Senile dementia is a neurodegenerative disease that represents much more than a simple memory loss because it generates a decline in the person, undermines their independence, and negatively affects their health and quality of life.

The management of incontinence of an elderly person with senile dementia is very complicated and can be highly delicate from an emotional point of view. Caregivers often feel overwhelmed by the constant work of assistance and support, especially if they are taking care of a family member, and over time they find themselves facing destabilization of their private life. Caregivers often feel overwhelmed by the constant work of assistance and support, especially if they are looking after a family member, and over time they find themselves facing moments of instability in their private life. In many cases, they ask themselves if it is worth continuing like this or if it would make more sense to get help and entrust their loved ones to a retirement home.

The goal of this article is to help the caregiver to have a more peaceful life and to help the assisted person cope with everyday life in a better way through small tricks. You are asking yourself what are the small tricks? In the following paragraph we give the answer:

Two simple things you can do to improve your loved one’s lifestyle and routine are to promote proper nutrition and link physiological needs to moments of daily routine. Furthermore, to increase the patient’s personal safety, it is important to make the bathroom clearly visible and accessible. It is important to have a steady bathing routine using specific and quality products. From a psychological point of view, empathic and communicative assistance is equally important, which makes your loved one feel understood and understood.

In the next paragraphs, we go into much more detail through 7 useful tips to understand how to put these precautions into practice.

• Living with dementia is a challenge
• What causes urinary incontinence in people with dementia?
• At what stage of dementia does incontinence occur?
• 7 tips for caregivers
  • Make the bathroom easily recognizable, accessible, and usable
  • Ensure the hygiene and cleanliness of the client and the place where he lives
  • Use the most suitable products for the elderly
  • Promote proper nutrition and hydration
  • Try to establish periodic urination
  • Treat pelvic emptying in detail.
  • Be empathetic, understanding, and communicative

Living with dementia is a challenge

Dementia affects more than 55 million elderly people in the world and leads to the loss of cognitive and motor skills. Many family members are directly or indirectly involved in the care of their loved ones. We are talking about millions of families who suffer physically and psychologically every day.

In fact, senile dementia has implications not only for the life of the elderly but also causes suffering, frustration, and discomfort in family members. Taking care of one’s parent, and seeing his psycho-physical state worsen constantly is not an easy process to face. Often one does not feel up to par and in many cases, all this leads to high levels of stress or worse, severe depression.

What causes urinary incontinence in people with dementia?

One of the most common problems with advancing age is incontinence, in fact, after the age of 60 between 15% and 35% of the elderly begin to suffer from it. These percentages rise significantly in the elderly with dementia, up to 60 to 70% of the cases. Several studies also show us that a high percentage of these, about 75 to 80%, are living in a nursing home, therefore many more than those domiciled at home.

Chart 1: Among people over sixty, incontinence occurs mainly with elderly with dementia

In people with advanced dementia, incontinence is due to a mix of factors, both physical and mental. Bowel and bladder control is often lost due to the inability to react quickly to the need or to remember where the bathroom is. In severe cases, the physical and mental perception of the urge to urinate or bowel movements vanishes.

In general, the reasons that cause incontinence in people with senile dementia are:

• The physical limits of reaching the bathroom on time
• The loss of mobility
• The feeling of confusion that leads to not recognizing the bathroom or not remembering how to reach it
• Difficulty communicating with the caregiver

In which phase of the dementia incontinence can start?

Generally, the first cases of incontinence begin to present themselves in the intermediate stages of the disease, especially due to mental blackouts.

It is in this phase that the elderly begin to have the first cases of disorientation, confusion, moments in which one can forget where the bathroom is located, not remembering well how to use the appropriate accessories, or even urinating and defecating in places that are not the right ones.

To these can be added physical issues, such as difficulty in undressing, undoing buttons, or a general lack of interest in one’s personal hygiene.

In the more advanced stage of the disease, on the other hand, the elderly incur much more frequent and prolonged episodes of disorientation in which they do not realize the surrounding environment, and do not recognize the signals given by their body such as the urgency in having to do their own needs and develops severe difficulties in communicating this need.

At this moment the person loses the perception of the problem and becomes totally dependent on someone, a caregiver who will have to deal with it continuously.

7 tips for caregivers for elderly with dementia

Incontinence is recognized by caregivers as the major problem in the management of an elderly person with senile dementia.

