1. PROJECT ECHO: Behaviors Associated with Dementia
JABSOM Department of Geriatrics

2. Mrs. F.I CC: Combative behaviors during bathing care
Mrs. F is a 76 yo F with hx of Alzheimer’s dementia, HTN, who has been living at a Nusing Home with her husband for the last 3 years.
She often refuses to take bath/shower and she also refused to have bed bath.
Despite behavior interventions by NH staff, she continues to refuse to bathe.
Staff noticed she occasionally has odors due to lack of bathing.

3. Mrs. F.I Meds: Zoloft, Trazodone, Lisinopril, Metoprolol
Social: No EtoH, no smoking, no illicit drug use
Her functional status
Cognitively interactive.
Able to stand, transfer and walk with walker, needs supervision.
Needs assistance for bathing, lower trunk dressing, needs supervision for grooming, walking.

4. Physical Exam BP 100/76, HR 86, RR 20, afebrile
Weight: 120 lbs, Height: 5’2
ENT: moist oral mucosa, ill-fitting dentures
Chest, lungs: unremarkable
CVS: RRR, no Murmur
Abdomen: Soft, no tnederness
Ext: Low muscle bulk, trace edema
Skin: Dry skin, no rash
Neurologic: Nonfocal. Sensory intact

5. MMSE and Depression MMSE: 14/30 Geriatric Depression Scale (GDS)
4/15 (not depressed)

6. Bathing for elderly patients with Dementia
Before bathing care
Gathering bathing supplies.
Making the room comfortable.
Placing soap, shampoo and other supplies within reach.
Monitoring water temperature.
bathing.asp#ixzz4doS2CDqs
People with dementia may become resistant to bathing. Such behavior often occurs because the person doesn't remember what bathing is for or doesn't have the patience to endure lack of modesty, being cold or other discomforts. Loss of independence and privacy can be very difficult for the person with dementia. The disease also may increase sensitivity to water temperature or pressure.
Do not take disruptive behaviors personally. Remaining flexible, patient and calm will serve you best as you try the tips on this page. For more ideas, join ALZConnected, our online support community where caregivers like you share tips on bathing a person with dementia. You can also sign up for our e-newsletter to receive tips on a variety of caregiving topics.
Read more:

7. Bathing Give the person choices.
Fill the tub with 2 to 3 inches of water.
Be sure the person has a role.
Be aware that the person may perceive bathing to be threatening.
Always protect the person's dignity and privacy.
Have a familiar person of the same sex help, if that is more comfortable.

Read more: bathing.asp#ixzz4doSQ4zNw

8. Bathing Set a regular time for bathing. Be gentle.
Simplify the bathing process.
Coach the person through each step.
Use other cues to remind the person what to do.
Use a tub bench or bath chair.
"Sponge bathe" as an alternative.
Individualized care

9. Interventions
NH staff set up “Date Night” with her husband complete with a “couple dinner table” and encouraged her to bathe prior to the date.
Her attending physician wrote a “You need to take a bath” prescription and RN shows it to her before her bath.
Play her favorite music during bathtime.

10. COMMENTS?
QUESTIONS?
OTHER CASES?