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Bob Demarco: Water is invisible and disconcerting to dementia patients
Posted: Monday, February 22, 2016 6:56 AM
Joined: 5/20/2014
Posts: 4408

Water is Invisible and Disconcerting to Dementia Patients3

The simple facts are this: many Alzheimer's patients don't like water because they no longer perceive water in the way that you and I do.

Posted: Monday, February 22, 2016 6:58 AM
Joined: 5/20/2014
Posts: 4408

By Bob DeMarco 

+Alzheimer's Reading Room

We often discuss how difficult it is to get an Alzheimer's patients or a patient with a related dementia to take a bath.

Carole Larkin estimates that bathing is one of the top three problems that Alzheimer's caregivers face.

I agree.

We have discussed the use of the smile, nonverbal communication, and a number of techniques and timings that might help the caregiver accomplish this mission --bathing .

This time around I am going to talk about water.

Do Alzheimer's patients fear water? Is water nearly invisible to Alzheimer's patients?Does water disorient Alzheimer's patient and make them feel anxious or confused?

My observations with my mother Dotty, and discussions with other caregivers leads me to believe the answer is often yes

Search the Alzheimer's Reading Room for Answers to your Questions about Alzheimer's and dementia

Lets start with a simple question. Do you have a problem getting an Alzheimer's patient to drink water? Do they say No or refuse to drink water? Many of you will answer yes.

Did you ever wonder why?

Did you ever notice that when an Alzheimer's patient gets in the shower they immediately move to the side so the water doesn't come down on them? In other words, hit them in the head.

When you go into the shower with the water on, do you willing step under the water (assuming you have it at the desired temperature), and put your head under the water?Answer? Or, do you step to the side and ease your way in?

Have you ever considered that an Alzheimer's patients can't see water, or at least they don't perceive water the way we do? 

Is it possible that water is invisible, in a sense, to Alzheimer's patients?

If something you couldn't see, or perceive, started hitting you in the head would you get confused, disconcerted, or angry? If something that you couldn't see or perceive started hitting you in head, would you run from it? Answer?

Custom Search - How to talk and communicate with dementia patients

When Dotty would step into the shower she would never let the water hit her in the head; and she was clearly disconcerted until she moved out from under the shower water. 

I learned how to get Dotty to accept (take) and cooperate at shower time. However, I worked diligently over time to help make that happen. This should actually read, worked with and together with Dotty to accomplish our mission.

There is an obvious alternative to having the water hit the person in the head when they enter the shower. You can use a hand held, detach it from the wall, let it hang down, and aim in at the floor, or away from the patient. Of course if you do this, you will then most likely have to assist the patient in taking the shower.

I strongly suggest you start right now in assisting the patient to take a shower. It is likely that you will have too sooner or later anyway.

Yes, my fellow men, you will likely have to give your mother a shower. It is a very rewarding if you get into the right mind set.
When my mother would go into the pool she would go into the water with great trepidation. One thing for sure. As she stepped into the water and down the steps she had no idea how far down it was to the next step. In fact, I often thought that when she looked at the water she thought it was very deep. Even though she had been entering into the same three feet of water for 40 years.

While going in, and then when in the water and walking my mother would always says, this water is making me dizzy. It clearly disconcerted her if she looked down at the water.

Here is something else we know. Many Alzheimer's patients will eat off red plates but won't eat, or eat much off white plates. Is the food invisible for some on white plates, or does it look less appetizing? 

Custom Search - 16 Ways to Get a Dementia Patient to Eat More Food

Dotty would almost always stop when she went from a colored carpet on to a white tiled floor. It was like there was some kind of magic fence. She would stop dead, and most of the time I would have to assist her for the first few steps on to the white.

She did not have any trouble by the way going from white tile onto colored carpet. She just kept on trucking.

So if white is hard to see, or scary due to depth perception, think about how scary water might be.

White a lack of color, water, no color. Invisible.

If I asked you to get in (or under) water that you couldn't see, or that made you dizzy, or worse made you feel scared, what would you do?

The simple facts are this: many Alzheimer's patients don't like water because they no longer perceive water in the way that you and I do.

