Understanding the consequences of poor hygiene in the elderly

Health issues from poor hygiene in older adults

Poor hygiene can cause a number of health issues for people of any age, however older adults may be particularly at risk of this due to an inability to take care of their own personal hygiene. Here, we are exploring why older adults may find it difficult to stay on top of their personal hygiene, the physical and emotional consequences of this, how this could impact those with dementia, how to recognise the signs of poor hygiene in an older person you are caring for, some strategies older adults can use to maintain good hygiene, and how caregivers can help manage this.At Home Instead, our aim is to help people age positively and in place by bringing expert care to their home. For nearly 20 years, we have been providing the highest standard of care, and creating industry-leading training programmes for our Care Professionals that are accredited by nursing and medical professionals. Today, we are the world’s largest global domiciliary care network, supporting over 100,000 older adults with personalised, tailored care at home. So whatever questions you have about hygiene in older adults, we can help.

What are the physical health consequences of poor hygiene?

Neglecting hygiene in older adults can lead to serious physical health consequences, such as:

• Increased risk of infections – Infections such as urinary tract infections (UTIs), skin infections, respiratory illnesses and more can result from a lack of personal care. 
• Seasonal illnesses – Older adults with poor hand hygiene can be hit harder by seasonal illnesses like colds and flu due to a weakened immune system, so personal hygiene is important to avoid these. Studies have found seasonal influenza-related diseases can negatively impact the health of older people, with 70-90% of seasonal influenza-related deaths involving those aged 65+. 
• Poor oral hygiene – Older adults should brush their teeth twice a day as recommended, as neglecting the care of teeth and gums on a regular basis can lead to issues like gum disease, tooth decay and bad breath. You can learn more about this in our guide to dental care for older adults.
• Skin irritation – As well as skin infections, unclean skin can cause sores or rashes, since skin can become dry, cracked or irritated. Studies suggest around 53% of homebound older adults suffer from incontinence, which is known to cause skin issues, so cleaning and checks should be a regular part of home care. 
• Foot problems – Foot care is essential to avoid fungal infections, ulcers, ingrown toenails and more, which could lead to mobility issues if walking becomes painful. This is important for those with diabetes who have an increased risk of neuropathy and foot ulceration. You can read more about this in our article: Common Foot Problems In Older Adults

• Missed signs of illness – One of the main reasons for performing regular personal hygiene tasks is to identify any early signs of health complications. As an example, while carrying out personal care tasks you or your caregiver might notice symptoms like swollen glands, skin conditions or a rash that may be otherwise missed.

What personal care challenges do people with dementia face? 

Personal care tasks can be more challenging for those with dementia or other cognitive problems. Cognitive decline may result in a lack of awareness or recognition of their own personal hygiene needs, which means they may be inconsistent with their care and require help from a caregiver. This may be necessary due to: 

• Behavioural symptoms such as agitation or resistance, which can make hygiene routines more stressful for both the person themselves and their caregiver
• Memory loss which can cause confusion or reluctance during hygiene activities like bathing or brushing teeth
• Physical impairments associated with dementia which can further complicate hygiene tasks, making them difficult to perform independently
• Other physical impairments, such as slower healing from broken bones and limited mobility due to conditions like arthritis. These issues can reduce independence, cause emotional distress, and require constant care or environmental adjustments.

Caregivers must exercise patience with those they are caring for. Older adults with dementia could benefit from a structured routine, and a reassuring approach when suggesting certain personal care needs to minimise anxiety. These could be broken down into much smaller steps, simplified to make them accessible for those with cognitive issues, or caregivers could use visual and verbal cues to guide hygiene activities.Some people with dementia will require only reminders or prompts for their personal care needs, while others in the advanced stages of dementia will need help with all aspects of this, including emotional support and behaviour management. You may find more helpful information in our guides to caring for someone with dementia at home or living with Dementia.

What are the signs of poor hygiene in older adults? 

It is important to recognise the signs of poor hygiene in older adults so the necessary steps can be taken to intervene if needed, to help them to remain in good health. Some of the signs to watch out for include: 

• An unpleasant body odour from infrequent bathing 
• Dirty or stained clothing
• Unkempt hair
• Unclean nails
• Dental issues
• Skin problems such as rashes or infections
• Frequent infections or illnesses
• A reluctance to engage in regular self-care activities
• A change in their mood 
• Withdrawal from social activities 
• Environmental clues such as an unclean living space or accumulation of unused personal care products 

What personal hygiene needs should be considered for older adults? 

