5. How does food and drink affect continence in dementia?

Key points

Remind your clients to eat meals and drink fluids regularly – they may forget
Don’t cut down on drinks to avoid accidents
Look out for food and drinks that cause tummy upsets or bladder irritation
Encourage your clients to move about – this helps digestion and toilet habits
Check for food allergies and help your client to make healthy choices

Eating with dementia

In the early stages of dementia people may be fully independent and able to manage their diet by themselves. As their dementia increases they may:

forget to eat and drink
have a smaller appetite
find swallowing difficult
hide food instead of eating it
think that they have had a meal when they haven’t.

Help to set a routine for meals and check that your client is eating them. A restricted or poor diet can cause constipation: watch for people’s facial expressions (grimacing/pain) when trying to poo, becoming restless or having a smaller appetite than usual. Some people prefer to eat their meals in the company of others and will not eat if they are alone. Inform your manager if you have concerns about your client’s nutrition or bowel habits and keep their family informed of your concerns.

Drinking

To avoid accidents, people may drink less and then become dehydrated and constipated. They may also get a urinary tract infection (UTI), which can make older people confused. Encourage regular drinks during the day and then reduce the amount they drink 3-4 hours before bedtime.

Encourage your client to drink little and often
Encourage your client to drink at mealtimes
Aim for 5-8 cups/glasses of fluid each day: may need to increase input in hot weather
Use prompts, like a chart with 8 drinks that they can tick off, to help them keep track of their drinking.

If your client struggles to drink enough fluid they may be tempted by eating or sucking on sweets that are designed to hydrate, such as Jelly Drops, and water-rich fruits such as melon.

Food and drink irritants

Certain foods and drinks can irritate the bladder causing more trips to the toilet, especially at night. Reducing their intake may help a client to control their continence. Common irritants include:

caffeine in tea, coffee or cola
fizzy drinks
citrus fruit juices - orange and lemon
high amounts of vitamin C
spicy foods

Try limiting these one at a time if symptoms appear. Taken in moderation they may not cause a problem. If these are favourite drinks or food, you may need to compromise - it is better your clients eat and drink them than become dehydrated or unwilling to eat.

Keep active

Remind your clients to regularly move about if they physically can, rather than spending long periods of time sitting down. Encourage them to eat fibre-rich foods such as fruit, vegetables, nuts and seeds. Being physically active and eating a fibre-rich diet will help their digestion, avoid constipation and also encourage them to make regular visits to the toilet.

As their dementia progresses, your client may become bedbound. Inactivity slows down digestion and the natural gut movement that helps to move food through the bowel. Regular re-positioning of your client in bed will help their gut to move food along the bowel and avoid constipation.

Constipation can be difficult to avoid and poo may get hardened or impacted in the bowel. Leakage of watery poo around this ‘poo plug’ can appear as diarrhoea. If you are worried that this may have happened, do seek help from a healthcare professional.

Practical Tips

Encourage your client to eat / suck on water-rich foods or sweets if they are not drinking very much
Regular re-positioning of someone who is bed-bound can help avoid constipation
Reduce drinks 3-4 hours before bedtime to reduce the need to pee in the night

Things to look out for and how to deal with them:

Concern	Signs	Management / Things to do
Dehydration	Colour of pee: dark Small amounts of pee Poor / low fluid intake	Encourage client to drink throughout the day. Monitor drinks taken, such as ticking a box on a chart. May need to keep a fluid balance chart. Try water-based sweets and foods to boost fluid intake
Urinary infection	Client is confused Smell of pee – not ‘normal’ Dark pee; small volume of pee	Encourage client to drink throughout the day. Try water-based sweets and foods to boost fluid intake. Monitor drinks taken, such as ticking a box on a chart. Seek advice from a healthcare professional.
Constipation	Hard poo Straining on toilet Blood streaked poo	Encourage your clients to be active. Mobility helps with digestion and movement of food through the gut. A laxative may be required – seek advice from a healthcare professional.
Diarrhoea	Loose / watery poo	Check client is not constipated (known as constipation with overflow). Medicine may be needed to control the diarrhoea – seek advice from a healthcare professional.
Irritable bladder	Frequent peeing Small amounts of pee Stinging or burning when peeing	Establish that diet and fluids are not contributing to the issue; adjust if necessary. Ensure there is no infection (smell and colour of pee). Encourage drinking of water.
Poor food intake	Weight loss Hidden food Refusing to eat	Ideally, client should have company at mealtimes to encourage and ensure food is eaten. Establish a routine. Client may need help with feeding in later stages. May need to seek advice from a healthcare professional on diet or to check for an underlying cause.
Infections	Raised temperature	Seek advice from a healthcare professional.
Miscellaneous	Blood in pee or poo Unusual smells Swollen stomach Sore skin / rash Not taking prescribed medication	Report your concerns to your manager / central office and family members. Follow your employer’s protocols.