While the devastating effects of memory loss are what we so closely associate with Alzheimer's disease, its progression has many consequences that are physically troubling for caregivers to manage, including incontinence. Alzheimer's and the other types of dementia can lead to the inability of the patient to take care of activities of daily living, like going to the bathroom, and can worsen physical problems like geriatric incontinence. Surprisingly, there can be many reasons for incontinence with Alzheimer's disease, from losing the inability to recognize when they need to urinate to forgetting where the bathroom is to not being able to take off their clothes in time. Some Alzheimer's medications even have incontinence as a side effect. (This is why if incontinence in someone with Alzheimer's is a new symptom, a doctor visit is a must to find out the cause.)
Even though incontinence products, like diapers for adults and adult pads, are practical supplies to use, being able to help a loved one with toileting issues can be an unexpected difficulty, especially if he or she is heavy and you aren't strong enough to bear their weight.
Surprisingly few studies have been done to find the best ways for caregivers to handle incontinence in Alzheimer's patients. One review of existing research found that toileting programs and incontinence adult pads are the mainstays of treatment and also pointed to the need for training programs to help caregivers—both family members and paid professionals—deal with this situation, as well as further studies to find ways that continence can be achieved. According to another study, the burden of caring for someone with incontinence is often the tipping point when caregivers feel they can no longer successfully tend to their loved one at home. Having strategies in place to manage incontinence can delay the decision to move a loved one into a nursing home.
One of the few reported strategies involved working with an occupational therapist (OT). According to one small study, home visits from an OT can show caregivers specific techniques to better manage a loved one's bathing and incontinence care needs. Another study looked at caregivers who worked with a nurse practitioner. They learned toileting training to help reduce incontinence episodes in the loved one along with practical tips. These include eliminating caffeine from the patient's diet, making sure there was a clear, lit path to the bathroom, and having a bedside commode chair
Practical Steps for Caregivers
Here are approaches that can ease the burden of caring for someone with Alzheimer's and incontinence:
- As challenging as it is to care for another person's toileting issues, resist making your loved one feel like a child or feel embarrassed. Resist berating them for something they likely have little or no control over. This can diffuse some of the raw emotions you have over the situation.
- While it makes sense to limit or eliminate caffeine, a common incontinence trigger, from your loved one's food and beverages, don't restrict daytime fluids, which could lead to dangerous dehydration and, in turn, urinary tract infections, worsening incontinence and agitated behavior.
- Get toileting instruction tips from your loved one's doctor. This often includes creating a regular bathroom schedule with the aim of avoiding accidents. A typical schedule involves taking him or her to the bathroom for voiding first thing in the morning, then every two hours as well as after meals and snacks, and a final time before bed.
- Make the path to the bathroom free of hazards and make the bathroom itself safe with a raised toilet seat if bending is hard and grab bars on the adjacent walls or a toilet rail if support is needed.
- Have a commode toilet next to their bed for use in the middle of the night when it can be hard to get to the bathroom fast enough to avoid an accident.
- Both for your ease and your loved one's (if he or she is able to use the bathroom), make sure their clothing is easy to put on and take off.
- To limit the amount of clean-up needed after an accident, use appropriate incontinence products, such as incontinence pads on the bed and furniture, adult briefs, or adult diaper pads within regular underwear.