Alzheimer's Disease, Dementia and Incontinence

Around 49% of nursing home residents have some form of dementia.* Alzheimer’s disease is the most common form of dementia and may contribute to 60-70% of cases.**. Dementia can affect memory and other cognitive functions, and impacts mobility and dexterity. All these symptoms can contribute to incontinence. Residents may forget where they are and why they're there. They might not be able to ask to use the toilet, or even realize they need to go until after they've had an accident.

Let's see an overview of the condition, and look at some of the ways that person-centered care can help you manage incontinence in residents with dementia or Alzheimer's Disease.

Dementia symptoms vary between the different types, which part of the brain is affected, and the individual. These can include problems with cognitive functions, orientation, comprehension, calculation, learning capacity, language and judgement. Dementia develops over time and is categorized in the following three stages.

Individuals with dementia find it increasingly more difficult to communicate their needs and understand the world, this can result in a resistance of care. In fact, 90% of people with dementia will experience BPSD, which can include anxiety, apathy, restlessness, paranoia, hallucinations and reactional behaviour. 

Many things that can trigger BPSD, such as pain, constipation, itching, sleep deprivation, lack of privacy, and a stressful environment. 

Since BPSD greatly affects quality of life, it’s important to identify and minimize these triggers through person-centered care.

Person-centered care means to treat the resident as an equal partner, helping them help themselves to improve their own independence, quality of life and wellbeing, and give them the knowledge, aids and confidence to do so. 

When caring for people with dementia it’s important to treat them with dignity, compassion and respect, to support them developing their strengths and abilities, to live an independent life and preserve their identity for as long as possible. 

So, get to know the resident, talk to their relatives and involve the individual in their own care. Participation in activities can help to prevent frustration and challenging behaviour for residents. Manage any symptoms through music, massage, an active lifestyle, and spending time outdoors. It also helps to say and do one thing at a time, be patient and wait for answers.

Encouraging residents to enjoy a healthy and active lifestyle, maintaining social interactions and a good, consistent sleeping routine can all improve symptoms of dementia.

Person-centered incontinence care supports residents’ independence as much as possible. Here are some ways to achieve this which ensuring residents’ dignity, comfort, and safety. 

• Assess the resident’s needs and set personalized times for toileting (TENA Identifi or a bladder diary are helpful tools). 
• Observe signs of needing to go to the toilet and help as needed 
• Maintain independence by ensuring clothes and incontinence products are easy to put on and remove, like TENA Incontinence Pants. 
• Ensure each resident knows the way to the toilet – clearly mark out toilet, light switch, and toilet seat. 
• Leaving the toilet door open and the light on at night to make it easy to find. You could also put a commode next to the bed at night. 
• Have easily accessible personal hygiene products so resident can maintain hygiene and skin health. 
• Use mobility aids like a raised toilet seat and handrails.

Audited by Josefine Grandin, District nurse, urotherapist, 2023-06-08

*Nursing Home Statistics 2023 | U.S. News (usnews.com)
**Dementia (who.int)