However, once the AD patients gets into the water, and as long as it not too hot or cold, they will be just fine as long as stick around.

I suggest you use the hand held shower attachment. Take it down and let the water hit the ground at foot level. Gently pick it up once the patient is in the shower and shower their hand for a bit. Then arm. Then warn them well in advance that you are going to wet their hair. Be gentle. Start with the back of the head, not the top, and not the face.

If your patient is capable of washing themselves you can then hang the shower head up on its connection and let the AD patients wash themselves. In fact, if possible, I am going to encourage you to allow the AD patient to wash themselves for as long as is possible. Let them do it.

Custom Search - Just Let an Alzheimer's Patient Do What They Can

When Dotty wasn't sick I would give her one really good shower a week. When I was finished she looked like a finely waxed car. This included a hair wash and shave which we did first in the kitchen sink.

Now don't misunderstand me here. Dotty gave herself a shower the other 6 days of the week with some assistance from me. Like turning on the water and getting the temperature just right, by placing a nice soft towel on the floor for her feet, by making sure the bathroom was warmed up if necessary, and by cheering her own from outside the shower.

Yes, I layered on an enormous amount of positive reinforcement every step of the way at shower time. Including raving at how wonderful she looked and smelled at the end.

Water is invisible and disconcerting to the typical AD patient. They don't like to drink it, and they don't like to get in it.

So, they need some very positive assistance. 

Big tip. Once you break the bad pattern, and replace it with a new pattern, you are home free and on to the solving the next problem.

Related articles

How to Get An Alzheimer's Patient to Bath

5 Tips, How to get an Alzheimer's Patient to Shower

Original Content Alzheimer's Reading Room

Posted: Monday, February 22, 2016 7:48 AM
Joined: 7/24/2015
Posts: 3020

I love you an respect you work...but I often dislike Bob's work, an this be no exception.  It no be that he does no try, it just be that he no real get it.  He be take our writing things, an ignores why we say issue is (man be try tell him, he no care listen) makes up what he think it may be. 

Like water.  MANY pwd write talk bout no liking water (99% pwd in video online groups say this).  But that be because it has a horrible sensation on body, due break down our because is invisible an scary.  It is painful, disturbing sensation on skin.

One of biggest barriers our care, be that our carers just do no understand what disease be do us.  Unfortunately, it be take us write say what it do us, for them start listening adapting. 

Be cause, in you treat me bath if you mistakenly think I be scared invisible thing verses if you understand that water be disturb sensation on my skin, be ver diff.


Posted: Tuesday, February 23, 2016 6:53 AM
Joined: 5/20/2014
Posts: 4408

I thought Bob's hypothesis put an interesting twist on the subject of bathing. But you're right he really does not know firsthand, and it is after all just a hypothesis.

I would think the skin sensations do play a big factor. There could also be a combination of factors for different PWD such as, feeling vulnerable w/o clothing, feeling a loss of dignity, weakness, balance issues, room temperature, water temperature, and fear of falling or slipping in the tub or shower. 

Jo C.
Posted: Tuesday, February 23, 2016 9:04 AM
Joined: 12/9/2011
Posts: 13599

Interesting topic, llee.   I read in a journal about some experiences in a NH in New York that was dedicated to the care of Jewish residents.   The admin. staff related how careful they had to be with bathing for some of their patients. 

So sad; the shower room for some of the compromised elders with dementia was an overwhelmingly terrifying place as some of them had experienced the holocaust camps and equated the shower room with the gas chambers in the camps.  For them, of course, their bathing routine was changed.  One has to be so sensitive to all matters and honor the fears of our LO no matter what they may be.  We would want no less for ourselves.

It broke my heart on those elder's behalf to read about those poor souls who are so deserving of our protection and peace as much as can be. 

My mother was one who began to have a difficult time with showering as her dementia advanced.   She would shower, BUT one could NOT get water on her face.  It caused her to panic.   We got a hand held shower head that slid up and down a long rod so the water did not reach her anywhere except her lower body, let her cover her face with a dry wash cloth and that did the trick.

