Bathing, toileting, personal hygiene, and grooming are basic activities of daily living that advancing Parkinson's makes more challenging. The following tips will help make these activities easier.
Using the Toilet
Bladder changes in Parkinson's may create the need to use the toilet more frequently, so create a regular toileting schedule to help decrease accidents during the day
Limit fluid intake during the evening hours if the person with Parkinson's has difficulty getting up at night (It is still important to have adequate fluid intake during the day to prevent dehydration and manage constipation). Some people may also place a bedside commode or urinal near the bed to avoid travel to the bathroom in the evening.
Use a stool softener such as Miralax (recommended by the American Academy of Neurology for treating constipation in PD) to help produce more regular bowel movements. Avoid bulk fiber laxatives as these require significant fluid consumption to work properly.
Install an elevated toilet or place an elevated seat on the existing toilet to make getting on and off the toilet easier. Some elevated seats have sturdy arm rests attached, or a grab bar can be installed on the wall next to the toilet. This can be helpful to hold onto before pivoting to sit down, or to hold when standing up during the process of hygiene/wiping and clothing adjustments.
Encourage loved one to use arm rests and ease down on the toilet - remembering that it is a hard surface below, not to be confused with a soft chair to avoid crashing into the toilet.
Make sure your loved one gets close enough to the toilet seat with body properly aligned before attempting to sit down. Marking the floor with colored tape may help to signal proper foot placement during the transfer.
Have moist, flushable hygiene wipes available in addition to toilet paper to achieve proper cleaning after toileting. If you are assisting with helping your loved one wipe- consider keeping a clothes pin or chip clip on the back of the toilet to clip shirts up while wiping.
Make sure the person with Parkinson's can wash his or her hands, even if this needs to be accomplished from a seated position.
Consider buying incontinence pads if the person with Parkinson's has accidents during the day. Larger pads can be placed on the bed if incontinence is a problem at night. Read pad labels and packaging carefully to determine proper sizing.
Bathing
Make sure the room is warm and gather all necessary supplies before you turn on the water.
Use a walk-in shower with handheld nozzle, grab bar, and tub bench with a back rest, when possible, for safe bathing.
Consider a tub bench that extends over the side of the tub if a bathtub is the only available option.
Use a non-slip mat to decrease fall risk.
Adjust the water temperature before the person with Parkinson's enters the bath. Use warm water and gentle water pressure.
Rinse skin and hair well.
Wrap your loved one in a robe or towel after bathing. Make sure skin is dried thoroughly. Powders and lotions should be used to ensure good skin care.
Consider a bed bath if immobility prevents getting into a tub or shower. Make sure the water is warm and the person is covered to only expose the portion of the body being washed and dried. Raise bed height, if possible, to ensure good care partner body mechanics.
Use hand sanitizer gels, antibacterial soaps, and moist towelettes throughout the day to maintain hygiene.
Remember that antibacterial soaps and sprays can also cause dry skin - be sure to moisturize with appropriate lotions to discourage chapping and skin breakdown.
Shaving
Use an electric razor.
Rinse the skin well with a washcloth and pat dry.
Apply a soothing lotion; aftershave astringents are often too harsh for sensitive skins which often accompanies Parkinson’s.
Oral Care
Assemble needed supplies in advance (soft toothbrush, fluoride toothpaste, small basin for rinsing, dental floss picks). An electric or sonic toothbrush may be used to promote better oral health.
Choose a place that is comfortable. The kitchen or dining room may be better than the bathroom.
Make sure you have good light. Sit or stand where you can see all surfaces of the teeth.
Brush your loved one's teeth twice daily. Be patient and verbalize each step in the process.
Keep a small towel nearby for quick clean-up.
Try to encourage them to do as much for themselves as possible, brushing yours at the same time can also be a cue to help them make sure they cover the right spots.
Rinse with mouthwash that does not contain alcohol. Use oral swabs (small sponges on a stick) soaked in mouthwash between meals to clean and freshen the mouth.
Sources:
Parkinson's Foundation. Page 81. Bathroom. Chapter 6. Advanced Parkinson's. Caring and Coping. A Care Partner's Guide to Parkinson's Disease. "Booklet."
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