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Posted: January 31, 2008

The Hygiene-Health Connection

Meeting the Challenge of Personal Hygiene in Our Elderly

Good hygiene is a more than a matter of appearance: It’s a critical matter of health. And for older adults who often face multiple and chronic health conditions, the neglect of hygiene for whatever reason may become a life and death issue.

While many family caregivers willingly delve into the medical, legal, and financial details of their parents’ lives, they’re often uncomfortable asking Mom or Dad, “When’s the last time you had a good bath?” 

Are you among them? Are you noticing signs that you need to ask that uncomfortable question? If so, there’s every important reason to do so – and some ways to do it comfortably and effectively.

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Watch for Warning Signs

Joyce Traina, RN, director of health care services for the Metropolitan Council on Jewish Poverty in New York, says family elder-caregivers should be on the alert for these five warning signs that a loved one may be neglecting or unable to perform the basics of good hygiene:

  1. Bad breath
  2. Body odor
  3. Dirty clothing
  4. Dirty bed linen
  5. Pressure sores on the buttocks or groin region due to incontinence

Vision impairment, fear of falling, depression, memory loss, mobility problems, fatigue, and pain are just some of the reasons why our elderly have difficulty maintaining good hygiene. Other reasons may include a reluctance to ask for help, modesty, or fear of losing one’s independence.

“It is important that the caregiver assist the patient in maintaining and preserving his or her independence, while assisting with personal care tasks,” says Traina.

Here are some important areas to watch and what to do:

Scalp Care

A “scalp” check is one way family caregivers can help a loved one catch health problems that may otherwise go undetected. Checking for signs of infection, lesions, or rashes could turn into a “life saving” step. Skin cancer, shingles, and tinea capitis (an infectious disorder of the scalp) often appear first on the scalp, head, and neck.
Care of the scalp and hair can be difficult for people with limited mobility, balance problems or pain. Water-free, no rinse shampoos are handy when a full, wet shampoo is not possible. So-called self-contained “shampoo caps” are another option growing in popularity. These caps are warmed in a microwave, placed on the elderly’s head, and cleansing is activated by massaging the scalp through the outside of the cap.

Oral Hygiene

According to Dr. Theresa Redling, chief of the geriatric division at Newark Beth Israel Medical Center in New Jersey, “Many seniors will not complain of oral pain, or may become insensitive to oral pain. Diabetics in particular may not know there is a serious infection present that may give a person who is younger or without diabetes severe pain. Symptoms may manifest as poor oral intake, halitosis or -- in the very frail and or demented patient -- confusion.”

Periodontal disease (gum disease) is one consequence of poor dental hygiene. Signs of gum disease include swelling and bleeding.  Research shows that those with gum disease, who are diabetic, have respiratory disease or osteoporosis, are at risk of developing other serious health problems including heart disease and stroke.

“A senior should have a good oral exam yearly looking for any pathology such as tumors, ill fitting dentures, and of course a good cleaning. There are mobile dental units that can visit the elderly in their homes, if homebound,” says Redling. “Alternatively, most medical centers with large dental programs have the resources to manage complex and very frail seniors with oral problems.”

Skin Care

One of the most common skin problems for older adults is dry skin. As we age, the layer of fat under the skin diminishes, so skin becomes more sensitive to temperature changes and more susceptible to damage. As we age, blood flow to the skin decreases, leaving us with fewer white blood cells to fight infections on or beneath the surface of the skin.

The constant itching and irritation of dry skin can lead to dermatitis, eczema or even cellulitis, a condition where bacteria can enter the bloodstream and the lymph nodes through a break in the skin.  In this way, cellulitis can be a very difficult condition to treat and one that can be life-threatening.

Keep these skin care tips in mind:


As Traina says, “Incontinence or loss of bowel or bladder control requires the caregiver to maintain exemplary hygiene to prevent the occurrence of pressure sores.  A warm, moist, dark area is a good breading ground for potential bed sores.  The perineal [genital] area should be kept clean, and fresh underwear or adult diapers should be used to prevent odors.”

Foot Care

Known as the “mirror of health,” the feet may be the first place to find signs of serious health problems. Symptoms including swollen ankles, non-healing wounds, brittle nails, or burning and tingling sensations may be indications of diabetes, circulatory problems or arthritis.

Most foot ailments are due to poor hygiene or other neglect and abuse of the foot. Most foot ailments can be effectively treated, and sometimes the “treatment” may be as simple as a change in shoe size. As we grow older, feet spread and the pads that cushion the bottom of our feet are not as thick as they once were. If we gain weight, our bone structure changes. This is why it’s important for the elderly to have their foot measured frequently to assure proper shoe fitting.

Follow this advice from the American Podiatric Association:

There’s no doubt that dealing with a loved one’s hygiene is one of the most intimate of all caregiving responsibilities. But remembering that talking about hygiene as a matter of health rather than as a matter of personal care can help neutralize discussions for caregiver and care recipient alike.

“There are times when an individual may be unable or simply unwilling to attend to personal care needs,” says Ann Marie Ghumman, director of clinical services at Visiting Nurse and Community Health, Inc., in Arlington, Massachusetts.

Concerned family caregivers may choose to reach out to the individual’s own physician, a geriatrician, public health nurse, social worker or representative from the local Area Agency on Aging for help. Turning to others for help may be necessary and in the best interest of a loved one. As Ghumman says, “If self-neglect persists and is affecting the individual’s health, then this is the time when family caregivers need to question if their loved one has the capacity for self-care.”


Paula S. McCarron has more than 20 years of experience in health care, including nursing homes and hospice. She lives in Chelmsford, Massachusetts, and can be reached at .

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