Dementia is an irreversible cognitive condition that affects millions of people worldwide, affecting memory and cognitive skills, and eventually leaving the person dependent on daily care. Incontinence, both urinary and fecal, are often present in dementia patients.
Nursing home residents with dementia are twice as likely to have urinary incontinence as their peers without dementia, since the brain damage caused by the disease also affects the ability to control the bladder. In addition, many of the incontinence problems experienced by dementia are due to functional incontinence.
- 73% of people with dementia live at home
- 34% of people with dementia suffer from incontinence during the day
Causes of incontinence in dementia patients
Incontinence in dementia patients can be caused by a number of factors, including certain medications, physical or medical conditions, stress, or not being able to recognize or find the bathroom. If a person with dementia suddenly starts experiencing incontinence, consulting with a health care professional to determine the possible cause is important.
For patients with dementia, the loss of bladder control is likely inevitable with time, but several things can be done to help the dementia patient remain independent and maintain a high quality of life for as long as possible.
A thorough check of medications by a health care professional can determine if medications or diet are causing incontinence, or perhaps making it worse. Sleeping pills and anxiety-reducing drugs may relax the bladder muscles, while certain beverages can work as diuretics or irritate the bladder. In addition, medical conditions such as urinary tract infections, prostate problems or diabetes may be making incontinence symptoms worse.
Lastly, check for environmental or functional obstacles that contribute to incontinence. For patients with dementia, this may include barriers or obstacles on the way to the bathrooms or clothing that is difficult to remove. By removing or limiting functional barriers, independence and quality of life can be maintained for a longer period of time.
Special care needs for dementia patients with incontinence
Navigating the special care needs of patients or residents with dementia and incontinence is difficult and time consuming. Continence care takes up a great deal of effort and care when it comes to overall care for a dementia patient.
Poorly managed continence care affects overall health and creates extra work load in the form of laundry, washing, bathing and changing clothes. All of these activities can be stressful for a dementia patient, who, depending on the progression of their illness, may either be embarrassed or stressed about the situation, or may not understand why they have to be bathed by a stranger.
If a patient uses incontinence products, minimizing the amount of product changes while still avoiding leaks can be a major challenge. It is important to choose the right incontinence product and take the condition into account when choosing.
Patients with incontinence are at extra risk of developing skin conditions related to incontinence, such as incontinence associated dermatitis, and urinary tract infections. To avoid these, ensure they do not spend time in wet products or bedding and take preventive skin care measures to avoid IAD.
Developing an individual routine, based on the continence pattern, progression of dementia and overall health of the dementia patient, is essential for good continence care. For some, a toileting program may be recommended, with automatic reminders and timetables to prompt a visit to the toilet or changing of an incontinence product.
Skin problems, incontinence and dementia
Patients with dementia are especially prone to bedsores and incontinence associated skin disorders. Dry and thin skin is extra sensitive to skin problems, especially when exposed to urine or feces over a longer period of time. This gives bacteria and yeast the chance to grow and crawl under the skin. That is why it important to pay special attention to the skin in order to avoid rashes, infections and wounds.
Good hygiene and the right choice and use of incontinence product is vital to preventing incontinence associated skin conditions and maintaining a high quality of life. Enforce routines to take preventive skin care measures to avoid IAD.
Incontinence products and Dementia
It can be difficult to approach the topic of using incontinence products with a person suffering from dementia, as it in most cases requires accept by the person concerned. If the person is still lucid but has not accepted that they suffer from incontinence, they may not be able to be convinced to use continence aids.
Incontinence products should be chosen individually based on the type, cause and needs of the individual dementia patient, and it is important to promote and maintain self-management for as long as possible to promote independence and acceptance.
Be aware that patients with dementia may try to remove the product, for these people a snug fitting product with fixation pants may be a good option. For those patients who want to maintain independence, discrete pull-up pants can be a good choice.
Supplement incontinence products with bed protection and skin care products as needed.
Dementia friendly bathrooms – incontinence advice
People with dementia can find it difficult to remember where the toilet is, so a picture of a toilet on the toilet doors can be helpful. Pictures are better and easier to remember than words, but a combination of both, including bright colors, may be a good option.
Avoid any barriers that make it difficult to find, see or reach the toilet in time. This may include raising the toilet in height or installing handrails. Make sure the bathroom is well lit, or use motion light sensors. Avoid mirrors or check their placement. A person with dementia may mistake their own reflection for another person and avoid going to the bathroom because they think it is occupied by another person, or they may become scared by their own reflection.
In addition, choose a brightly colored toilet seat in a contrast color to the bathroom so the patient can easily identify the actual toilet.
Do not necessarily disable the locks, as you want to ensure the patient has privacy, but make sure health care staff will be able to gain access to the toilet if needed, to avoid the person locking themselves in.
General tips for taking care of dementia patients with Incontinence
- When helping dementia patients with incontinence, always be aware of maintaining dignity, privacy and independence.
- The first step with any type of incontinence, including dementia patients, should be to determine and diagnose the type and degree of incontinence. This will help determine how to tackle incontinence going forward.
- A part of the assessment may include a keeping urination journal that includes keeping track of fluid intake. This can help a healthcare professional determine if changes should be made to fluid intake and introduce a toilet program if needed.
- As well as having an individual toileting program, care takers can learn to look for signs that the patient needs or is looking for a toilet. They may appear anxious or be fidgeting with clothing or have a change in facial expressions. Be sure to document these signs so other care staff know that this could mean they are looking for a toilet.
- Help maintain the patient’s independence and dignity by ensuring they wear appropriate clothing, such as avoiding buttons or complicated zips or clips. If necessary, clothing can be adapted.
- If a continence product is required, make sure the product is as small as possible but as large as necessary. A small product is far more comfortable and can be very absorbent; a product does not have to be large to be absorbent.