2. Why is managing continence different for people with dementia?
Key points
“People living with dementia have different incontinent issues than people not living with dementia. They may not recognise the appropriate place, and they’re unlikely to know how to deal with an accident when it’s happened. They just don’t recognise the signs and mechanics of it. ‘What’s that’? Is that a toilet or not? I can’t remember which of these is a toilet’. So, the mechanics of going and the appropriate place”.
Practical Tips
What you can try when...
- Your client is unable to tell you that they need the toilet
A client with dementia may not be able to tell you that they need the toilet. Instead, look for signs of discomfort, such as:- Fidgeting with their clothing.
- Pacing around/having difficulty sitting still.
- Becoming distressed for no obvious reason.
- Frequent passing of wind.
- Your client goes to the toilet repeatedly
A person with dementia may keep going to the toilet repeatedly. For example, they might use the toilet, sit back down in their chair and then immediately get up and go back to the toilet. This can happen several times. Try distracting your client to stop this pattern, especially if they are in an unfamiliar place. It is also important to check that there is no underlying medical cause for frequency, such as a urinary tract infection (see section 4). - Your client tells you they don’t need the toilet, but you think they do
If you think your client needs to go to the toilet but they say they don’t, try distracting them with an activity or a chat. After a few minutes, ask again in a slightly different way to see if they need the toilet.
Planning ahead
Not everyone who has dementia becomes incontinent. Also, many people with dementia manage their incontinence very well. Planning ahead and being prepared for managing future continence problems can help with this. For example, it might help to talk to the person about using pads sooner rather than later to help them get into the habit of using them.
If they are still able to recognise that they need to use the toilet and have started using pads as a precaution, encourage them to go to the toilet. This will help them to remain continent.
“Just because there is a pad, if somebody wants to go to the toilet or has that urge to go to the toilet, please take them to the toilet. We need to remember the pad is there just in case. But, other than that, it can be used as just a normal pant. It’s there in case, but if you can go to the toilet, go to the toilet”.
Caring with empathy
Homecare workers often need to be detectives, working out the reason for client behaviour in order to respond with empathy.
Time
Your visit may take longer than expected if your client has been incontinent. People can become flustered and upset, angry or uncooperative if they are rushed. You may want to let your manager know if you are likely to need to stay longer with any client.
Extending the length of time that is usually allowed for a home visit can be difficult to negotiate. Ensure you have all the information that your manager will need, providing the evidence to them, before making requests for a longer client visit. For example, your client may have become more immobile, taking more time to get up, walking to the toilet, or getting washed and dressed.
“Some days you might go: ‘Actually, do you know what? This is a five-minute job, that’s cracking’. And, another day you’re going: ‘No, this is a whole shower. In fact, this is a whole shower and some’. It’s about the management understanding that actually, what might be a 5-minute job one day could be a 25-minute job the following day”.
Emotional impact on carers
Feelings of disgust when managing people’s poo (particularly, for example, if the client has been handling poo) are very common and a natural response. Avoid showing those feelings to your client as far as possible. Remember that their actions are a result of the disease and not a conscious choice.
You might turn an unfortunate incident into a quick pamper session. This can help encourage hand washing, followed by a gentle manicure to clean under the nails and give a hand massage. It can be a calming way for both the client and the carer to deal with a poo-handling incident.