of functioning. A geriatric assessment can serve as a starting point for deciding whether the senior needs help with personal hygiene and laundry, and if so, the type and frequency of assistance required.

Some seniors may need help only with doing laundry, changing bed linens, and shopping. These tasks can be performed by homemakers. If the senior requires personal care, however, they will need the services of a home health aide . Home health aides are trained to assist elderly persons who require help with bathing, toileting, oral care, and other ADLs. They may also give advice or instruction about personal cleanliness and self-care. In some cases a physical therapist may be able to help the senior by prescribing exercises that will help him or her to regain or improve functioning well enough to take care of personal hygiene again.

Safety measures

Seniors can often be helped with personal hygiene by careful attention to the safety of their home or apartment. Safety measures help the senior to feel more comfortable using the bathroom for washing or to use the toilet, as bathrooms are a common location for falls in the elderly. As of 2008 there are building consultants who can evaluate a senior's housing for safety and make appropriate changes in wiring or plumbing if needed. Recommended safety measures include:

• Adequate lighting.
• Nonslip surfaces, carefully anchored tub or shower mats, and grab bars or hand rails in shower stalls. In some cases, the purchase of a small stool and a handheld shower extension that will allow the senior to shower sitting down are useful. There are also devices that can be installed to help a senior enter and leave a tub.
• Proper securing of electrical cords and checking the adequacy of existing wiring and outlets.
• Setting the hot water heater at a temperature low enough to prevent accidental scalding.
• Installing a cabinet or other form of storage that will allow the senior to keep bathroom supplies as close as possible to where they are used.

Resources

BOOKS

Beers, Mark H., M. D., and Thomas V. Jones, MD. Merck Manual of Geriatrics, 3rd ed., Chapter 4, “Comprehensive Geriatric Assessment.” Whitehouse Station, NJ: Merck, 2005.

Mace, Nancy L., and Peter V. Rabins. The 36-Hour Day: A Family Guide to Caring for People with Alzheimer Disease, Other Dementias, and Memory Loss in Later Life, 4th ed. Baltimore, MD: Johns Hopkins University Press, 2006.

Morris, Virginia. How to Care for Aging Parents, 2nd ed. New York: Workman Publishing Co., 2004.

Struyk, Raymond J., and Harold M. Katsura. Aging at Home: How the Elderly Adjust Their Housing without Moving. New York: Haworth Press, 1988.

PERIODICALS

Cheek, P., L. Nikpour, and H. D. Nowlin. “Aging Well with Smart Technology.” Nursing Administration Quarterly 29 (October-December 2005): 329–338.

Cohen-Mansfield, J., and B. Jensen. “Dressing and Grooming: Preferences of Community-Dwelling Older Adults.” Journal of Gerontological Nursing 33 (February 2007): 31–39.

Dunn, Joshua C., Brenda Thiru-Chelvam, and Charles H. M. Beck. “Bathing: Pleasure or Pain?” Journal of Gerontological Nursing 28 (November 2002): 6–13.

Gill, T. M., Z. Guo, and H. G. Allore. “The Epidemiology of Bathing Disability in Older Persons.” Journal of the American Geriatrics Society 54 (October 2006): 1524–1530.

ORGANIZATIONS

Administration on Aging (AoA), One Massachusetts Avenue, Washington, DC, 20201, (202) 619-0724, [email protected], http://www.aoa.gov/index.asp.

Alzheimer's Association, 225 North Michigan Ave., Floor 17, Chicago, IL, 60601, (312) 335-8700, (800) 272-3900, (866) 699-1246, [email protected], http://www.alz.org/index.asp.

American Association of Retired Persons (AARP), 601 E Street NW, Washington, DC, 20049, (800) OUR-AARP (687-2277), http://www.aarp.org/.

Look Good … Feel Better, (800) 395-LOOK (24-hour hotline), http://www.lookgoodfeelbetter.org/general/requests.htm, http://www.lookgoodfeelbetter.org/index.htm.

National Aging in Place Council (NAIPC), 1400 16th Street NW, Suite 420, Washington, DC, 20036, (202) 939-1784, (202) 265-4435, [email protected], http://www.naipc.org/NAIPCHome/tabid/36/Default.aspx.

Rebecca J. Frey Ph.D.