It is good, when the first symptoms appear, to consult a doctor to find out if there are any physical issues behind these difficulties, otherwise, it can be very useful to follow these 7 tips that can significantly improve the lives of both.

1 Make the bathroom easily recognizable, accessible and usable

It seems trivial, but the elderly with dementia, especially in the more advanced stage, have difficulty in reaching the bathroom due to physical inability or may not remember where it is located, even in their own home.

There are ten tips that can be of fundamental importance for the safety of the elderly:

1. Make the bathroom visible by always leaving the door open
2. Stick photos on the door and use strong colors to make it stand out from the surrounding walls
3. Create a comfortable and fragrant indoor environment that entices the person to stay there for as long as necessary
4. Make sure the door can be opened easily
5. Rearrange the spaces so that the bathroom is as close as possible to the patient’s bed.
6. Always leave a light on at night
7. Install support handles, perhaps colored, to which the elderly can cling to avoid falls
8. Remove all obstacles both external and internal, such as plants, baskets, and items that could be mistaken for a toilet
9. For men, it can be particularly fixing the toilet at the right height and coloring the water inside to create a contrast and make it easier to distinguish
10. Hide or disguise the bidet to prevent it from being confused with the toilet.

2 Ensure the hygiene and cleanliness of the client and the place where he or she lives

The skin of the elderly is very fragile and incontinence can weaken it, even more, becoming the cause of irritation and skin lesions. This happens due to prolonged contact of urine and/or feces with the skin of your loved one. Fragile skin, having a poor physiological barrier of protection, is more prone to the onset of lesions. The lesions are easily penetrated by bacteria that can cause irritation or infection.

It is therefore essential to wash the elderly correctly, check that the skin is perfectly dry and that he always has clean clothes to wear.

Many experts recommend using no-rinse products because they allow you to wash the elderly without continuously using water that could damage the skin. Farmoderm has created the home care kit, perfect for incontinence. Contains products with balancing pH, applicable without rinsing.

For washing, it is preferable to use soft disposable cloths that guarantee greater hygiene than classic sponges and which, thanks to their high absorbency and resistance, guarantee dry and lint-free skin.

Another important aspect is to try to make the patient live in a safe, pleasant, and clean environment.
To do this, it is important to regularly clean and ventilate the rooms, eliminating possible sources of bad smells.

It is essential to clean clothing, sheets, as well as the covers of chairs and mattresses. For everyday objects that cannot be washed consistently and practically (chairs, sofa, mattresses…), it is advisable to use covers made of special waterproof and breathable materials.

Image 2: Caregiver who takes care of an elderly person

3 Use the most suitable products for the elderly

Using the right products is a fundamental element that can help a lot to reduce the possible onset of skin problems related to incontinence, guarantee greater cleanliness and safety and obviously facilitate the work of the caregiver.

The following aspects are most important:

• Choose clothing that is easy to remove and clean
  For example, you could use pants with elastics instead of zippers which are considerably easier to unfasten. Pants with button closures, complicated zippers, and narrow openings are to be avoided. Older people may have physical difficulties in removing clothes, which may cause them to be slower to reach the bathroom. Obviously also for the caregiver, this involves a huge saving in time and physically.Often seniors with dementia tend to want to take off their clothes or diapers, even at inappropriate times. So in these cases, it would be advisable to use clothes that cannot be removed without help, perhaps with back zip.
• Have the patient wear diapers
  Even in the absence of real incontinence (urinary and/or fecal), it is recommended to use absorbent pants which prove essential when there is difficulty in reaching the bathroom. There are various types, very comfortable to wear, both disposable and washable and reusable.The pants or diaper should be changed as soon as you notice that they are dirty, generally every three hours to avoid prolonged contact with liquids and bacteria, except at night when it can be kept longer in order not to interrupt sleep.
  The correct attachment of these containment devices is also essential. This is because in the event of a fastening that is too loose there is the risk of embarrassing leaks or that the elderly can easily remove it while otherwise, it could cause redness and abrasions on the patient’s skin.
• Use skincare products daily
  Losses due to incontinence can cause skin irritation in the long run and, in the most serious cases, injuries. It is therefore good to create a daily routine, using a series of products that can facilitate the patient to have healthier and more hydrated skin. These products should be used carefully after each diaper change.Fundamental is the choice of these products (creams, detergents, and shampoos) and the method of use and application that must be carried out with delicate movements. Drying the skin thoroughly is also very important, which must be accurate and carried out by dabbing the skin, without rubbing. Barrier creams are very useful for protecting the skin from prolonged contact with moisture and irritants.

