How to get a dementia patient to wear depends: a compassionate guide for caregivers

Incontinence affects up to 70% of people with dementia, creating a significant challenge for caregivers. Understanding how to get a dementia patient to wear depends requires patience, empathy, and effective strategies to maintain their comfort and dignity.

Quick Summary

Approaching incontinence with a dementia patient requires a compassionate, consistent, and low-stress approach. Caregivers can encourage cooperation by using respectful language, selecting comfortable products, and establishing a predictable toileting routine. Managing expectations and responding to resistance with patience helps maintain the individual's dignity while ensuring their needs are met.

Key Points

• Prioritize Dignity: Focus on respectful communication and empowering choices, never shaming the patient for accidents.

• Use Compassionate Language: Avoid stigmatizing terms like 'diaper'; use respectful alternatives like 'protective underwear' or 'briefs.'

• Establish a Predictable Routine: Implement a consistent schedule for toileting to reduce anxiety and increase cooperation.

• Select the Right Product: Choose a comfortable and appropriately absorbent product based on the patient's mobility and needs, such as pull-ups for more active individuals or tab-style briefs for those who need more assistance.

• Modify the Environment: Make the bathroom easily accessible and clearly identifiable with clear signage and good lighting to reduce confusion.

• Respond to Resistance with Patience: If the patient refuses, don't argue. Take a break and try again later, focusing on a calm and gentle approach.

Understanding the Reasons Behind Resistance

Caring for a person with dementia presents unique challenges, especially when it comes to sensitive topics like incontinence. Resistance to wearing incontinence products, often referred to by the brand name Depends, is common and can be frustrating for caregivers. This refusal often stems from factors related to their cognitive decline and emotional state. The individual may not understand why they suddenly need assistance or protective underwear, leading to feelings of embarrassment, confusion, or a perceived loss of control. Their memory loss may cause them to forget why they are wearing the product, or they may feel like they are being treated like a child. Addressing these underlying emotions is the first step toward finding a compassionate solution.

Psychological and Emotional Factors

• Embarrassment: The stigma associated with incontinence products can cause significant shame and distress.
• Cognitive Confusion: The patient may not recognize their own memory problems or incontinence, making the suggestion to wear protection illogical to them.
• Loss of Control: Refusal can be a way for the patient to assert some remaining independence and autonomy in a world that feels increasingly out of their control.
• Discomfort: Physical discomfort or an unfamiliar feeling from the product can cause them to repeatedly remove it.

Communication Strategies for Promoting Acceptance

Open and respectful communication is crucial. The language used can make a world of difference in reducing a patient's resistance and preserving their dignity. Avoiding terms like "diaper" and instead using adult-appropriate phrases such as "protective underwear," "briefs," or simply the brand name can help a patient feel less infantilized. A matter-of-fact and calm tone can also normalize the situation and prevent it from becoming a point of contention.

1. Introduce the Product Gently: Present the protective underwear as a way to stay comfortable and prevent accidents. For example, say, "Let's put on this extra-comfortable underwear to make sure you stay dry." Avoid confronting them about past accidents.
2. Use Visual Cues: Hold up the product and demonstrate how to put it on. For some, seeing the item and having a clear, simple instruction can help bridge the gap in understanding.
3. Offer a Choice (If Possible): Giving the patient a choice, even a small one, can help them feel more in control. "Would you like to wear the beige or the white protective underwear today?" This re-establishes a sense of autonomy.
4. Involve a Trusted Figure: If resistance is high, sometimes a family member, trusted friend, or even a healthcare professional can have a more successful conversation. A third party might be seen as a more neutral source of information.

Establishing a Predictable Routine

Just as routines provide comfort and predictability in other areas of dementia care, they are essential for managing incontinence. Tying the wearing of protective underwear to a specific, regular daily activity can normalize it. This can be part of the morning dressing routine, after meals, or before bed. The goal is to build a habit that is followed without negotiation or distress.

• Frequent Prompting: Take the patient to the bathroom on a regular schedule, such as every two hours. This can reduce the chance of an accident and get them used to a predictable routine.
• Observe and Adapt: Pay attention to the patient's body language for cues. Fidgeting, pulling at clothes, or pacing might signal a need to use the toilet. Adjust the routine based on these observations.
• Nighttime Management: Limiting fluids a couple of hours before bed can reduce overnight accidents. Using a more absorbent product for the night and having a bedside commode can also be helpful.

