Dementia Personal Care at home
Toileting is not usually one of the problem ADLs (activities of daily living) for people in the early stage of dementia, but it becomes more problematic as the disease progresses. The most commonly observed sequence of the loss of independence in toileting goes this way:
- Fully continent of bowel and bladder
- Occasional bladder incontinence, less than once a day
- Bladder incontinence at least one time a day
- Occasional bowel incontinence, less than once a day (might be observed before daily bladder incontinence)
- Fully incontinent of bladder and occasional bowel incontinence
- Fully incontinent of bowel and bladder
What is incontinence?
Incontinence is the loss of control of bowel or bladder elimination. It is potentially one of the most difficult and embarrassing of medical problems that caregiver and patient alike must often deal with. Fortunately, as with most of the ADLs, incontinence is not normally an issue early in the dementia process.
Your family member might need reminders to go to the bathroom, even in early stage dementia. Even signs that lead to the bathroom with a picture of a toilet may be helpful. Urinary incontinence usually begins first, most often at night. Then occasional bowel incontinence. Incontinence spreads into the daytime hours, occasional at first, then becoming daily.
Every person with dementia will eventually require assistance with toileting ADLs, if the dementia progresses far enough. Such assistance might mean physically taking your family member to the bathroom, pulling down down their pants. You may even need to offer help to sit on the commode. Supervision during elimination, wiping and cleaning, pulling up the adult diaper and clothes, then assisting with washing their hands. then assisting your family member back to the chair or bed. Prompt, consistent care will help “eliminate” a variety of problems and promote general well-being.
More on dementia personal care at home ..Some pointers to keep in mind include:
Do not assume that incontinence is necessarily due to dementia or that it cannot be helped; another disease or condition, such as a urinary tract infection, can cause both confusion and heightened incontinence in the elderly person.
Report any worsening of incontinence to the physician
Be alert to signs that could signal the need to go to the bathroom, including pulling on clothing, picking at self, being restless, pacing, undressing
Develop a schedule and anticipate incontinence episodes Put your family member on a bathroom schedule and and try to get the person to the bathroom every 2 hours before incontinence occurs, if possible
Be understanding when accidents occur and NEVER scold your family member
When accidents do occur (as they will with all ADLs) be calm about it and don’t blame for doing it on purpose
Know that infections, medication side effects, and an enlarged prostate gland can cause further problems with urination
The dementia patient should wear clothing that is easy to remove. This is to avoid undue anxiety when going to the bathroom, or when changing/cleaning after incontinence
Objects like planters, trash cans, and water pitchers, and places like closets, room corners, and other small, confined areas might be mistaken for toilets; this is common with later stages of dementia; remove those objects as feasible.
I had one client that had a father that urinated in the corner of the bathroom everyday. The primary caregiver got creative and put a litter box in the corner. This solved her problem of a ruined carpet and it was easy to clean up everyday.
Those who are prone to incontinence or otherwise have toileting problems should have a bathroom nearby and readily accessible.Urinals and 3 in one commodes can be helpful to prevent incontinence. There areFemale Urinals for those that are up frequently at night.
Limit fluid intake in the evening after 6 PM and night
Avoid stimulants in the evening, as these make incontinence more likely at night
Try to observe patterns to incontinence and quickly respond when the person appears to need to go to the toilet
Sometimes a sign or illustration representing the bathroom or bathroom door might help reorient some dementia sufferers to the bathroom
Routinely taking the person to the bathroom on a regular basis will lessen the likelihood of incontinence
Let incontinent, ambulatory patients use the bathroom, even if they have to use adult incontinent supplies, until they cannot use the bathroom anymore (such as when they fight the caregiver)
Activity, proper nutrition, and good hydration can help decrease the frequency of incontinence
More on Dementia Personal Care at home…
Assisting your loved one with their ADLs can be physically taxing and emotionally draining, especially in the later course of the disease. These sections on ADL assistance is to hopefully provide you with an “edge” that will both decrease problematic occurrences and increase your caregiving efficiency. And in doing so, you and your family member will benefit.
Series on Successful Dementia Home Care Tips
Dementia Communication Tips
Understanding Dementia Behaviors:Tips and Strategies