Dementia Care: Managing Toileting and Incontinence



A compassionate approach to incontinence starts with understanding why it happens. Understanding the causes can also allow caregivers to mitigate or prevent incidences of incontinence for their clients. If a senior has dementia, incontinence usually occurs as the result of this illness. With quality dementia care, there is the opportunity to greatly reduce instances of incontinence, which will improve quality of life and well-being for the person with dementia.


What causes incontinence in seniors with dementia?


Incontinence is a loss of bladder or bowel control that is common in later stages of diseases such as Alzheimer’s, other forms of dementia, and Parkinson’s. A healthy brain sends messages to the bladder and bowel, telling them when it is necessary to empty. Being in control of these functions depends upon awareness of bodily sensations such as the feeling of a full bladder, and the memory of how, when and where to respond. Seniors with dementia struggle with this type of bodily awareness, which leads to incontinence. For example, they might not recognize the sensation of needing to urinate and can confuse it with something else. Seniors with dementia might not be able to remember where they are or where the bathroom is located.


A positive and compassionate approach from in-home caregivers helps seniors maintain their dignity when they encounter symptoms of incontinence. Maintaining consistent toileting and preventing incontinence also helps with hygiene and reduces the risk for urinary and bladder infections.


Not all instances of incontinence in seniors with dementia are caused by their dementia illness. There are also medical reasons for incontinence that are unrelated to dementia. These include:


  • enlarged prostate

  • constipation and bowel problems

  • neurological complications, often caused by a stroke

  • diseases such as Parkinson’s disease, multiple sclerosis, and prostate cancer

  • side effects of medications that relax muscles of the bladder and reduce awareness, such as sleeping pills and tranquilizer


Whatever the cause, assistance from experienced in-home caregivers will help keep seniors on a regular schedule and will reduce instances of incontinence.


At what stage of dementia does incontinence appear?


Dementia is a broad category of brain diseases that cause long term loss of the ability to think and reason clearly. It is severe enough to affect a person’s daily functioning. There are many stages of dementia, with different sets of symptoms appearing at each stage. However, these stages and symptoms can vary for each person with dementia, which is why a personalized dementia care plan from an experienced caregiver is important for maintaining optimal well-being.


Incontinence typically appears during middle to late stages of dementia. It is a very common symptom, one that 60%-70% of people with Alzheimer’s develop. However, not all people who have dementia will develop incontinence. It all depends on the unique circumstances and medical history of each individual.


How in-home caregivers help reduce incontinence


Experienced in-home caregivers understand the psychological effects of incontinence, both on the people experiencing this symptom and on the people who are caring for them. Family caregivers often feel overwhelmed from dealing with this symptom, due to its highly personalized nature and the vigilance required to keep incontinence from occurring. This is why the assistance of even a part-time caregiver can greatly reduce the burden of stress for family caregivers.


If incontinence is not managed well, seniors with dementia can end up feeling isolated, embarrassed, unclean, self-conscious, and anxious. These feelings can lead to body image issues and concerns of being rejected by others.


Quality in-home caregivers know the importance of maintaining a consistent toileting schedule and how to reduce the occurrence of accidents. For example, in-home caregivers watch for cues that their clients need to use the bathroom. Restlessness, pacing, making unusual noises, and pulling at clothes can all be cues that clients are needing to use the toilet. A quality in-home caregiver will understand these nuances in the behaviors of their clients, and whether they signal a need for toileting or a different need entirely.


Personalized care plans are part of the foundation for setting up this high quality level of care. With personalized care plans, Alegre Home Care provides individuals with the ability to age or recover from the comfort of their own home. Our in-home caregivers in San Francisco and the surrounding Northern California areas receive the best training and attend to each person with compassion, empathy, and respect.


If you or a loved one is looking for dementia care services or general in-home caregiving, please reach out to Alegre Home Care for a free consultation.


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