Incontinence Care for a Mentally Impaired Loved One

Incontinence often shows up among older adults who have memory issues like dementia or alzheimer's.^1,2 These conditions could affect your loved one's ability to reach the toilet for a few reasons, like: ^1,2

• Forgetting how to use or where the toilet is because of memory loss
• Losing their ability to recognize the urge to go

These issues could leave them feeling disoriented or even afraid when it's time to go. As a caregiver, this could take a toll, physically, emotionally, and mentally. You might feel exhausted, frustrated, or unsure of what to do next.

The good news is that with patience, a consistent routine, and a non-judgmental mindset, incontinence can become more manageable for both you and your loved one, leaving them feeling safe, respected, and supported.

The level of support your loved one needs depends on their mental condition as well as their physical health.

You might have found they’re unable to cope with things like they used to. For example, maybe they forget things, or miss visits to the toilet, or have dramatic mood swings. If they show those symptoms, this section is for you. Here you can pick up practical tips on how to take better care of an incontinent loved one who is mentally impaired. But we also recommend seeing a medical professional as well.

If they show those symptoms, this article is for you. Here you can pick up practical tips on how to take better care of an incontinent loved one who is mentally impaired. But we also recommend seeing a medical professional as well.

Establishing A Routine for You and Them

It helps people with mental health challenges to feel much safer if they have an established routine. That applies especially when changing their incontinence products. You can help them to feel less anxious and more relaxed by doing it at the same times each day, and by saying and doing the same things when you change them.

Then they’ll know what to expect at the time of the change, and they’ll understand where it fits in with their meals, naps and other activities, like watching television.

 

If you ever must hand over your caregiving responsibilities to someone else, it will be good if they understand your routine. If your back-up caregiver continues to do what you do, at the same time, your loved one is more likely to feel at ease.

Creating the Right Environment

This will vary according to your loved one’s condition and their situation. If they can get to the bathroom on their own, be sure the path there is clear. Try to create the safest possible environment.

You can do this by adapting to your surroundings and buying and installing right products and amenities. The aim is to make it possible for them to use their space comfortably and safely.

Here’s what to do, as soon as possible:

 

• Examine the floors in each room where your loved one is likely to go. Are they slippery? Do they pose any risks? If so:
  • Install anti-slip tape under rugs, and get rid of uneven or ragged carpets
  • Add anti-slip mats wherever the floor is often wet, like in the bathroom and kitchen
• Install a lidded trash can for used incontinence products in the bathroom or bedroom. It makes for a more pleasant atmosphere and keeps the rubbish out of the way.
• Also, the person you care for may also prefer clothing that is easy for you or them to remove, such as wide skirts and drawstring trousers. Clothing that is easy to remove helps them feel more self-reliant and can make your assistance easier.

For other practical tips about keeping your loved one safe – including advice on lifting and moving them – see  Home safety and Ergonomics.

Creating a Calm Bathroom Environment to Reduce Confusion

When managing incontinence for your loved one, making the toilet easy to find and use could help them get there on time.² A predictable and safe environment can ease stress and confusion.³

Here are some tips to help them feel calm and confident when using the toilet:

• Keep only the essentials and remove any clutter.
• Use bold labels and pictures to make products easy to find.
• Keep the bathroom setup consistent - even small changes like moving towels or supplies can cause confusion.
• Use contrasting colors to highlight the toilet and door.
• Install bright lighting, grab bars, or motion-sensor lighting.
• Place a picture of a toilet on the bathroom door.
• Set a regular toileting schedule.
• Choose easy-to-wear clothing; avoid zippers, laces, buttons, and hooks.

Night-Time Incontinence: How to Manage Bedtime Accidents

Night-time bathroom trips could feel difficult or even risky for your loved one.⁴ Darkness, confusion, and mobility issues could all make getting to the toilet harder.⁴ Also, the urgency that comes with nighttime incontinence in the elderly could increase the risk of falls.⁴

Don't worry, there are ways to help your loved one feel confident and safe throughout the night. Here are some dementia toileting tips: ²

• Reduce fluids before bedtime.
• Use absorbent products like mattress protectors, and overnight incontinence pads.
• Create a regular bedtime routine, like using the toilet before bed.
• If possible, set reminders close to when they normally have urges to check on them.

The Importance of Hygiene

Personal hygiene is an important part of anyone’s daily routine. It’s not so easy and straightforward though when you’re caring for a person whose physical and mental health are in decline.

People suffering from dementia can be less cooperative, and more resistant to any change. So, taking good care of your loved one’s hygiene might take a lot of patience. You’ll need to talk with them more and spend more time washing them.

Caring for Elderly Skin

 As you may know, in later life our skin becomes more fragile and more easily damaged. For that reason, it needs special care, with a gentle hygiene routine that helps to prevent skin irritation and infection.
 

That’s especially the case when your loved one is incontinent – urine and feces can harm their skin. Good hygiene for the elderly not only protects skin health; it also soothes your loved one, helping them feel clean, comfortable, refreshed and healthy. It boosts their confidence, too.

