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Many older adults live with bladder leaks, but for older adults who also have Alzheimer's disease or dementia, there are a few special considerations for how to manage urinary incontinence. If you’re caring for an older adult who has both dementia and incontinence, here’s what you need to know:
Incontinence is fairly common in the overall population: in the United States, over half of adults over sixty-five have mild incontinence and a quarter of older adults experience moderate to severe incontinence, with constant bladder leaks.
That said, incontinence is even more common in people with dementia, as 60-70% of those with dementia will develop incontinence. However, not all incontinence in people with dementia or Alzheimer's disease is caused by this medical condition. If incontinence is caused by other factors, treating those issues could resolve the bladder leaks as well.
People with dementia can become incontinent for all the same reasons others become incontinent. Some common types of incontinence include overactive bladder, stress incontinence (a common problem in women e.g. from muscle damage during childbirth), incontinence caused by a blockage in the urinary tract, and nerve damage that makes it hard to tell when you need to use the bathroom.
In addition to these types of incontinence, people with dementia are likely to have functional incontinence. Functional incontinence refers to when the urinary system is healthy, but the person can’t get to the restroom in time or can’t use the toilet on their own.
People who have incontinence caused by their dementia might:
Remember: dementia isn’t always the main cause of incontinence. If a person you care for has urinary or fecal incontinence, it’s good to keep track of what kind of leaks they have (are there frequent dribbles or larger spills? Is there pain or not?) and talk to a doctor, so they can help determine whether the underlying cause of incontinence is treatable.
Regardless of the cause, it’s important for people with incontinence to keep clean and dry for their own health and comfort. If you care for someone with dementia and incontinence, you can help keep them comfortable with well-fitting, absorbent pads and underwear and with gentle skin care.
Absorbent underwear can catch leaks and keep people clean and dry even when they can’t get to the bathroom in time. Another good option, if you don’t need the all-round protection of absorbent underwear, is to add pads and guards to normal underwear. Choosing the right kind of protection for the type of urinary incontinence you are dealing with can help you and the people you care for feel more confident about going out and doing normal activities without worrying about leaks.
To control odors, it’s important to keep skin and clothing clean and dry. Use well-fitted underwear with good absorbency to ensure that even when a bladder leak occurs, it doesn’t cause noticeable odors. High-quality absorbent underwear also keeps skin dry, which helps prevent infections.
Other odor control tips include:
Older people typically have more delicate skin, and bathing every day can make it brittle and dry. In addition, skin can be easily irritated or develop sores by staying wet for too long or due to chafing from ill-fitting underwear.
To stay clean, it’s important to use absorbent underwear and change it when it no longer keeps skin dry. Gentle cleaning products - for example, cleaning sprays and personal wipes- can help people with incontinence keep fresh between baths, and protective skin cream can guard against excess moisture or chafing.
People living with Alzheimer's or dementia might struggle to make it to the toilet at night, leading to more accidents and sleep disturbances than those without dementia. Preparing for accidents ahead of time can make them less of a disruption. Some tools to help deal with incontinence at night include:
People with incontinence often feel embarrassment or shame about their symptoms. This might lead them to hide their accidents or not ask for help when they need it. Try to talk about bladder leaks matter of factly; reassure the person you’re caring for that it’s not their fault, stay focused on managing the symptoms, and ask what would make them more comfortable.
Some simple changes to their drinking schedule can help keep a person with dementia and incontinence healthy without causing extra accidents:
Sometimes accidents happen because the person with dementia or their caregiver can’t remove clothing in time. Choose clothes with elastic waistbands, nightdresses rather than pants, and other easy-to-remove clothing options to help people get to the toilet more easily.
People with dementia often have accidents because they can’t find the bathroom in time. To help:
Prompted voiding is a strategy to avoid accidents by taking the person you’re caring for to the restroom every few hours. Create a bathroom schedule, and try to stick to it every day, so the person with dementia gets used to going to the toilet and has fewer urges to urinate between bathroom trips.
Accidents are inevitable, but with preparation they don’t have to be a big deal. You can prepare by bringing along cleaning wipes and an extra change of clothing and underwear when you go out.
Although medications are available to reduce incontinence, these can have negative cognitive side-effects and make dementia progress more rapidly, so you should consider carefully and discuss with a health professional before using them if you’re caring for someone with incontinence and dementia.
Exercises like pelvic floor training can strengthen the muscles around the bladder and improve bowel control; working with a physical therapist will ensure the person you're caring for does their exercises and gets the most benefit from this practice.
Behavioral changes can boost brain function and slow the progress of Alzheimer's and dementia, which could reduce the amount of dementia-related incontinence you and the people you care for have to manage. Activities like exercise, meditation, embroidery, and memory games all keep the brain healthy and agile. These interventions are most effective when started early, so encourage friends and family to stay active and engaged as they get older for the best outcomes.
Although dementia isn’t always the cause of incontinence, it can make incontinence more difficult to deal with because a person with dementia might not be able to recognize or communicate their needs. With a few changes, however, including making the bathroom more accessible, investing in good incontinence and hygiene products, and talking to your doctor about the underlying causes of incontinence, you can improve the quality of life for the person you care for and help them cope more effectively with the realities of living with dementia and incontinence.
Are you caring for someone with incontinence? Take our Bladder Protection Quiz and get a free starter pack for your loved one to try today!
WebMD. (2014). Over half of seniors plagued by incontinence: CDC. Retrieved from https://www.webmd.com/urinary-incontinence-oab/news/20140625/over-half-of-seniors-plagued-by-incontinence-cdc?msclkid=8aa18790cd2e11ec8b4c8a393a18f0a7National Institute on Aging. (n.d.). Urinary incontinence in older adults. Retrieved from https://www.nia.nih.gov/health/urinary-incontinence-older-adultsRiebl, S. K., Davy, B. M., & Mitchell, D. C. (2021). An investigation of dietary intake, hydration status, and urine color among older adults in assisted living facilities. Nutrients, 13(1), 216. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8718555/Illinois Department of Public Health. (n.d.). Urinary incontinence fact sheet. Retrieved from http://www.idph.state.il.us/about/womenshealth/factsheets/inc.htmWilson, L., Brown, J. S., Shin, G. P., Luc KO, E., & Subak, L. L. (2014). Annual direct cost of urinary incontinence. Obstetrics & Gynecology, 124(3), 612-621. Retrieved from https://journals.sagepub.com/doi/full/10.1177/1533317514524814National Association for Continence. (n.d.). Patient perspective: The shame of incontinence is real. Retrieved from https://www.nafc.org/bhealth-blog/patient-perspective-the-shame-of-incontinence-is-real?msclkid=65f66532cd3f11ec895276eb4e38e450Dementia Care Clinical Research Center. (n.d.). Toileting and incontinence. Retrieved from https://www.dementia.cindrr.research.va.gov/caregiver_topics/activities_daily_living/toileting_incontinence.aspWake Forest University Baptist Medical Center. (2008). Dual treatment of incontinence and dementia associated with functional decline. Retrieved from https://newsroom.wakehealth.edu/News-Releases/2008/05/Dual-Treatment-of-Incontinence-and-Dementia-Associated-with-Functional-DeclineKane, R. L., & Kane, R. A. (2015). What older adults with cognitive decline want in a toilet. Journal of Aging and Health, 27(5), 882-899. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26169438/
