Many persons with dementia have difficulty using the toilet properly. If the person is in the beginning or middle stages of the disease, there are several things you can try that have helped other caregivers in your situation. Place your cursor over a common problem for simple things you can do that can make a big difference in ability and comfort.
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Common Toilet Problems for Dementia Patients & Solutions
Forgets to flush/use toilet paper– Outlining the toilet tissue holder with bright tape may make it easier to notice or locate. Hanging reminder signs for putting used tissue in the toilet and for flushing may be helpful if the person can still read and comprehend. If this happens use simple language and as few words as possible.
Uses wastebasket as toilet– Some people with dementia cannot distinguish between objects if they have similar shapes. As a result, the person may use the wastebasket instead of the toilet due to its similar shape. You can resolve this problem by removing the wastebasket and try to bring attention to the toilet seat by using a colorful seat that contrasts with the floor.
Misses toilet bowl– If the person has problems with finding the toilet or missing the bowl, there are few things you can try. You could use tinted blue water in the bowl (use freshener tablets) improves aim for some men and/or use contrasting colors for the toilet seat and lid (against the floor and the wall) makes locating the toilet easier.
Puts used tissue in wastebasket– Stay outside the bathroom and, when you think they are ready, enter and gently remind the person to place the paper in toilet. Some individuals may simply refuse to place used paper in the toilet, sincerely believing the wastebasket is the correct method of disposal. In this case, replace the wastebasket with a diaper pail that has a cover to help contain unpleasant odors.
Puts briefs in toilet- Stay outside the bathroom and, when you think they are ready, enter and gently remind the person to place the adult brief in the wastebasket. Purchase a diaper pail and try placing a picture of an adult brief on the wall above the pail, along with a bright arrow pointing towards the pail.
Finding the bathroom– Some individuals have difficulty finding the bathroom. They may not be able distinguish the bathroom door from the surrounding doors. Or they may have completely forgotten where the bathroom is located. If they’re in the early to mid stage, you may be able to help them find the bathroom by trying one or several of the following: place large sign on door, paint door a bright color or leave light on in the bathroom or hallway. Try several strategies, alone or in combination, to find what works for the person in your care.
Toilet Overflow
At some point in the disease, many individuals forget to flush or flush the wrong items, resulting in messy overflows. Reminder signs for flushing or for where to place non-flushable items like adult briefs aren’t always effective. Consider installing a toilet overflow sensor. The sensor sounds an alarm and shuts off the water when it detects it’s about to overflow. Once the blockage is removed, and the reset button is pushed, the toilet resumes normal operation.
Transfers
At some point, he or she will have difficulty getting on and off the toilet, whether it’s due to dementia or a physical condition such as arthritis. It’s extremely important that you use special equipment to make transferring as easy as possible – to reduce the risk of injury to both the person and to yourself. Lifting a person off the toilet can cause serious back injuries and increase fall risk. In the next few frames, we’ll show you several solutions that may help.
Toilet Frame with Side Arms
The ability to transfer on and off the toilet can be dramatically improved through the use of a toilet frame with arms. This allows the person to use upper body strength to gradually lower the body to the toilet seat, and push off while rising. The person can hold the side arms for support while you help them pull clothing up or down or help with hygiene tasks. A toilet frame is especially good for people with weak leg muscles and poor balance but who have good upper body strength.
Seat Height
Many toilets are only 15 inches high, which can cause transferring problems. While sitting on the toilet, if the person’s knees are above their hips and/or they have difficulty getting up or sitting down – the seat is too low. There are several ways to raise the height of toilet seats.
Standard Raised Seat– Ranging in height from 3 to 5 inches, a standard raised toilet seat usually replaces the existing seat. Choose the right seat height so the person’s feet are flat on the floor. If the seat is too high, the person’s feet will dangle, causing discomfort. If the person recently had a hip fracture, you’ll need to follow your physical therapist’s or doctor’s instructions for the correct type of raised toilet seat. Choose a raised toilet seat with a “lock” that clamps onto the toilet. Otherwise the seat and the person may slide off.
Hinged Riser Under the Toilet Seat– This hinged 3 inch high riser fits under the existing seat and can be raised and lowered like a standard toilet seat. As it doesn’t significantly change the appearance of the toilet, some individuals find this option more aesthetically pleasing than the standard raised seat. Other benefits are that they can easily be used by both males and female, existing toilet seat & riser are bolted to toilet and that this type of seat can be lifted for easy cleaning. On the downside, they are only available in a 3 inch height and cost more than a standard raised seat.
Regular Commode Over the Toilet– This type of seat offers padded seat and back for extra comfort. They also come with wheeled legs if person needs to be wheeled into the bathroom to be positioned over the toilet. They also include adjustable seat height and drop arm for wheelchair transfers. Medicare pays for a basic non-padded “3-in-1” commode that can be used at the bedside or over the toilet if prescribed by a health care professional.
Automatic Seat Lift– This commode features an automatic non-electric seat lift. When the person’s ready to get up, the seat lifts the person up and forward, raising the person to a semi-standing position. This commode can be used at the bedside or over the toilet, if there is sufficient space. Person still requires adequate balance skills & strength to lean forward, push off for arms and legs, and straighten to stand. It also requires caregiver help (push levers to rise, etc.) and the ability to comprehend instructions.
