How to keep Depends on dementia patients?

According to the Alzheimer's Foundation of America, up to 70% of people with dementia may experience some form of incontinence. A primary challenge for caregivers is knowing how to keep Depends on dementia patients, especially when behavioral changes lead to frequent removal. This comprehensive guide provides sensitive, practical strategies to manage this difficult situation and maintain your loved one's dignity and hygiene.

Quick Summary

Ensuring incontinence products stay on a dementia patient requires a multifaceted approach focused on understanding their behavior, ensuring comfort, and utilizing adaptive strategies. This guide details techniques like selecting proper products and clothing, managing routines, and using distraction to prevent removal, preserving both the patient's dignity and caregiver's peace of mind.

Key Points

• Identify the Cause: Understand that a dementia patient removing their briefs isn't malicious, but likely due to discomfort, confusion, or agitation. Rule out medical issues like UTIs first.

• Upgrade Product Type: Switch from pull-ups to tab-style briefs, which are more difficult for patients to remove themselves. Consider putting them on backward for added security.

• Use Adaptive Clothing: Invest in specialized anti-strip jumpsuits or pajamas with back zippers to physically prevent a patient from accessing and removing incontinence products.

• Layer Clothing Effectively: Create a barrier by layering regular underwear over pull-ups or using elastic-waist pants that are harder to remove.

• Implement a Regular Schedule: Create a timed voiding schedule to reduce accidents and the discomfort of a wet brief, helping to minimize the motivation for removal.

• Maintain Dignity and Comfort: Use respectful language like 'protective briefs,' ensure privacy during changes, and keep skin healthy and dry to reduce irritation and feelings of shame.

• Utilize Distraction: During changes, redirect the patient's attention with a calm conversation, music, or a familiar object to reduce anxiety and resistance.

Understanding the Root Cause of Incontinence and Removal

For a person with dementia, removing a protective brief isn't a malicious act but a reaction stemming from confusion, discomfort, or memory loss. The cognitive decline associated with dementia can cause a patient to forget what an incontinence product is for, feel restricted by it, or be unable to communicate that it's wet or uncomfortable. Identifying the specific trigger is the first step toward finding a lasting solution.

Common reasons for product removal

• Confusion and disorientation: The patient may not recognize the product or understand its purpose, viewing it as a foreign, unnecessary item that needs to be removed.
• Discomfort or irritation: A wet brief, skin irritation from moisture, or a product that fits poorly can cause significant discomfort. A person with dementia may respond by simply pulling it off.
• Physical agitation or restlessness: For some, agitation is a symptom of dementia. Removing clothing can be a repetitive, restless behavior.
• Search for normalcy: The patient may be seeking to return to a time when they didn't need assistance, and removing the brief is a way to assert independence or feel more like their old self.
• Infection: A urinary tract infection (UTI) can cause increased confusion, agitation, and discomfort, which may prompt a patient to pull at or remove their undergarments.

Practical Strategies for Secure Incontinence Management

Managing incontinence products for dementia patients involves a combination of product selection, clothing adjustments, and behavioral techniques.

Choosing the right products

• Opt for adult briefs with tabs: Unlike pull-ups, briefs with tabs can be more difficult for a confused patient to remove, especially when secured properly. Some caregivers even report success with putting them on backward.
• Use higher absorbency products: Overnight or maximum absorbency products can reduce the frequency of changes and the chance of wetness-related discomfort. Booster pads can also be added for extra absorption.
• Consider specialized anti-strip products: Some brands offer one-piece jumpsuits or other garments specifically designed to prevent undressing. These often feature zippers or fasteners at the back that the patient cannot easily reach.
• Ensure the correct fit: A brief that is too tight can cause binding and discomfort, while one that is too loose can leak and feel bulky. Regularly reassess your loved one's size to ensure the product fits snugly and comfortably.

Utilizing adaptive and protective clothing

• Adaptive jumpsuits or one-piece pajamas: These garments, often with back zippers, can effectively prevent access to incontinence briefs. Brands like Silverts and Buck & Buck specialize in this type of apparel.
• Layering clothing: Placing a second, more difficult-to-remove layer over the incontinence product can add a barrier. Try putting underwear over a pull-up or using elastic-waist pants that are harder to pull down.
• Eliminate restrictive clothing: Opt for loose-fitting clothing with elastic waistbands over zippers, buttons, or belts, which can cause discomfort and frustration.

