Dementia and Incontinence

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Measures developed to assess independent living skills include toileting as one of the activities of daily living (ADLs). As part of an evaluation of senior care needs, an individual’s ability to independently get to the toilet, use it properly, and clean oneself are assessed as indicators of a need for help at home. As seniors progress through the stages of dementia, the decline in their cognitive abilities impacts their ability to accomplish these basic physical tasks. What may start as incontinence events or “accidents” usually progresses into chronic incontinence issues for those with severe dementia.

Toileting & Late Stage Dementia

Loss of bladder control due to an inability to get to the bathroom or use it properly is defined as functional incontinence. Late stage Alzheimer’s is marked by the loss of ability to respond to the environment as well as a loss of ability to communicate and express needs. As a person with Alzheimer’s loses awareness of their environment, they often become confused within their own home. Although individuals may continue to be aware of the urge to urinate, forgetting the steps to complete the toileting process or confusion while navigating to the location of the bathroom prohibits them from getting to the toilet in time.

Toileting properly is further complicated by the loss of ability to communicate; people with severe Alzheimer’s cannot communicate the need to void. In the final stages of Alzheimer’s disease, people no longer recognize the urge to urinate and become completely dependent on others for their personal care.

Incontinence Care

Incontinence is identified by many dementia caregivers as one of the most challenging care issues to deal with. At the first signs of incontinence, seek medical attention to rule out any reversible causes of bladder control issues such as a urinary tract infection (UTI), medication interaction or diabetes. If no reversible cause is identified, implementing the following strategies may help with managing incontinence at home.

Tips for Managing Incontinence in Alzheimer’s Disease

  1. Evaluate accessibility of the bathroom. Leave the door open and the light on to aid in finding the room. Consider labeling the door with a descriptive photo to trigger the memory of the bathroom.
  2. Evaluate accessibility of clothing. Are buttons or zippers inhibiting the ability to open pants quickly enough to avoid accidents?
  3. Evaluate the safety of the bathroom. Seniors with mobility challenges may have a problem getting to the toilet because it’s hard to move quickly. Additionally, as cognitive issues arise, so do fears and uncertainties. Consider what may be needed to prevent stressful and/or dangerous situations. Does the bathroom have a nightlight? Are the floors clear of hazards? Avoid clutter and distractions in the room.
  4. Improve visibility of the commode. Use a toilet bowl cleaner that colors the water and/or a toilet seat that lights the bowl in order to improve “aim.” Adult males may be more comfortable sitting while urinating to reduce messes caused by low vision. Remove waste baskets or other objects that may be confused for the commode.
  5. Schedule regular trips to the bathroom. The loss of ability to communicate and express the need to “go” requires that the caregiver be proactive about scheduling toileting breaks. Watch for non-verbal cues that might indicate the need to use the toilet. Encourage a senior to visit the bathroom upon waking, after each meal, and before bed. Timed voiding throughout the day may help minimize accidents.
  6. Provide verbal assistance with the toileting process. Prompt with cues regarding the steps involved in toileting in matter of fact language. Caregivers also report some success with making signs. Simple reminders to flush the toilet or wash your hands with descriptive pictures may be helpful to seniors who can still process what they read.
  7. Limit resources. Overuse of toilet paper, or tissue “obsessions” are often frustrating for care providers. Some caregivers limit access to toilet paper, or install an after-market bidet to minimize the need for toilet paper. Adding a bidet nozzle or hand held bidet to an existing toilet simplifies clean up by spraying private areas to remove waste.
  8. Replace undergarments with well fitted incontinence briefs. Seniors who are resistant to wearing incontinence products, may be pleasantly surprised by the advances that have been made in incontinence supplies. Disposable briefs allow for a comfortable fit and leak protection in styles that resemble underpants. Absorbency plays an important part in improving personal hygiene and maintaining skin integrity.
  9. Use absorbent pads on furniture and the bed. A portable commode may be useful near the bed for nighttime urgency. A waterproof mattress cover will protect the mattress from soiling, while oversized disposable bed pads protect the bedding from overnight accidents.
  10. Maintain dignity. Incontinence care requires patience, understanding and a commitment to upholding your loved one’s dignity. Family caregivers sometimes draw the line at providing incontinence care for an aging parent. When Alzheimer’s progresses into total care, needs may be more extensive than can be safely and comfortably met at home. Placing an Alzheimer’s patient in the care of dedicated, trained professionals is a way for the family to ensure that their loved one’s needs are met safely and appropriately.

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Sources: Toileting Tips and Tricks (https://www.alzheimersblog.org/2016/09/06/toileting-tips-tricks/); Alzheimer's Association Daily Care (https://www.alz.org/help-support/caregiving/daily-care/incontinence); Urinary Incontinence in Older Adults (https://www.nia.nih.gov/health/urinary-incontinence-older-adults)

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