January 2, 2011

Difficult Conversations: How To Talk To Someone About Incontinence

Incontinence in a relative or someone else close to you is impossible to ignore: the odor, the mess, the cleanup. Ironically, the subject is often ignored anyway at least for a while because of the complicated emotions connected to a loss of bodily control. Embarrassment and frustration may feed denial on either side. And because urination and elimination are so personal, awkwardness about broaching the issue can feel almost paralyzing.

Looking after someone in failing health is fraught with tough conversations. But as challenging as unfamiliar and emotionally charged topics can be especially those that tend to flip our usual family dynamics -- they don't have to be forbiddingly uncomfortable. Talking is almost always better than ignoring, provided you prep yourself first on what to say and how to say it.

In later stages of dementia, the person may no longer be capable of insight into the fact that they've been incontinent. They may wake up and say, "Oh, you must have spilled water in my bed." An hour later, they may forget even that.

At this stage of impairment, Robbins says, the person may remain cooperative. Or the person may begin to refuse therapies such as scheduled bathroom visits or may even try to remove a diaper. It can be difficult to convince someone in late-stage dementia about the importance of following doctor's orders or staying clean. By this point, there are usually other behavioral problems going on as well.

It's often not helpful to try to reason with someone who has late-stage dementia. Often their beliefs are fixed, and your attempt to change their mind will be met with anger rather than as new information to consider.

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