Behavioral and routine management

• Maintain a strict toileting schedule: Regular, prompted trips to the bathroom can help reduce the frequency of accidents and the feeling of a wet brief. Schedule visits every two hours, and after meals and waking up.
• Use distraction: During a diaper change, engage the patient with a familiar object, music, or a calm conversation. This can make the process less stressful and shift their focus away from the brief.
• Check for underlying medical issues: Always consult a doctor if the behavior is new or worsening. As mentioned, UTIs or other medical problems can be a source of discomfort. Address the medical issue, and the behavior may resolve.
• Create a calming environment: A chaotic or over-stimulating environment can increase a patient's agitation. Ensure changes are done in a calm, private space with a matter-of-fact attitude.

Comparison Table: Incontinence Product and Clothing Options

Feature	Pull-Up Underwear	Tab-Style Adult Briefs	Adaptive Jumpsuit/Onesie
Ease of Removal by Patient	Easy to remove independently	Difficult to remove, especially if put on backward	Very difficult to remove independently
Application	Put on like regular underwear (pull up)	Fastened with tabs at the sides	Back zipper or snaps, requires assistance
Ideal for	Patients in earlier stages of dementia who are cooperative	Patients who repeatedly remove pull-ups or briefs	Advanced-stage dementia with persistent stripping
Dignity	Resembles underwear, high dignity	Tab style may feel more like a diaper	May feel more restrictive, but prevents accidents
Caregiver Effort	Simple to pull up	Slightly more effort, but secure	Higher effort to dress, but prevents access

Addressing Sensitive Situations and Maintaining Dignity

Compassionate care is essential when dealing with incontinence. The loss of bladder or bowel control is humiliating, and a dementia patient's response is often a reflection of their frustration or embarrassment.

• Use respectful language: Avoid calling products 'diapers.' Use terms like 'protective underwear' or 'briefs' to preserve dignity.
• Maintain privacy: Always conduct changes in a private, warm space, and be calm and reassuring throughout the process.
• Never scold: The patient is not acting maliciously. Scolding will only increase their anxiety and frustration. Instead, use a matter-of-fact tone and focus on the task at hand.
• Protect skin health: Frequent moisture can cause rashes and skin irritation, which only increases the likelihood of product removal. Use a protective barrier cream and ensure the skin is clean and dry with each change.

Conclusion: A Patience-Driven Approach

Learning how to keep Depends on dementia patients is a common challenge that requires patience, observation, and a trial-and-error approach. By understanding the underlying reasons for the behavior, choosing the right combination of products and clothing, and implementing compassionate routines, caregivers can reduce stress for everyone involved. Regular communication with a healthcare provider can also help address any underlying medical causes and ensure you are using the most effective strategies for your loved one's specific needs. The goal is to manage incontinence effectively while always prioritizing the patient's comfort and dignity.

For more detailed guidance and resources, visit the Alzheimer's Foundation of America website.

Frequently Asked Questions

Why do dementia patients take off their protective underwear?

Dementia patients may remove protective underwear for various reasons, including confusion about what the product is, discomfort from a wet or ill-fitting brief, skin irritation, or physical restlessness. It is rarely a malicious act and often a reaction to a sensation they cannot articulate.

What kind of clothing can help keep protective briefs on a dementia patient?

Adaptive clothing is often the most effective. This includes one-piece jumpsuits or pajamas with zippers or snaps at the back. Layering regular elastic-waist pants or shorts over the protective underwear can also create a barrier that is harder for the patient to bypass.

Are there special products for keeping diapers on dementia patients?

Yes, aside from regular tab-style briefs which are harder to remove than pull-ups, there are specialized anti-strip garments available from companies like Silverts and Buck & Buck. Using booster pads for extra absorbency can also help by reducing the number of changes needed.

How can I prevent a patient from removing their brief at night?

At night, consider using adaptive pajamas with back closures to prevent access. Additionally, using a higher absorbency overnight brief or adding a booster pad can keep them drier for longer, reducing the discomfort that often leads to removal. Limiting fluids before bed can also help.

What if my loved one is resistant to wearing protective underwear?

Approach the situation with sensitivity and use respectful language, referring to them as 'protective underwear' or 'briefs.' Maintain a calm and matter-of-fact tone. Distraction techniques, such as engaging them in a favorite activity during changes, can also be effective.

Could a medical issue cause my loved one to remove their brief?

Yes. A urinary tract infection (UTI) is a common culprit and can cause increased confusion, discomfort, and agitation. Always consult a healthcare professional to rule out or treat any underlying medical conditions.

Should I scold or punish a dementia patient for removing their protective underwear?

No, you should never scold or punish a dementia patient for this behavior. They are not acting out intentionally. It is a symptom of their disease. Scolding will only cause distress and anxiety, making the situation more difficult for both of you. Instead, stay calm and reassuring.