Incontinence in the Alzheimer's patient can be due to several factors, including confusion, decreased sensory awareness, disinterest in hygiene or a medical illness. It's important to first rule out a urinary tract infection or other medical condition that can be treated. Adapting the home environment for successful toileting may enable the person to maintain health status and independence for as long as possible during the early stages of the disease.
Impact of Incontinence During the Early Stages
Individuals in the early stages of Alzheimer's may be humiliated and try to hide urinary accidents. Others may not be aware of the wet sensation or odor and require caregiver assistance to have their clothing changed. Family members/caregivers may avoid bringing the person to social activities and public places, thus limiting valuable support and recreational enjoyment. Furthermore, if the person is living in a senior housing or assisted living facility that doesn't provide incontinence care, a sudden change in housing will be required.
Impact of Incontinence During the Moderate Stage
During the moderate stage of Alzheimer's, the person has greater confusion that makes it difficult to find the bathroom and remove clothing in order to successfully toilet. In addition, the person may have visual perceptual confusion, such as thinking that the waste basket is the toilet and forget how to use toilet paper. Possible home adaptations include: creating a cleared path from the bed to the bathroom, labeling the bathroom door and keeping it slightly ajar, providing good lighting, color contrast between the toilet, wall and floor, and placing adequate amounts of toilet paper in plain view so that the person doesn't need to rip it off the dispenser. It may be helpful to have the person limit drinking liquids in the evening to avoid urination during the night. Provide pants with stretch elastic waistbands that can be quickly pulled down and assist the person to follow a toileting schedule of at least every two hours. These adaptations may help the person remain continent for as long as possible.
Impact of Incontinence During the Advanced Stage
During the later stage of the disease, the person likely needs to wear disposable underwear. If she is still ambulating and transferring to use the toilet, grab bars should be installed for safety and a raised toilet seat makes it easier for the caregiver to help the person stand up. A waterproof mattress pad or absorbent pad placed on top of the sheet helps maintain sanitation. Patients in the advanced stages of Alzheimer's may not be able to stand and are changed in bed. They may fear movement and being touched when a caregiver changes or dresses them, and behaviors may develop, such as striking out. One strategy is to undress and bathe only one part of the body or one leg at a time. Remove nearby hard objects that the person may hit and provide soothing music, dim lights and pleasant aromas that may help the patient remain calm.
References
- "Still Giving Kisses: A Guide to Helping and Enjoying the Alzheimer's Victim you Love", Barbara A. Smith, 2008.
- "What If It's Not Alzheimer's?", Lisa Radin & Gary Radin, 2003.
- "Your Name is Hughes Hannibal Shanks", Lela Knox Shanks, 1996.
