Reducing and managing accidents

Tips for reducing accidents

Making it as easy as possible for the person with dementia to use the toilet can help reduce accidents, whether you are at home or out and about.

Help with using the toilet at home

The following ideas may help someone to find, recognise and use the toilet more easily:

• Help the person to identify where the toilet is. A sign on the door, including both words and a picture, may help. It needs to be clearly visible, so place it within the person’s line of sight and make sure the sign is bright so it’s easy to see. You can also help the person to know when the toilet is vacant by leaving the toilet door open when it’s not in use.
• Check the position of mirrors in the bathroom. The person with dementia may confuse their reflection for someone else already in the room, and not go because they think the toilet is occupied.
• Make it easier for the person to find their way to the toilet. Move any furniture that’s in the way, and leave open any doors that the person may find hard to open themselves. The room and the route to the toilet should be well lit, especially at night.
• Help the person to identify the toilet. A contrasting colour (for example, a black seat on a white base) can make it easier to see.
• Make sure the person has privacy in the toilet, but check that they don’t have difficulty managing locks. Some people with dementia struggle with this. To avoid the person locking themselves in, disable the locks or check that you can open them quickly from the outside (for example with the edge of a coin).
• Choose clothing that will be easier for the person to undo when using the toilet. Trousers with an elasticated waist are often easier than zips. Some people find ‘adaptive clothing’ with Velcro fastenings easier to use than zips or buttons.
• If the person is less mobile, handrails and a raised toilet seat may make it easier for them to use the toilet. Some men with reduced mobility or balance, or who are not able to direct their pee when standing, may find it easier to sit.
• If getting to the toilet becomes too difficult because of mobility problems, an aid such as a commode may be useful. This will require the person to recognise the commode, know how to use it and be willing to use it.

Going to the toilet during the night

Many older people get up during the night to pee. A person with dementia may wake up disorientated and be unable to find (or get to) the toilet in time. Ideas that might help include:

• installing motion sensors for lights or night lights in the bedroom, hallways and bathroom. Set the timer so they won’t suddenly leave the person in darkness
• keeping a urinal bottle (designed for men and women) or commode next to the person’s bed at night
• not drinking anything for two hours before going to bed – but making sure that the person drinks enough during the day to avoid getting dehydrated.

For more information on aids and equipment that can help with continence, speak to an occupational therapist – ask the GP or social services to refer you. Products are also available at shops selling independent living aids and equipment.

Help when out and about

Staying active and seeing people are hugely important, but toilet problems and incontinence can make it harder for someone with dementia to be out and about. However, there are ways to help increase the person’s confidence and manage accidents. The following tips can make travelling or being out and about easier for the person with dementia:

• Plan in advance – for example, find out where accessible toilets are.
• Be prepared – for example, fit a lightweight pad (the kind that attaches to underwear) and carry spare clothing and pads, as well as a bag for soiled items.
• Buy a Radar Key – this gives disabled people (in this case including those with dementia) independent access to thousands of locked public toilets around the country. Radar Keys are sold by Disability Rights UK (see Other resources).

Remembering to go to the toilet

Giving the person with dementia regular reminders about using the toilet can help reduce accidents. The following tips may be useful:

• For someone with urinary incontinence, ask them regularly (every two to four hours) whether they need the toilet.
• Give the person encouragement and assistance if they ask for help.
• It’s important to check that the person has used the toilet, and not forgotten or become distracted. Over time, this can help some people reduce the number of accidents they have.
• Be sensitive when prompting the person to use the toilet, to avoid patronising, annoying or upsetting them.
• Watch for signs that the person may want to go to the toilet, especially if they cannot communicate this clearly. These signs may include fidgeting, pacing, getting up and sitting down, or pulling at their clothes.

Developing a routine

Creating a routine can help someone with dementia manage incontinence and other toilet problems. The following tips may be useful:

• For someone who regularly wets themselves, try making a timetable that includes reminders for going to the toilet. For example, it could include reminders when the person wakes up, before each meal, at coffee or tea times and before bed.
• An automatic reminder – for example, on a smartphone – can also be useful in prompting a person to use the toilet or to check if their pad needs changing.
• For faecal incontinence, it is possible to help the person become continent again by supporting them to go to the toilet at a set time each day, and helping them to stay long enough to have a bowel movement.
• Trying to go to the toilet a few minutes after a meal can help – for example, some people find it helpful to go after breakfast.

Tips for managing an accident

Hygiene and going to the toilet are very personal and private issues. Having difficulties or being incontinent can make someone feel like they are losing control, and this can affect their dignity as well as their self-esteem. Many people find it very hard to accept that they need help from someone else in such a private area of their life. It can be particularly difficult if the help is from someone very close to them.

Everyone will react differently to incontinence. Some people find it very upsetting, while others find it easier to accept. Approaching it with understanding, a matter-of-fact attitude and humour – if this feels appropriate, can help.

If someone has an accident, it’s important for carers and friends to:

• remember that it’s not the person’s fault
• try to overcome any embarrassment or upset they may feel
• avoid appearing angry or upset.

This may not always be easy, particularly if you are very close to the person. Whatever your relationship, this kind of support will be a change for you both.

If you find feelings about incontinence difficult to handle, it’s a good idea to talk things through with a health professional. This could be the GP, a community nurse or a continence adviser. It’s important to try not to let dealing with incontinence get in the way of your relationship with the person you are caring for.

Ensuring good personal hygiene

It’s important to make sure that the person cleans themselves properly after using the toilet, or that you help them to do so, if appropriate. You should:

• be mindful that the person may prefer to use a bidet rather than toilet paper, or may use a preferred hand to clean themselves
• wipe from front to back (which helps to prevent infection), rather than back to front
• remind the person to wash their hands after they have used the toilet.

Incontinence can lead to skin irritation and feeling uncomfortable. This can also increase the risk of pressure ulcers (bed sores).

After an accident, it’s important to act quickly to make sure the person feels comfortable again and maintains a good level of hygiene. The following steps will help:

• If someone has become wet or soiled, they should wash afterwards with mild soap and warm water, and dry carefully before putting on clean clothes and fresh pads, with assistance if needed.
• Soiled clothes, reusable pads or bedding should be washed immediately, or soaked in an airtight container until they are washed.
• Used disposable pads should be stored in a disposal bag or other appropriate container, and thrown away as soon as possible.
• Moist toilet tissues may be suitable for minor accidents, as they clean better than dry toilet paper. However, be aware that they may irritate the person’s skin.

When using the toilet, some people with dementia who have constipation may try to remove poo by inserting their fingers. It’s important to make sure the person’s hands and nails are kept clean at all times.