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Introduction
Dementia can make it difficult for people to use the toilet and control their bladder and bowel movements, This can be caused by a number of factors, including memory problems (forgetting to use the toilet or where it is; reduced mobility (difficulty reaching the toilet in time); difficulty recognizing signals (not being able to tell when they need to go, or recognize the physical signals of needing to go); communication problems ; coordination problems or brain damage (damage to the area of the brain that controls the bladder). It can be frustrating and upsetting. Here are tips to help.
Strategies for Success
By following our person-task-environment approach to dementia care, OT can help reduce accidents, improve toileting routine, and reduce care provider stress.
The Person
Learn the person's natural voiding tendencies and ask the care provider to keep a schedule if possible. The goal will be to implement a routine that matches natural tendencies but prevents accidents.
Watch for behaviors that indicate the person may need to void such as being restless or agitated.
Provide clothing that is easily manipulated such as pants with elastic waistbands or hook and loop fasteners.
Provide single-step instructions or demonstrate what is needed. For example "pull your pants down" instead of "pull your pants down and then sit down on the toilet".
Assist as needed to pull pants back up. Sometimes the person will walk away without pulling pants up, which is a fall hazard. Provide as much privacy and modesty as possible.
Consider using incontinence pads at night or a bedside commode if there is concern about rushing to the toilet at night.
Monitor for signs of a UTI and be aware of any impact medications may have on bowel and bladder habits.
The Task
Consider adding a brightly colored, padded toilet seat to draw attention to the toilet (in some cases, removing the toilet seat completely may be preferable).
Install a raised toilet seat and grab bars if needed.
Make sure toilet paper or wipes are within easy reach.
The Environment
Provide visual cues to help the care recipient know where to toilet. These should be simple and straight forward such as a picture of the toilet on the door.
Remove objects from the bathroom that may be confused as a toilet such as flower pots, wastebins or laundry baskets.
Ensure lighting is adequate during the day and night.
Provide a clear path to the toilet; consider closing other doors and leaving just the bathroom door open.
Brainstorm with the care provider on ideas that can be tried and