Environmental Adjustments for Success

Modifying the home environment can support independence and reduce accidents. Small changes can make the bathroom more accessible and easier to identify for a person with memory loss.

• Ensure the path to the bathroom is clear and well-lit, especially at night.
• Place a clear sign or picture of a toilet on the bathroom door.
• Use a contrasting-colored toilet seat to make it easier to see.
• Remove rugs or clutter that could cause trips or confusion.

Comparing Incontinence Products for Dementia Patients

Selecting the right product is critical for comfort, fit, and managing leaks. What works for one person may not work for another. The table below compares different types of incontinence products commonly used in dementia care.

Feature	Pull-Up Underwear	Adjustable Briefs (Tab-Style)	Booster Pads	Underpads (Chux)
Best for	Mobile individuals; maintains dignity and independence	Less mobile individuals or those who need caregiver assistance with changes	Added absorbency inside another product	Protecting beds, chairs, and other furniture
Ease of Use	Similar to regular underwear; patient can manage themselves	Tabs allow for changes in lying or seated position; easier for caregiver	Simply inserted into another product	Placed on surface; not worn
Absorbency	Varies by brand; good for mild to moderate needs	Higher absorbency options available; excellent for heavy needs	Boosts absorbency of existing product	Primarily for surface protection, not worn on body
Discreetness	High, similar to normal underwear	Can be less discreet due to bulk; depends on clothing	High, fits inside existing product	Not worn, so not applicable

When Resistance Persists and Professional Help is Needed

Despite best efforts, some patients may continue to resist wearing protective underwear. When this happens, it's important to remember that it's a symptom of their disease and not willful defiance. At this point, focusing on other strategies to manage the situation and seeking professional guidance is advisable. It's also important to have a backup plan for managing accidents, such as waterproof mattress and furniture covers.

For additional resources and support, caregivers can consult with a healthcare professional or an organization specializing in dementia. The Alzheimer's Foundation of America offers valuable insights and assistance for families navigating these difficult caregiving situations. A doctor can rule out other medical causes for incontinence, such as a urinary tract infection, which can worsen confusion and behaviors.

Conclusion

Navigating incontinence with a dementia patient requires a blend of practical strategies, compassionate communication, and a deep understanding of their emotional and cognitive state. By choosing the right products, establishing predictable routines, and maintaining a calm, respectful approach, caregivers can successfully get a dementia patient to wear depends while upholding their dignity. Remember to be patient with yourself and your loved one, and don't hesitate to seek support from medical professionals or support groups when needed. With the right approach, this challenging aspect of caregiving can be managed with grace and respect.

Frequently Asked Questions

Why does a person with dementia resist wearing protective underwear?

Resistance often stems from confusion, embarrassment, a perceived loss of independence, or discomfort. They may not understand why they need the product or feel ashamed by the necessity.

How should I talk to my loved one about wearing Depends?

Use a calm, matter-of-fact tone and avoid the word 'diaper.' Instead, use adult-appropriate terms like 'protective underwear' or 'briefs.' Frame the conversation around comfort and convenience, not as a consequence of an accident.

What if they keep taking the protective underwear off?

This could be a sign of discomfort, confusion, or a desire for control. First, check that the product fits correctly. Try different products or styles. If the behavior continues, distract them with another activity and try again later, or consider adaptive clothing that is harder to remove.

Is it better to use pull-ups or briefs for a dementia patient?

The choice depends on their mobility. Pull-ups are good for more mobile individuals who can still assist with dressing. Adjustable briefs with tabs are often easier for caregivers to change when the patient has limited mobility.

How can I make the bathroom more accessible?

Ensure a clear, well-lit path to the bathroom. Use high-contrast colors, such as a colored toilet seat on a white toilet, to make the toilet easier to see. Place a simple, clear sign with words and a picture on the bathroom door.

Should I limit fluids to prevent accidents?

No, limiting fluids can lead to dehydration and other health problems. Instead, manage the timing of fluid intake. Encourage regular drinking throughout the day but reduce intake in the evening to prevent overnight accidents.

What are some signs that a patient with dementia needs to use the bathroom?

Watch for non-verbal cues such as restlessness, fidgeting, pulling at their clothing, or pacing. Some may stand or move toward the bathroom area. Pay attention to their personal routines and look for patterns.