 There are three steps to taking care of their skin: cleansing, restoring and protecting. For a range of products that cover those steps, and are specially designed for elderly skin, see the TENA skin care range. 

Incontinence Products

It’s important to remember that people with dementia aren’t keen on change. So, they might not understand why you’re doing something – for example, helping them with their incontinence.

That’s why TENA incontinence pants are designed to look and feel like normal underwear. This helps your loved one feel comfortable about changing into them. Experienced caregivers, including those in nursing homes, tell us that persons with dementia in their care offer little resistance to wearing them.

Helping them with Diet and Fluids

Some people with incontinence worry about drinking too much – that it will just increase the urge to go to the toilet. So, they may want to drink less. That can be a problem – it can make their urine more concentrated and put their health at risk. So, try to encourage your loved one to drink as normal, responding to their natural thirst.

 Mealtimes are important to them – not just for the nourishing food and drink, but also for the opportunity to spend time together with others. It’s good if you, and even friends and family members, eat with them. Your company and the opportunity to chat and laugh will help them feel good. Also, try to serve their meals at the same time each day.

Having memory issues can make anyone feel out of control. If your loved one resists your help, it’s often not about you. It may come from embarrassment, fear of losing independence, or confusion about what’s happening.

Here are a few gentle ways to reconnect with them:

• Speak in a calm, soft voice; avoid rushing through your words.
• Break tasks into small, simple steps.
• Offer choices so they feel more in control.
• If things get tense, gently change the subject or try lighthearted humor or distraction.
• Always respect their dignity, even if you disagree with their choices.

If they continue to resist your help, it might be time to involve a professional, like a dementia-trained caregiver. These specialists help give respectful and effective care tailored to your loved one’s needs.

Incontinence may not always show up because of dementia or Alzheimer's, especially if it's sudden.⁵ It could be because of conditions like:

• Diabetes⁵
• An enlarged prostate⁵
• Kidney disease⁵
• Urinary tract infection (UTI)⁶
• Side effects of medications⁵

That's why it's important to watch out for signs like the following when caregiving for a loved one: ⁵

• Fever
• Blood in the urine
• Pain or discomfort
• Sudden incontinence
• Worsening of bladder leaks

If you notice any of these signs, consider talking to your loved one's doctor to get them timely help.

Incontinence care could bring both financial strain and legal responsibilities. Talking to a legal or financial advisor could help you plan ahead with confidence.

A legal advisor could guide you through important documents like:

• Advanced care planning: It helps you respect your loved one's wishes when they can't dictate their care.⁷ It includes documents like a durable power of attorney or living will.⁷
• Guardianship: It lets you legally make decisions on their behalf if they're no longer able to do so.⁸

A financial advisor could help you create a long-term care budget and find funding support. They may also help you explore programs such as:

• Medicaid
• Social Security Disability Insurance (SSDI)
• The National Caregiver Support Program

Caregiving can be demanding, and you shouldn’t have to carry the load or make decisions alone. Disagreements will happen, but remember, it’s all of you against the problem, not each other.

To keep communication open and fair, try these tips:

• Share updates on your loved one’s health as soon as they happen.
• Schedule regular check-ins so everyone can voice their thoughts.
• Acknowledge and normalize any guilt that comes with caregiving.
• Involve everyone in choosing and dividing tasks.
• Use team-friendly language like “we” and “together.”
• Speak honestly about your challenges.
• Document your loved one’s care plan and make it accessible to all.
• Keep your loved one’s perspective in mind; they’re part of the team too.

Sometimes your loved one might need more care than you can provide. It's okay to feel conflicted about it; this is a heavy decision with lots of things to consider. A helpful affirmation to help you through is: "I just want the best for my loved one."

Here are some signs that your loved one may need professional support or a care home:

• Worsening incontinence despite your current support⁹
• Urinary tract infections⁹
• Frequent falls¹⁰
• Increased forgetfulness that affects toileting safety10
• Withdrawal from friends and family¹⁰

Don't forget about you; you matter. If you often feel tired, overwhelmed, or stressed, it's time to protect your own wellbeing.¹¹

Caregiver's stress could harm your health and make it harder to provide the care your loved one needs.¹¹ Respite care options, like adult day programs, could help give you a much-needed break.¹¹

When choosing a facility, here are some tips to ensure they provide the best and most compassionate care:

• Visit in person to check for cleanliness, safety, lighting, and a welcoming environment.
• Observe how staff speak with and help residents.
• Ask specifically how they manage incontinence with dignity and respect.
• Inquire about care policies and how often they will update you.
• Trust your instinct; it’s often right.

If your loved one suffers from mental impairment, and limited mobility, they may not be able to enjoy their old hobbies like they once did. Whatever their condition, they probably still like you holding their hand, hugging them and talking gently to them. It will be good if you can find new activities to do with them – things that will help keep them entertained and feel connected.

Don’t Wait to Ask for Help

When the person you’re caring for has dementia and is incontinent as well, it’s extra challenging. Experienced caregivers recommend that you seek help and support from others – family members, friends or local community or government social services.