She was always afraid of water from the time she was a child.   She would not get in a swimming pool, (even prior to dementia and when in her younger years or young adult years), even in the most shallow water; it frightened her.  She said she never had a "drowning" scare or out of control scare in the water as a child, it was just one of those free floating fears.   Later, as the stages advanced much farther and she refused all bathing, we used the soft lighting, warm towels on a chair in the bathroom and used the large, pre-moistened bathing cloths we got from the pharmacy and warmed then in the microwave.       

 This is an interesting topic, thank you for sharing this with us.


Posted: Tuesday, February 23, 2016 3:43 PM
Joined: 9/12/2013
Posts: 3608

llee08032 wrote:

 I would think the skin sensations do play a big factor. There could also be a combination of factors for different PWD such as, feeling vulnerable w/o clothing, feeling a loss of dignity, weakness, balance issues, room temperature, water temperature, and fear of falling or slipping in the tub or shower. 


YES! having water hit me in the head is creepy, and weakness, fear of falling, fear of being scalded, all that is part of it. 


In past year I bought some cobalt blue and bright green plastic water glasses (at thrift shop! ) and really like them. They have a heavier base to them and just really LIKED them instead of clear glass.  I am often bumping water glass near computer !  clear ones do not stand out.  


about saying "NO" to a glass of water ...
 People with dementia often say "NO"to things that would take them more time than they feel they have to understand what they are committing to. This automatic "NO" was so prevalent some one figured out, easier for us to say NO than agree to something we might not really want.   


I said NO regularly for about a year or so, the year I swore like a sailor all the time! I have learned to say OK more often now and the <constant> swearing stopped.


The hand held shower is a good. I like to sit on bench in shower more than stand.  I am SWIMMING in large pool and  love swimming because I can not fall in water and can dance in water without breaking a hip. Ha!


SUN - Some of what Bob saw in his Mom's behavior might not be accurate because he was learning it all as he went. It took years to figure out what made his Mom happy and give her that. So much is experimenting.
I read info at other site today and scrutinized it sentence by sentence thinking "that is baloney" and "that is demeaning" and so on. Then I read the comments and the people were so thankful for these explanations! 

 when we debunk erroneous lingo and beliefs here it opens eyes and hearts, how huge this is for us to be able to provide more accurate information.  In each life this is sorted out uniquely, what does not help me still might work for someone else.

Have you seen the photo of dogs not wanting to take bath? I wish I could post the one where dog had front paws on far side of tub and rear paws on other. I so identified with that!


Posted: Tuesday, February 23, 2016 3:49 PM
Joined: 9/12/2013
Posts: 3608

Image result for image dog doesn't want bath     

Dog refuses bath! can you see?

Posted: Tuesday, February 23, 2016 4:06 PM
Joined: 7/24/2015
Posts: 3020

Love the pics dogs baths.  <3
Posted: Tuesday, February 23, 2016 4:13 PM
Joined: 9/12/2013
Posts: 3608

SUN - how come no one is taking "cute"pics of us refusing to bathe?! Ha!
Posted: Tuesday, February 23, 2016 5:54 PM
Joined: 9/30/2015
Posts: 1155

I personally have found that taking a bath in sudsy water works for me. There is something about showers I do not like. I do not like the feeling of the water on my skin from a shower. Put Dreft in the bath though and I do not have the problem of wondering about the water.
Posted: Tuesday, February 23, 2016 7:11 PM
Joined: 7/24/2015
Posts: 3020

Yup, well I will stick by my 99% of peop disease just don't like feel it on their skin. 

I think would be riot pics us. My daughter I used joke bout doing bad dementia humor things...this could be funny. 

Eve see the pic of cat print snow say cutest nope eve?

I just be found out we will be get increase in PCA time (Yea), will be able hire second pers get me bathed dressed mornings.  My friend say that she does no mind extra time.  I had say, I just do no think can go there her.  I know I can no go there daughter.  I imagine it be easier peop with spouses in pic. 


Posted: Tuesday, February 23, 2016 9:04 PM
Joined: 5/20/2014
Posts: 4408


We just never know what things can bring up for some people with awful experiences like that. My mom was afraid of water too and insisted on us taking swimming lessons.

Alz+ these dog pictures are so darn cute and cheery!