Toileting Assistance For People With Dementia

By Starr Hospice Staff

As dementia-related diseases progress, incontinence may occur. This can be from forgetting to use the bathroom when one feels the urge to urinate or have a bowel movement, not recalling the bathroom’s location, not being able to get there in time, or not being able to make the cognitive connection that tells one what the bathroom is used for. All these problems are results the of body’s declining brain function—not just memory, but also deterioration in information-processing functions, motor skills, vision, and more.

Incontinence usually begins in the late-middle stage of dementia diseases, and it is something many family caregivers fear they will not be able to handle. Even professional caregivers can feel uncomfortable providing this very intimate level of assistance. Time, practice, and knowing how to use the proper products will help mitigate discomfort you may feel.

When incontinence becomes a regular problem, first ask the patient’s doctor if there could be a physical cause, such as a urinary tract infection, rather than the progression of brain disease.

Reducing Incontinence Problems

A regular toileting schedule and reading the signals of when the patient needs to go will help them maintain toileting independence as long as possible. However, you will probably need to use protection for the bed, since the person may no longer awaken in response to urination urges as they once could.

• Always be calm and understanding when accidents occur. Find ways to preserve dignity. For example, say, “Anyone can have an accident.” Don’t make the person feel guilty or ashamed.
• Wear gloves to prevent the spread of disease; wash hands before and after.
  If the person cannot use the toilet and cannot learn to use a bedside commode or in-bed toileting, incontinence products will be necessary.
  Watch for signs of urinary tract infection (blood in urine, cloudy urine with sediment, etc.).
• Reminders to go to the bathroom can be very helpful—just a simple mention after a meal, for example, or before bedtime.
  If the patient is in the early stage of dementia and can manage their own hygiene and toileting, you may only need to introduce some safety measures and visual cues. (See below.)
• Some caregivers will wake the person at night to take them to the bathroom, while others prefer to use incontinence products.
• The patient may forget to wipe themselves or may have mobility/flexibility issues that prevent them from properly cleaning up. In these cases, you’ll need to assist. Wash the genitals at least once a day using unscented soap. Do not use talcum powder, as it has come under scrutiny as a potential carcinogen, and it can interfere with the absorbency ability of incontinence products.

Safety Measures and Visual Cues

Even if a patient is able to maintain independent toileting, care partners should introduce some safety measures. These include using night lights along the pathway to the bathroom and ensuring that pathway is free of trip hazards. A low light left on in the bathroom is also helpful.

Be mindful that brain diseases eventually cause trouble with the interpretation of what the eyes see. The person may, for years, be able to identify a toilet. Then one day, that object looks familiar, but the person isn’t quite sure what it’s for. Or, the person can’t as easily recall which door leads to the bathroom. Visual cues will help the patient’s brain more easily make connections. Keep the bathroom door open so the toilet is visible. Put a picture of a toilet on the bathroom door and/or right outside of that entryway.

Vision changes can also cause confusion. A person with dementia may start struggling with depth perception and not being able to distinguish objects of similar colors. This is why high contrast is important in the bathroom. Paint the bathroom door with a color in contrast to the wall for better visibility. A colored toilet seat will be better than a white one, especially if the floor tiles are a light color.