Helping Someone With Dementia With Toileting

Assisting someone with dementia with daily living activities such as toileting is essential. It's important to recognize and understand these challenges to provide the best care possible.

Toileting challenges for people with dementia

Dementia often leads to difficulties remembering everyday routines or recognizing the need to use the restroom. For those with dementia, even finding the bathroom can become a challenging task due to memory lapses or spatial disorientation. As the condition progresses, individuals may struggle to communicate their needs effectively, including expressing the urgency or need for toileting.

Cognitively, dementia affects a person's ability to plan, remember, and execute tasks. These impairments can hinder their ability to initiate and complete the toileting process independently. Physically, dementia can accompany a decline in motor skills, balance, and coordination, which increases the risk of falls and accidents in the bathroom. This makes it imperative to assist them to ensure safety and maintain hygiene.

Ahead, how to adapt to the environment, establish routines, and choose appropriate facilities and supplies to support these needs effectively.

Creating a supportive environment

Adapting the bathroom environment to meet the needs of your loved one with dementia can significantly reduce the risk of accidents and enhance their comfort and dignity.

To minimize risks and enhance safety, several features can be installed:

• Grab bars: Placed near the toilet and in the shower area to provide support.
• Non-slip mats: Essential in preventing slips on wet surfaces.
• Raised toilet seats: Useful to assist those with difficulty sitting down or standing up from a lower position.
• Shower chairs or benches: Provide comfort and safety during bathing.
• Walk-in tubs or showers without thresholds: Reduce the risk of trips and falls.

Visual cues are also helpful in navigating around the bathroom and performing necessary tasks. These can include:

• Color-coded areas: Different colors can help distinguish elements like the toilet, sink, and shower.
• Labels: Clear labels in large print and simple icons or pictures should be placed on doors and drawers to indicate contents or purpose.
• Directional signs: Signs pointing to the bathroom can help those with difficulty finding it from other areas of the house.

Proper lighting and unobstructed pathways are essential:

• Adequate lighting: Ensuring that the bathroom and pathways leading to it are well-lit, especially at night, can prevent disorientation and help maintain visual clarity.
• Clear pathways: Keeping the path to the bathroom clear of obstacles is crucial to prevent falls, particularly in moments of urgency.

Establishing a toilet routine

Maintaining a consistent toilet routine helps manage incontinence and promotes comfort. This daily routine might involve guiding your loved one to the bathroom every two to three hours during the day, especially right after meals and just before bed, to prevent accidents.

Effective communication through verbal cues and reminders is also important to your routine. Using clear, simple instructions or questions like, "It's time to use the bathroom now; let's go together," helps orient your loved one and reduce resistance. Use consistent language to reinforce the routine and minimize confusion. 

Resistance to a toilet routine might stem from fear, confusion, a loss of privacy, or physical discomfort. You might try distraction techniques such as gentle conversation, humor, or playing a favorite song.

Remember to approach toileting assistance with respect for your loved one's dignity, ensuring privacy as much as possible and acknowledging their need for independence. 

Adapting toilet facilities and supplies

Choosing the right clothing, using appropriate incontinence products, and incorporating accessible toileting aids are important in caring for someone with dementia, as they enhance their ability to manage toileting independently and safely. 

• Adaptable clothing that is easy to remove, such as pants with elastic waistbands or Velcro closures, can significantly improve someone's ability to use the toilet independently. 
• Providing suitable incontinence products, such as pads, briefs, or underwear, as needed can help manage accidents and maintain skin integrity and hygiene. Choose products that are not only absorbent but also comfortable and easy for you or your loved one to change.
• Toileting aids, such as commodes placed conveniently next to the bed for easy access at night or hand-held showers for those with difficulty standing for long periods, ensure cleanliness and reduce the risk of falls. 

By carefully selecting and adapting these facilities and supplies, caregivers can significantly improve the quality of life for individuals with dementia, making toileting a safer, more dignified, and less stressful experience.

Assisting with personal hygiene

Helping a person with dementia with their hygiene affects both health and dignity. It's not only about helping with toileting; it includes helping your loved one uphold their hygiene even after using the bathroom.

Providing hands-on help with washing hands after toileting can help prevent the spread of bacteria. Guide your loved one through the process by physically showing them how to apply soap, rub their hands together, and rinse them under water. 

Here are some additional tips to encourage autonomy even when not providing direct assistance:

• Use adaptive equipment: Equip the bathroom with easy-to-use soap dispensers, automatic faucets, and towel dispensers or hooks that are simple to operate.
• Maintain a routine: Consistency in personal care tasks can help the individual remember the steps involved in personal hygiene.
• Create an enabling environment: Organize the bathroom so that everything needed is within easy reach. For instance, placing soap, a towel, and lotion in an easy-to-reach spot.
• Encourage self-care: Prompt the person to initiate each step of their hygiene routine by themselves before assisting. 

Assisting with personal hygiene is about finding the right balance between providing the necessary support and fostering independence.

Managing toileting issues

Addressing challenges such as urinary incontinence and bowel control, seeking professional advice, and maintaining proper skin care are key components of comprehensive care.

Urinary incontinence and bowel control

Incontinence is often a distressing symptom of dementia that can affect a person's self-esteem and social interactions. Implementing a toileting schedule can help manage these issues by ensuring regular bathroom visits, which may prevent accidents. Additionally, using the right incontinence products and changing them regularly is crucial to keep the individual comfortable and avoid skin irritation.

Seeking medical advice and support

Continence professionals specialize in bladder and bowel health and can offer strategies tailored to the individual's needs, such as exercises to strengthen pelvic floor muscles, advice on fluid and diet management, or medications that can alleviate symptoms.

Managing skin care and preventing infections

Proper washing and drying after the bathroom is vital to avoid irritation and infections. Barrier creams may be applied to protect the skin from moisture and prevent breakdowns. Regular skin inspections can help catch potential issues early before they develop into more serious conditions.

A note from Givers

Caring for someone living with dementia, especially as the disease progresses, can be hard work. When possible, we encourage you to utilize respite care and formal caregiver services to get a much-needed break and additional resources.