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Caring for a person with dementia can be challenging. Helping the person be free from incontinence (or “accidents” related to bladder or bowel issues) can be increasingly hard as the disease gets worse. In the severe or later stage of the dementia, the person will eventually lose control of bowels and bladder. However, each person should have an individualized plan of care related to maintaining bowel and bladder continence and function for as long as possible. Here are some general approaches to toileting that can be helpful.

Ensure that toilets are visible.
Keep bathroom doors open.
Place signs/pictures as visual cues.
Keep paths to the bathroom clear.
Systematically assess voiding and bowel patterns.
Offer toileting frequently.
Use incontinence pads/briefs, as needed.
For persons who can still toilet, use “pull-up”-type protective products if needed.
Provide adequate fluids during the day.
Limit fluids at bedtime.
Avoid beverages with caffeine.
Ensure adequate fiber in diet.

Adapted from Schwartzkopf, C. E. & Twigg, P. (2014). Nursing management of dementia. In K. L. Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Burlington, MA: Jones and Bartlett Publishers. Used with permission.

Adapted from Schwartzkopf, C. E. & Twigg, P. (2014). Nursing management of dementia. In K. L. Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Burlington, MA: Jones and Bartlett Publishers. Used with permission.

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Caring for a person with dementia can be challenging. Helping with bathing and personal hygiene can be increasingly hard as the disease gets worse. The person with dementia may be resistant to bathing or getting dressed. Each person should have an individualized plan of care related to bathing and maintaining good personal hygiene. Here are some general approaches to address resistance to bathing.

Remain calm.
Use a soft voice.
Choose a time when the person is most rested and least confused.
Consider the person’s lifelong preferences:
Shower vs. bath
Morning vs. evening
Maintain a leisurely pace. Avoid rushing the person.
Give pain medications at least half an hour before bathing if pain with movement is an issue.
Allow the person to wear underwear or a loose-fitting housecoat/duster/gown if desired.
Avoid spraying water directly on the head or face.
Pantomime the desired hygiene activities.
Use distraction: conversation, snacks, or music.
When complete, give praise for clean appearance.

Adapted from Schwartzkopf, C. E. & Twigg, P. (2014). Nursing management of dementia. In K. L. Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Burlington, MA: Jones and Bartlett Publishers. Used with permission.

Problems with Bathing in Persons with Dementia

Caring for a person with dementia can be challenging. Negative behaviors often arise during meals. Care for behavioral symptoms of dementia needs to be individualized based on examining the entire picture of personal and environmental factors (such as living situation and what is going on around them). However, some general approaches to managing certain behaviors can be helpful. Here are some suggestions for issues with eating or feeding.

Thoroughly prepare meal trays (open cartons, cut food).
Offer small, frequent meals and snacks.
At meals, provide one food and one utensil at a time.
Provide nutritious finger foods.
Provide nutritional supplements, if indicated.
Offer fluids in containers that can be self-managed (“sippy” cups, sports bottles).
Request speech therapy (ST) and occupational therapy (OT) services, if needed.
Provide adaptive utensils, if indicated. An OT can order these as needed.
Assist the client to feed self, rather than feeding, whenever possible.
Use “hand-over-hand” feeding (your hand guides theirs).
Gently cue the person to continue eating, chewing, and swallowing. Make your cues short by breaking the process into small steps.
Avoid making comments about manners or messiness.
Provide the person with dignified protection for clothing.
If agitation develops during feeding, stop and retry a little later.
Avoid force feeding.
Reassure the person that his or her food has been paid for (a common concern).
Monitor body weight to detect gains or losses.

Adapted from Schwartzkopf, C. E. & Twigg, P. (2014). Nursing management of dementia. In K. L. Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Burlington, MA: Jones and Bartlett Publishers. Used with permission.

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Caring for a person with dementia can be challenging. Often, negative behaviors are symptoms of the disease process, but they could also be from unmet needs. Caregivers should look for any triggers of negative behaviors and address them directly. For example, if a person becomes agitated every time she needs to use the toilet, then a regular toileting schedule could be started. Look for clues in the person’s behavior. Care for behavioral symptoms of dementia needs to be individualized based on examining the entire picture of personal and environmental factors (such as living situation and what is going on around them). However, some general approaches to managing certain behaviors can be helpful. Here are some suggestions for managing agitation or aggression:

Avoid provoking situations.
Intervene early, before the behavior escalates.
Remain calm.
Speak in a soft voice.
Approach slowly from the front.
Avoid startling the person.
Stay at the eye level of the person.
Avoid touching initially; wait until the person is calmer.
Distract the person by talking about something pleasant.
Avoid rational arguments.
Avoid physical restraint if at all possible.
Identify and address unmet needs (food, fluid, toileting).

Adapted from Schwartzkopf, C. E. & Twigg, P. (2014). Nursing management of dementia. In K. L. Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Burlington, MA: Jones and Bartlett Publishers. Used with permission.

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