How can we get my dad, who has dementia, accept help in the bathroom?

A fellow caregiver asked...

My dad suffers from dementia/Alzheimer's. He is mild mannered and easy to please except in the bathroom. He gets very agitated and fights when his caregivers are helping with wiping his bottom and pulling up his underpants. He doesn't like for someone to see his privates, but he can no longer go to the potty alone. He has to have assistance getting up and down from the toilet. He screams out at the caregivers and sometimes hits at them. What can we do to make this easier. He is still very strong and the caretakers are becoming afraid that he is going to injure them or himself. He is better with male over female care, but he can't have male care full time. Any advice? Are there medications that will help with this problem without him being in daze as a result?

Expert Answer

Jytte Lokvig, PhD, coaches families and professional caregivers and designs life-enrichment programs and activities for patients with Alzheimer's disease and related dementia. Her workshops and seminars help caregivers and families create a healthy environment based on dignity and humor. She is the author of Alzheimer's A to Z: A Quick-Reference Guide.

I don't think any of us would be particularly thrilled to have a stranger wipe our butts. Your father is apparently especially modest, so it's quite understandable that he will refuse to accept assistance in the bathroom. Unfortunately there's no way to give him medication selectively "“ it would affect his quality of life, so before you consider that, let's look at other ideas:

First, some practical suggestions: For his comfort and ease, keep the bathroom very warm and invest in a raised toilet seat with handles, which might enable him to stand up by himself, or at least with minimal assistance. (It must lock onto the toilet-bowl to prevent it from shifting.)

You might also ease his anxiety by playing his favorite music in the bathroom.

Keep a bath sheet or large bath towel handy to drape over his lap when he's on the toilet.

DISTRACTION and DIGNITY. Any person who relies on others for his care is prone to feeling powerless and may rebel when he feels that his dignity is being violated. And when a person is very modest, it takes extra precaution in how he's approached in intimate circumstances. Shifting the focus helps to ease the situation.

Try this: Lock arms with him, start telling him a funny story or engage him in a light-hearted "conversation" "“ (even if it's one-sided.) Keep up your flow while you steer him to the bathroom. Once in the bathroom, keep distracting him with your chitchat. Ask him to hold the towel in front while you quickly pull down his pants and ease him down onto the toilet. The hardest part is keeping the towel over his lap. So you may have to secure it to his shirt with a couple of safety-pins. You'll most likely drop the towel at first. It often helps our care-receivers to see that we also make mistakes. You can share a good laugh, the best distraction of all.

Again, imagine how we'd feel if someone was hovering over us in this most intimate situation. Ask his caregiver to step out of the room until he's finished. If it's not safe to leave him alone for those few minutes, she can pretend to be busy with something else in the bathroom, with her back to him.

If he's incontinent, you don't necessarily have to take him to the bathroom. You're free to change his briefs anywhere in the house where he feels safe. Pull-up briefs are easy to tear apart and remove "“ they still pull on like regular underwear.

IMPORTANT: "Diapers" are for babies, "Briefs" are for adults.