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Dementia and Incontinence

Dementia is becoming increasingly more common although it is not a normal part of ageing. Diabetes, heart disease, lifestyle factors and genes can all contribute to the onset of this disease.

Dementia: The facts

Dementia is on the increase and is fast becoming a national and a global health issue. 

  • It is now the second leading cause of death in Australia(1) 
  • It is now the leading cause of death in women in Australia (out ranking heart disease and breast cancer)(1) 
  • Dementia is more common in women in both Australia and New Zealand(2,3) 
  • One person is diagnosed every six minutes in Australia (in 2018)(3) 
  • 52% of all residents in residential aged care facilities have dementia(4) 
  • The prevalence of incontinence increases as the dementia progresses

What type of incontinence do persons with dementia have?

In the early to mid stages of dementia, persons with dementia have a functional incontinence. Their barriers to speech, language, understanding, and dexterity can lead them to have accidents, not because they have a weakened pelvic floor or physiological or neurological changes to their bladder, bowel or sphincters. But as the dementia progresses, and significant damage to the brain occurs due to the disease process, it leads to a “true” incontinence, where the person with dementia will have no knowledge their bladder is filling or is full, or have no control over passing urine or faeces. 

Key symptoms

Behaviour changes

Tips to manage

Tips for communicating

TENA products

Helpful links

Key symptoms of dementia which will affect toileting and continence

  • Inability to recognise people and objects 
  • Reduced memory 
  • Decreased coordination and dexterity 
  • Impaired speech and understanding 
  • Reduced social appropriateness and awareness 
  • Behavioural changes such as anxiety, apathy, restlessness, paranoia, hallucinations and reactional behaviour

Behaviour changes to look for

  • May think the bed, chair or other furniture is the toilet 
  • May void in the shower thinking it is the toilet 
  • May pass urine in a corridor as unaware that it is not appropriate 
  • May not recognize care staff or family and resist assistance to the toilet 
  • May become angry or resistant to pad changes; may refuse to go to the toilet 
  • Unable to recognize own bathroom or bedroom 
  • Unable to take initiative to go to the toilet when bladder is full 
  • May take off a pad as it feels uncomfortable as do not understand why it is needed 
  • May throw pad in the toilet or hide it under beds etc.
  • Unable to remember how to use a nurse call bell and may void before assistance given 
  • May become angry or aggressive when approached for pad change due to confusion or paranoia 
  • Inability to judge distance or height of the toilet and therefore may struggle to toilet successfully

Tips to manage activity of toileting or pad changes

Environment 

  • Sign or picture of toilet on door; keep toilet light on and door open always to flag location 
  • Provide a safe environment for toileting/pad changes- safe footwear, dried floors after showers & toileting, motion sensor alarms on chair, bed, floor, beside bed 
  • Learn behaviours that may indicate signs of wanting to void or open bowels: agitated, restless, increased anxiety, trying to move or stand up unassisted, wandering 
  • Clothing should be easy to remove/undo to make pad/pant removal easy and quick (elastic waisted clothing or velcro fastening instead of zips, buttons) 
  • Contrasting objects in the bathroom- black hand wash & black towel dispensers, black toilet seats, black hand rails, and coloured toilet paper will make these key objects easier to recognise (simple design is also imperative)

Routine 

  • Establish toileting times to minimise “accidents” (if possible) 
  • Allow proper time for toileting as rushing activity could trigger aggression or paranoia 
  • Establish a bowel management plan to avoid constipation or faecal incontinence 
  • Encourage mobility/exercise if feasible, as this may reduce constipation & improve sleep 
  • Choose products that do not disturb sleep - dementia can cause difficulty falling asleep, repeated awakenings, confusion between night or day (for eg, the TENA flex “ultima” belted pad can hold up to 5 litres of urine overnight if appropriate) 
  • Limit drinks two hours before sleeping to minimise disruption with pad change/toileting overnight 

Communication 

  • Address person by name 
  • Ask/wait for permission to enter their personal space 
  • Squat at their eye level to explain upcoming activity 
  • Stand to the side and at a distance as this is less intrusive and confrontational 
  • Speak calmly, slowly & use simple language 
  • Check to see if they have understood you 
  • Don’t rush them; smile 
  • Use body language to help communicate 
  • Allow person to assist in activity as much as possible/feasible 
  • Show praise/empathy during toileting as it is very difficult losing one’s independence 
  • At a pad change or toileting try to distract them with singing, music or place something pleasant in their hands that could keep their thoughts occupied (doll, toy, pillow) 
  • Don’t argue if they resit care & avoid getting angry; if possible leave them if they refuse and come back later 
  • Involve relatives in care if this helps with behaviour and relatives agreeable
  • Establish key words they understand for toileting, and have them at the bedside or in bathroom, especially if English is their second language

TENA can help with product choice and managing toileting and behaviour

Managing challenging behaviour related to continence can be addressed by using the most appropriate product for level of mobility, absorbency, level of independence, ease of use, and to make pad changes or toileting as easy as possible. Below are product suggestions for the different stages of dementia. 

Stages Of DementiaIssuesTena Product
mild dementiathe individual has difficulty handling some daily activities – finding the toilet, not remembering why they went to toilet, might have some mood changes, may be getting lost in familiar places, but is mobile and dexterity is not an issue
  • TENA Pants encourage independent toileting, and are similar to underwear and avoid confusion around use of pads
    Go to product
  • High absorbency Pads can also be a good choice where some independence and understanding still exists
    Go to product
moderate dementiathe individual cannot manage daily activities; needs direction or some physical assistance with walking, clothing and placement/removal of pant/pad; memory and communication abilities worsenTENA Pants
  • TENA Pants encourage independent toileting, and are similar to underwear and avoid confusion around use of pads
    Go to product
severe dementiathe individual requires continuous support and care (24/7); the person is totally dependent on other people’s help and care. In this stage they are usually unaware of time and place, unable to recognize familiar objects, persons, friends and relatives. They can often have complete bowel and bladder incontinence.TENA Flex
  • Belted Products (Flex) are easier to apply than other high absorbency products and incorporates a wetness indicator
    Go to product
  • The wetness indicators on higher absorbency products can help ensure individuals are changed only when needed, and sleep can be uninterrupted

TENA offers a great range of incontinence products and aids to help those with dementia:

Helpful links

Dementia Australia 1800 180 023 www.dementia.org.au 

Carers Australia 1800 242 636 www.carersaustralia.com.au 

Dementia New Zealand 0800 433636 www.dementia.nz 

Carers New Zealand 0800 771 797 www.carers.net.nz

Call and order your Dementia kit now

AU: 1800 623 347
NZ: 0800 443 068

Order Online: click here

Dementia kit includes

  • Dementia and Incontinence brochure
  • Toilet Door poster
  • Tips and hint flyer
  • Words and Phrases Sheet

Order your TENA Dementia Kit

References

1Australian Bureau of Statistics (2017) Causes of Death, Australia, 2016 (cat. no. 3303.0)
2https://www.dementia.org.au/statistics
3http://www.alzheimers.org.nz/our-voice/new-zealand-data
4The National Centre for Social and Economic Modelling NATSEM (2016) Economic Cost of Dementia in Australia 2016-2056