My 70-yr-old husband with Alzheimer’s is starting to have toileting issues. The most current challenge is he will say he needs to use the bathroom. So I show him where it is. I have picture signs up, leave the light on, but he still forgets. So I will help him get there, then he will become befuddled and start looking in cabinets, filling with toilet seat, fiddling with whatever he can. When I tell him to pull down his pants and underpants (which are pull-ups), he will saying things like, “I don’t know why I need to do this” or “I was told I didn’t need to do this”. Or my favorite ,“I’ll get in trouble if I do this”. I’ll walk away and say let me know if you need help, so as not to pressure him. Then he’ll wander around the house, not sit still anywhere and this will go on for several hours until he finally will urinate in the toilet. The pull ups will not be sufficient to hold all his urine, but we’ve started using them for “leaks”.
Has anyone else had a similar issue with toileting? Any ideas? Obviously I can’t make him go if he doesn’t need to, but it’s as if he needs to, but can’t recognize the feeling and then fights me when it’s time to use the toilet.
He's been checked for UTI and has none.
People move from needing prompts/cues - to supervision - to needing hands-on assistance, with toileting & many other daily tasks eg dressing, grooming. Every daily routine sequence has many steps to it when you break them down.
Ability to keep these sequences diminishes.
Evenually incontinence means the caregiver must take over. Then the caregiver provides regular checks & changes pads as required (thicker, more absorbant wrap around type are good).
The inbetween stage is hard & frustrating. When he needs the assistance but can't understand why.
I think a *let's do this together* approach may be worth a try. Maybe even your hand over his hand to guide pants up & down if he will let you. Elastic waisted leisure wear & pullups should be easier than zippered pants & regular underwear now.
I would also suggest called an Alzheimer's advice line or Continence advice line (if there is one on your area) to discuss. I have had so much good advice from specialised Dementia services & a Continence Nurse over the years.
Try prepping him to go (get him in, help take down his pants & briefs), let him stand or sit there for a minute while running the sink water so he hears it. This often will help initiate urinating. It worked for my elderly Aunt with dementia. If nothing happens then try again in another hour or 2, like on a schedule.
I think he's now beyond any signs you may up for him and it's time for more hands on help from you.
You know your husband's needs and can decide on the interval. But if you wanted to encourage him into a scheduled type of toileting, then you would set an alarm for yourself every x hours. Then you prompt him, "Time for toilet" and take him in there and put him on the toilet... or let him go in on his own, whatever works.
Whether he voids or not is not the issue. It's just a way to give him the regular opportunity every couple of hours to void. If he cannot, that's ok, he comes off the toilet after five or ten minutes.
If you can find a way to make transitions to and from toilet time a funny or pleasant conversation and experience ("Good job, now let's go have biscuits and watch Jeopardy") and redirect him to his favorite snack or activity when toilet time is over, that could help this schedule work regardless of whatever happened during his toileting.
Just giving the opportunity at a regularly scheduled interval might be the best you can do in your case if you want to stop his fixation on it. Reward and redirect after every time, regardless of whether he "went" or not.
I'm glad you have the pull-ups.
**And I just read the thread and realized that folks with loved ones in care facilities are way ahead of me. lol Whether they go or not, they are taken in regularly and given the opportunity.
Do you register how long it is since he had a drink (not just a sip), so whether his bladder really might be full? What happens if you don’t respond to the first ‘need’? Have you tried distracting him if you think he probably doesn't 'need' it? Can you work out WHY he might be saying he ‘needs’ it when in fact he doesn’t? What else could be going on in his mind? Even boredom, or a wish for attention?
In facilities, it is common for people to be ‘toileted’ every 2 hours, automatically. Perhaps it might help to know that’s what you are heading towards. You make the decisions about ‘when’, because he is not getting it right.
Sorry but 😆. I don't know what facilities you are talking about, at this one, "toileted" are the aides going around changing the residents who can't go to the bathroom, after they have "gone to the bathroom" in their underwear.