not understanding instructions - toilet

Discussion in 'I care for a person with dementia' started by Muftib, Feb 18, 2018.

  1. Muftib

    Muftib Registered User

    Oct 8, 2015
    i wonder if anyone has the same experience and has any tips on how to cope? mum is 94 with alzheimers - she knows she needs to go to the toilet and asks to be taken. once there she is unable to understand any instructions like you can sit now, or we need to take your pants down. she becomes rigid and clutches her clothing making it impossible to remove anything so she can go to the loo. The toilet is turning into a battleground which we really don't want but nothing seems to work! any help or advice gratefully received thanks in advance
  2. Theresalwaystomorrow

    Theresalwaystomorrow Registered User

    Dec 23, 2017
    I’m in exactly same situation, mum does not understand anything we ask her to do she has to be guided with everything. I helped clean her teeth today and I gave her them to put back in her mouth but she didn’t know what to do with them!
    Then later she wet herself so I cleaned her up and was putting wet clothes outside toilet door and told her to wash her hands but I turned around and she was washing them in the toilet !!
    Yes she’s late stages of Alzheimer’s as well .
  3. karaokePete

    karaokePete Registered User

    Jul 23, 2017
    N Ireland
    My wife is early stages but can’t follow a list of instructions so I have to say things one step at a time. I also frequently have to keep repeating something to get through. Could this approach help?

    In relation to the “battleground”, does you mum know who you are? If she thinks you are just a carer she could be reluctant because she feels her privacy/dignity is not being respected. Would you telling her who you are and explaining you are helping and aware of her dignity help?

    Just a couple of ideas that you may treat with a pinch of salt if you think I’m wide of the mark.
  4. Shedrech

    Shedrech Volunteer Moderator

    Dec 15, 2012
    hi @Muftib
    with my dad, I took to doing a mixture of talking him calmly and gently through every little step of the process, telling him BEFORE I did anything exactly what I was going to do, plus showing him, maybe even miming for him - and there's a difference in 'you can sit down now', which meant little to dad, and 'sit down now' which was clear to him (in fact I generally back him up to whatever he is going to sit on until his legs touch it, so he knows for sure it's there, then ask him if he can feel it on the back of his legs, and then say 'it's OK to sit down now')
    do you have grab rails? dad needs things to hold on to, to make him feel secure - I guide his hand to each one asking him first if I can take his hand to show him where the rail is - and some toilet seats are very low; sitting down backwards is scary when you are not sure how far down the seat is (or even if it is actually there = feels like falling backwards) - plus toilet seats are often cold, which is worth considering
  5. LadyA

    LadyA Registered User

    Oct 19, 2009
    Dementia logic, working well! :( Your mum knew she needed water for washing her hands, and the only water she could find, she used! Sadly, it's another step. "Wash your hands" now means you've got to put the water in the washbasin for her - and if you can, put the lid down on the loo!
  6. marionq

    marionq Registered User

    Apr 24, 2013
    Don’t give a series of instructions eg “Pull down your pants and sit down”. She will have forgotten them immediately. Demonstrate as Shedrech says or give only one step at a time. Just one thing at a time and repeated several times.
  7. canary

    canary Registered User

    Feb 25, 2014
    South coast
    There may also, in addition to the other things mentioned, be problems with her not being able to see the toilet properly and therefore increasing her confusion.
    With dementia, black things are seen as holes and white things seem to fade from view - thats why care home usually put red seats on the toilet, so that the people with dementia can identify them better. Possibly another thing to consider
  8. Philbo

    Philbo Registered User

    Feb 28, 2017
    My wife has been mainly incontinent now for over a year. It started with her apparently forgetting to use any toilet paper, then little accidents etc etc.

    We progressed from liner type products to pull-up pants and initially, she would get through anything up to 6 a day. I got some great advice from a kind lady on the national dementia helpline, who explained that the PWD often forget the actual processes involved. She also suggested trying "preemptive toileting", where you take them to the loo at frequent intervals.

    It is quite time consuming, as my wife can often either sit there for ages or keep getting up, whereas I know she probably needs a wee. On those occasions, I just keep gently (most of the time) getting her to sit back down and eventually the "go switch" seems to engage.:rolleyes:

    What I have also found is that it's best to remove her trousers and pull-ups, as she will often pull them back up without wiping etc. I too, often have to coax her gently to sit down and then take her in the bathroom to wash her hands.

    If I didn't do all this, she would never actually take herself to the toilet - doing so means she is at least still following the toilet routine, with the added benefit of generally getting through far fewer pull-ups.
  9. marionq

    marionq Registered User

    Apr 24, 2013
    Good point Philbo. After Johns first respite he had a spell of incontinence which I eventually “cured” by taking him to the toilet at regular intervals eg before meals, hands washed, before going out, hands washed etc. By the end of the month he was back to where he had been and it’s now, fingers crossed a rarity.
  10. Risa

    Risa Registered User

    Apr 13, 2015
    This is a great point. We did try grab rails but Mum didn't like to use them and would cling on to the sink instead. We found that getting a padded, slightly higher toilet seat has helped.

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