4 Promote proper nutrition and hydration

Having a proper diet is a vitally important factor that avoids unpleasant repercussions in the already complicated management of incontinence. There is a whole series of drinks and foods that an elderly or incontinent person should not take because they involve an increase in the frequency of the need to go to the bathroom, which increases the occasions for discomfort.

It is very important to ensure the right degree of hydration, making sure that the client takes the correct amount of fluids.

While recommending a consultation with your general practitioner, a generalized indication could be to eliminate or reduce the following:

Table: List of foods that can help or harm people with incontinence

Obviously, not everyone reacts in the same way to these food types, so if they are part of the elderly’s diet it is important to try to reduce them individually, trying to assess each time what the body’s response to that change is.

5 Try to establish periodic urination

Trying to create a routine can be of great help because it allows the body to get used to certain rhythms.

In general, you should try to encourage the use of the bathroom as soon as you wake up, after meals, and before bed. When they are still quite independent, you can ask them to go to the bathroom approximately every two hours, trying to figure out what the perfect timing is for their body.

In the more advanced stages of the disease, the client is unable to manage their impulses regularly. At this stage, the lack of communication could be an obstacle, so you have to find some non-verbal forms in common that can indicate the need to use the bathroom.

When the elderly lose the communicative and physical ability to provide for their own needs The caregiver should therefore take care of accompanying the elderly person to the bathroom every few hours, generally two, and always try to do it at the same times.

We imagine this can be quite complicated so it is essential to ask for a hand from professionals or other family members who can contribute.

6 Treat pelvic emptying in detail.

The caregiver must be skilled, as mentioned above, in trying to establish a good routine. However, it should also help the client to carry out the practice of urination and evacuation correctly and then monitor it both in terms of quantity and quality. There are several aspects that the caregiver should monitor.

• The patient must sit correctly on the toilet. This is an essential aspect because it ensures that there is a correct emptying of the bladder and rectal ampoule.
• The patient must not push in an attempt to stimulate or speed up urination or evacuation.

A good caregiver must therefore be able to establish a routine in urinations and evacuations, monitor that these are carried out correctly, and create a sort of scheduled voiding. If this happens in the right way, the results can be great for both the client and the caregiver, with a consequent reduction in accidents and a reduction in stress and fatigue for those who care for the elderly.

7 Be empathetic, understanding and communicative

The last piece of advice is not related to physical issues, rather it focuses on the importance of emotional support for the elderly.

The person with dementia must be reassured and comforted, it is important that the caregiver tries to give serenity to the patient, shows approval for what he does, and above all does not make him feel guilty when episodes of incontinence occur. It may seem that the patient does not realize or feel no emotions, but in many cases, they feel humiliated by what is happening.

We must not consider this topic a taboo, rather we must talk about it and always have a positive and understanding attitude towards the patient.

It is necessary to realize that not everyone reacts in the same way to these inconveniences. Some may get nervous and grumpy, while others may recognize the problem as part of their illness. It is therefore important to approach the situation in a genuine way and be respectful, speak calmly about the subject and avoid being rude and nervous.

Choosing empathy instead of pity, trying to understand their feelings and thoughts, and instilling positivity. This can certainly help you in the long run.

Often they feel embarrassed, try to encourage communication and if they are reluctant, start the conversation clearly and make it clear that you are perfectly aware of their problems and their needs. Stay positive and patient even when an accident occurs.

Infographic: 7 tips for caregivers who care for the elderly

Ask for help

The management of an elderly person with dementia is an activity that also causes great suffering, especially if a loved one is cared for, perhaps a parent. Seeing him in those conditions can be heartbreaking and frustrating. All these elements can have a great impact on the caregiver’s life, cause stress, and in many cases even depression.

But we must understand that it is not a problem to take a break and not be there every day. There is nothing wrong with asking for help from other family members or from more experienced people. Indeed, it is absolutely necessary to take periods of rest, perhaps a vacation to regenerate both mentally and physically in order to be more efficient when you return to assist a person with dementia.