With several colleagues in Brazil and elsewhere, we are involved in two different research projects on older people with care needs living in poor Brazilian communities. One is about encouraging men to play a larger role in this demanding task (1). The other is about promoting hygiene in later life: how older people keep themselves clean, especially if they need someone to help them with washing and bathing. (2)

When planning these projects, we’d expected a small amount of overlap, but felt these were fundamentally separate issues. Data collection for the gender project is now almost complete, while the hygiene project is just starting. Going through the findings of the first project, we are finding that issues of washing and hygiene are coming to the fore. At the same time, our initial work in the second project is revealing the deeply gendered nature of hygiene behaviours. 

One reason for this close connection is that assisting older people with washing and hygiene can be one of the most demanding and difficult tasks for a family carer. This is especially true when the older person is confused, lacks mobility, is overweight and lives in a basic house without a suitable bathroom or where bathing occurs outdoors. Assisting with bathing often requires physical strength and skill on the part of the caregiver. It also requires patience, compassion and gentle persuasion. Some of the older people in our studies go for days or even weeks without having a proper body wash. 

But the most challenging aspect of this task is managing the shame and stigma experienced by the older person, especially if they require help with intimate hygiene. Limited male participation in caregiving means older men in need of assistance usually receive this help from women. Here are some comments from female paid caregivers employed by local governments in Brazil. 

Sometimes the older man will say to a female caregiver something like, “Oh, no way! You’re touching my private parts!”. They can get quite uncomfortable, right?  

Older men can come to accept being cared for by a woman. They aren’t ok with it the first time, and maybe the second time. One man I cared for was like that, but by the third time, he was fine. He let me change his pad, come into the bathroom. I would watch him on the toilet. He would have a shower, and I would help him to dry and put on a fresh pad…  So these men don’t put up a fight for long, it gets broken down.    

I don’t laugh when I see him undressed, right? I just say “I’m going to do a quick bit of business down there”. He looks the other way.  

Conversely, the idea that men may assist older women with hygiene appears to be unacceptable to most older Brazilians and their families. Here are some comments from male caregivers employed by the same scheme. 

Male carers like me can help an older woman to go out for a walk, get her hair done, that sort of thing. But they are not going to be allowed to help them in the bathroom.  

The old men I look after never get proper physical care from me. The families will tell me, “Oh, he’s fine bathing himself”, even when he never does that. Even if you try to reason with them, families will impose clear limits on what you can do.  

Bathing and intimate care in later life are highly sensitive issues which rarely get talked about or studied. Poor hygiene is a major cause of mental and physical health problems for older people. At the same time, men’s limited involvement in caring for dependent older persons is arguably the fastest growing cause of global gender injustice. Addressing both issues requires sensitive engagement with embedded norms and taboos. 

(1) A project developed within the framework of the project Initiatives to Strengthen Care Policies in Latin America and the Caribbean, led by the Group for the Analysis of Development (GRADE), in collaboration with the Global Alliance for Care (GAC), the United Nations Research Institute for Social Development (UNRISD), and with funding from the International Development Research Centre (IDRC). For further information, see https://sites.google.com/view/carefundeconomyla ac2 

(2) A project funded by the Reckitt Global Hygiene Institute. For more details, see https://rghi.org/research/research-portfolio/hygiene-older-brazilian-urban/ 

 For more information about this project, please contact Peter Lloyd-Sherlock (peter.lloyd-sherlock@northumbria.ac.uk).