For older adults, maintaining personal hygiene can be made easy by categorising their needs into daily needs, weekly needs, or more occasional needs. For example:

Daily Needs

• Wash hands after going to the bathroom or touching anything unhygienic 
• Wash intimate and sweat-prone areas, such as under arms and genitals 
• Wash face to feel fresh and clean 
• Brush teeth (it is recommended to do this twice a day) 
• Moisturise to promote healthy, soft skin 
• Manage false teeth (if applicable)
• Brush and style hair
• Change clothes regularly
• Shave (if needed)

Weekly Needs

• Bathe or shower at least twice a week (while bathing is a daily activity for most people, older adults may not need to get washed every day unless they feel confident and comfortable doing so, so they can limit this to a few times a week for safety, and organise for caregivers to help) 
• Bathe feet and check for signs of fungal infections or sores (this will be a daily check for those with diabetes)
• Change bedding regularly 

Occasional Needs

• Book and attend regular dental check-ups 
• Get regular haircuts for scalp hygiene and to improve confidence 
• Trim and clean nails to avoid ingrown nails (You can read more about the importance of this in our guide to hand, foot and nail care for older adults)
• Clean devices such as hearing aids and glasses

Studies suggest some of the most vital personal care activities include bathing, taking care of oral hygiene, using the bathroom for toileting, hair care (including shaving, brushing and styling) and nail care, so it is important to carry these activities out at a minimum. 

What are some key strategies for maintaining good personal hygiene for older adults? 

Caregivers helping older adults with their personal hygiene needs can take a number of helpful steps to make the experience as simple, streamlined and comfortable as possible for all involved. These include:

• Establishing a consistent routine for all personal hygiene tasks, such as brushing teeth at the same time each day, to create a sense of stability and predictability that can alleviate anxiety. A 2022 study found that a daily routine can be useful for older adults as it can reduce stress and anxiety, and increase feelings of safety. 
• Offering assistance with bathing or showering by making adaptive devices available or providing personalised support for their needs.
• Ensuring privacy and dignity as much as possible during intimate personal care tasks. Many personal care tasks are of an intimate nature, which can be difficult for older adults to accept and feel comfortable with, so it is important to show respect, empathy and compassion when helping with hygiene tasks to preserve their dignity. 
• Ensuring personal care items are easily accessible for the older person and suited to their needs, so they can use these independently if able.
• Making home adaptations and implementing adaptive devices such as grab bars or shower chairs to make the experience safe and more comfortable for an older person who may be anxious about falling. If they are able, home adaptations can allow them to do many of their personal care activities independently. You can learn more about what might be available in our guide to home adaptations for disabled older people.

If you are a caregiver for an older adult and assisting with their personal care, it can help to make the experience as comfortable as possible by providing things like good-smelling products, calming music, and regular explanations of what you intend to do next. This can be particularly helpful for those with dementia who may be confused or frightened. Some strategies for ensuring the safety of an older adult during personal care tasks include making sure the floor is never slippy, water is comfortably warm, the room is at a good temperature, and the environment is safe for you both to move around in. If the person is performing personal care tasks independently, it is safer to remove any lock from the door so you can gain access in an emergency. There are lots of resources available for anyone who is providing personal care assistance to an older loved one, and you can learn a lot about the local support groups and nearby resources from your GP if you register as a caregiver. Older adults who need help with personal hygiene duties may opt for the help of a professional home carer instead of having a loved one deal with intimate tasks. This might mean occasional visits from a home carer, or a live-in carer if the person needs more intensive assistance. If you feel you or a loved one could benefit from personal care at home, you can get in touch with your local Home Instead office to learn more, or read our guide on how to choose and arrange home care services for everything you need to know about organising this.Our Care Professionals are the best of the best, and highly trained to deliver the services you need. No matter what type of home care you are looking for, we can provide a tailored service that suits you or your loved one.We’re an award-winning home care provider and part of a worldwide organisation devoted to providing the highest-quality relationship-led care for older people in their own homes. Arranging care for yourself or your loved one shouldn’t be stressful, so whatever questions you would like answered, feel free to reach out to the Home Instead team to discuss your needs.