Problems in the bathroom

Some Alzheimer’s patients, particularly in moderate to advanced stages, may forget to pull down their underwear in the bathroom.

This can happen due to cognitive decline affecting memory, executive function, and spatial awareness. They might struggle with the sequence of steps involved in toileting (entering the bathroom, pulling down clothing, sitting) or fail to recognize the need to adjust their clothing. This behavior varies by individual and disease progression.

Executive function involves cognitive skills like planning, organizing, sequencing, and initiating tasks. In Alzheimer’s, damage to brain areas like the frontal lobes impairs these abilities, leading to:

・Forgetting steps: The patient may not recall the correct order of actions ( pulling down underwear before sitting).

・Incorrect sequencing: They might perform steps out of order ( sitting before lowering underwear or attempting to wipe prematurely).

・Difficulty initiating or completing tasks: They may start the process ( entering the bathroom) but get confused or distracted, leading to incomplete actions or wandering off.

・Reduced problem-solving: If something goes wrong ( clothing gets stuck), they may not know how to adjust, resulting in frustration or giving up.

- For the female patient you’re caring for, who exhibits nighttime or early morning wandering and urinates in her diaper instead of using the toilet, this impairment likely contributes to her inability to follow through with toileting steps, especially during irregular awakenings triggered by urinary urgency.

Strategies to Support Toileting with Executive Function Impairment

1.  Simplify the Toileting Process

• Simplify clothing: 

Use easy-to-remove items like elastic-waist pants or Velcro-fastened underwear

• Reduce steps: Place a portable commode in her bedroom or near her wandering area to shorten the process (fewer steps to reach the toilet). Introduce it casually ( “This is a comfy seat for quick stops”) to avoid resistance.

• Visual cues: Place clear, bold signs with words like “Toilet” or pictures ( a toilet icon) on the bathroom door or commode. Use glow-in-the-dark tape or motion-sensor lights to guide her at night without needing verbal prompts.

•Assist discreetly: 

Guide them to the toilet and assist with clothing if needed, while respecting their dignity.

Simple Plan for Using Sensors

1.  Get a Sensor

•  Type: A bed mat sensor (under her mattress) or a motion sensor (in her room or by the door) works best. They detect when she gets up.

Examples: Try brands like Smart Caregiver or Bed Alarm (available online ). 

They cost about $30–$100.

•  Setup: Place the bed mat under her sheet or the motion sensor near her bed. It sends an alert to your phone or a small device when she moves.

2.  Guide Her to the Bathroom

•  When the sensor alerts: 

Go to her calmly. Say something simple like, “Let’s visit the bathroom,” or smile and say, “Toilet time?” to avoid her resisting advice.

•  Make it easy: 

Keep the bathroom path clear with small lights (like nightlights) or a glowing “Toilet” sign so she knows where to go, even if confused.

•  Help with steps: 

If she forgets to pull down her underwear, gently start lowering it for her while chatting about something else to keep her calm.

3.  Make Toileting Simple

•  Easy clothes: Use stretchy pants or underwear she can pull down easily. Avoid buttons or zippers.

•  Nearby toilet: If the bathroom is far, put a portable toilet (like a bedside commode) in her room. Call it a “special chair” to avoid her saying no.

•  Diaper backup: Keep comfy diapers on her for accidents, but try to get her to the toilet first. Change diapers quickly if she uses them to keep her comfortable.

4.  Reduce Wandering

•  Safe space: Clear her room or hallway of things she could trip over while wandering.

•  Calm her at night: Play soft music or use a cozy blanket before bed to help her sleep better and wander less.

Tips for Success

•  Test the sensor: Make sure it alerts you reliably without loud noises that might upset her.

•  Stay patient: If she resists, try again later or distract her with something she likes (e.g., a favorite topic).

•  Get help: Nighttime caregiving is tough. 

Check out local support (e.g., dementia groups in your local community) or ask family to take turns.