Using the bathroom
How can we improve our communication in order to support someone with bathing, cleaning their teeth, or using the toilet?
As we learnt in step 2.6, the context of communication is important. The bathroom is usually thought of as a private space, so our presence may not be welcome. The layout and size can be problematic, so our physical proximity may appear threatening. In addition, the presence of reflective surfaces, such as mirrors and water can sometimes introduce confusion, fear, or even hallucinations (especially for people with DLB).
Bathing is an intimate experience which can be seen as unpleasant or threatening. A person living with dementia may struggle with depth perception and find it scary to step into water. We can prepare in advance with water and toiletries, and top up water later. We should try to keep time when a person is naked as short as possible. We may wish to simplify the process by using all in one gels which can be applied with a sponge. Asking a person to hold the sponge and signalling and miming the action of washing can help them to perform the activity themselves. It is usually best to wash hair at a different time to bathing. By placing a hand on shoulder when washing, this can reduce sensitivity when washing sensitive areas.
Good oral hygiene can help a person to stay at home in good health for longer. However, it is often difficult to know if someone is experiencing dental pain or discomfort. Paying attention to non-verbal cues can help us recognise if someone is in pain. Indicators include a refusal to eat, pulling at their face or mouth, leaving dentures out, or disturbed sleep and general agitation.
Cleaning someone’s teeth is particularly invasive, especially if rushed. Most of us would have a problem with someone else putting a toothbrush into our mouths. For someone with dementia, the mouth can become hypersensitive, and a lack of understanding can add to distress.
To support a person to brush their teeth, it is often better to use mime than give verbal instructions. By using a hand-over-hand technique (see below resources) to help a person participate in the process, their automatic memory for teeth brushing may kick-in (as an embodied action learned early in life with much repetition since) and they may take over unaided.
Going to the toilet
Urinary and faecal incontinence can be a symptom of advanced dementia. The causes and experiences of incontinence are be different for people living with dementia compared with other people. These can include:
- not reacting quickly enough to the sensation of ‘needing to go’
- failing to reach a toilet in time because of poor mobility
- not being able to communicate the need to go to carers
- inability to find or recognise an appropriate place to go to the toilet
- not understanding prompts from others
- not being able to loosen clothing or clean up afterwards
- refusing to accept help from others because of embarrassment
- not responding to the need to go because of apathy
- hiding signs of ‘accidents’ from others
As well as the psychological effects of incontinence and the impact on personal relationships, there are physical health implications too. Incontinence increases the risk of falls in older people and can also lead to skin irritation and infection.
What can I do?
As a carer, there are a number of ways you can help someone with difficulties going to the toilet:
- you can learn a person’s usual patterns, and offer encouragement by talking about going to the toilet using the same words they use
- Watch out for visible cues that they need to go, agitation, fidgeting, tugging on clothing, touching genitals.
- Remind the person of the actions they need to take (e.g. they need to pull down pants before sitting).
- Keep the bathroom door open so they can see the toilet.
There are also a number of support techniques that can help when encouraging or supporting someone in the bathroom. Take a look at the link to Teepa Snow’s hand-holding techniques at the end of the step.
Which pieces of advice have you found most useful?
© Newcastle University