How can we get my father with dementia to be more aware of his incontinence?

A fellow caregiver asked...

My Dad is suffering from dementia. He is 84 years old. He has begun bed wetting. His comprehension is bad. He does not realize he wet the bed, then when he wakes up, he puts on his pants over his urinated body. Mom is angry and depressed because she can not seem to get him to take a shower. When she tells him he wet the bed he says it's "sweat"! He does not smell the urine, but everyone else can. We think sometimes he goes in the bathroom, but forgets why he is in there and wets himself, then comes out of the bathroom (wet) and sits on the couch. Any suggestions? We live on Long Island, NY. Are there any places we can go for support?

Expert Answer

Ron Kauffman is a certified senior advisor (CSA), senior lifestyle radio host, syndicated newspaper columnist, and the author of Caring for a Loved One With Alzheimer's Disease. In addition, Kauffman is also the primary caregiver for his mother, who has Alzheimer's.

My sympathies for your situation and struggle regarding your dad. Unfortunately, with dementia, your dad isn't truly aware of the consternation he's causing your mother or the fact that his clothes and body may smell.

First, I suggest that you and your mom contact the local Alzheimer's Association to seek out any support groups in your area. Your mom's reactions of anger, while understandable, are not going to be helpful to her and are already taking a toll on her with depression and are possibly impacting her physical health.

As for your dad, based on his level of denial of the problem, I suggest several steps be taken: 1. Make an appointment with a doctor he knows and trusts. This could be his primary physician, neurologist or urologist. Prior to the appointment explain to the doctor his problem and ask for his help in introducing your dad to Depends or whichever brand of incontinence product you or the doctor prefers. He should then tell your dad that there's a ""┬Žnew treatment and he's recommending and that your dad begins to use them immediately." 2. Without any fanfare or notice, remove all of your dad's underwear and replace it all with the Depends type product. Do this so that he must put on the incontinence "pull-ups" that look like boxer shorts but will provide some protection. Don't make a big deal out of this, and if he asks where his underwear is, this is one of the situations where a "white lie" is appropriate. You may simply tell dad that this is what the doctor wants him to wear, and leave it at that. No arguing. 3. To protect his bedding (mattress & box spring) purchase a plastic mattress cover, and on top of that place a stain resistant mattress pad. When you make up the bed, the top sheet should also be covered with a product similar to Chux, which are absorbent sheet-like products with a waterproof side that draw urine away from the patient and helps protect the linens and mattress. You can also place a Chux on the sofa to protect it from his incontinence. Chux are available from most large drug stores or pharmacies as well as from sellers of disposable medical equipment and products. You might also ask the Alzheimer's Association for a referral for incontinence products and support groups. These groups can provide you with a great deal of information and personal experiences as to how to deal with this problem. 4. Personal hygiene is critical with incontinent patients, and the Alzheimer's Association may have some suggestions as to what to say and how to cajole your dad into showering on a daily basis or at least after he's had an incident that warrants a shower. If your dad has a favorite treat, TV show, snack or activity, it may be possible to entice him to shower in exchange for allowing him what he wants. With dementia patients it is often more about what works than about offering a democratic vote to the patient in such matters.

I can't emphasize strongly enough how important it is for your mother and you to seek the support and information available from the local Alzheimer's Association regarding his dementia, and support groups dealing with incontinence. Your dad's condition will continue to worsen with time and knowing what behaviors to expect and how to deal with his mental debilitation ahead of time is crucial. So too is having a support group you can lean upon so you don't feel totally alone or feel that no one understands your challenges.

You may also want to start thinking about getting outside help for dad as a way to provide respite for mom. Here again, the Alzheimer's Association may be of tremendous assistance. Dementia is a disease that impacts the entire family, and the more you know about dealing with it, the better you will be able to plan, cope and be supportive of your dad's needs. Best of luck.