Elimination

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Incontinence should not be presumed as the norm in patients with dementia.

Reasons for incontinence in patients with dementia include:

• Not being able to react quickly enough to the sensation of needing to use the toilet
• Failing to get to the toilet in time eg. because of mobility problems
• Not being able to tell someone that they need to go to the toilet because of communication problems
• Not being able to find, recognise, or use the toilet
• Not being able to, or forgetting how to perform the activities of using the toilet, such as undoing clothing and personal hygiene
• Not letting others assist in helping them go to the toilet, perhaps due to embarrassment or not understanding an offer of help
• Not making any attempt to find the toilet; this could be because of depression or lack of motivation or because the person is distracted.

Incontinence related to limited or restricted mobility can be improved with the use of walking aids, handrails, commodes, urinals or nursing assistance.

The toilet environment should be kept uncluttered and as accessible as possible. Clear visual signs with written and pictorial labels can aid people to identify the toilet. Also, leaving the toilet door open when not in use makes it obvious when the toilet is vacant.

Mirrors can confuse patients with dementia as they may think the reflection is someone else in the bathroom.

The effects of visual disturbances and disorientation can be reduced by using plain colours to identify and differentiate between the toilet and other bathroom furniture. A black toilet seat and white pan can make the toilet easier to see.

If a patient is incontinent at night, reducing or avoiding fluids two to three hours before going to bed may help but it is essential to ensure that the patient is drinking plenty during the day.