Updated: Jun 24, 2021
Dementia can create many challenges to living in an ordinary home. One area of particular concern is the bathroom, where the risk of slips or falls is greater, but facilities are essential and cannot be avoided. Just a few simple changes can constitute a safe, practical way to improve the bathroom so the person with dementia can maintain an independent and dignified life.
One of the best ways to ensure any room is easy to navigate and is dementia friendly is to ensure adequate lighting. It should be bright but not harsh and consistent throughout the space. People with dementia can often find shadows or glare confusing, so try to position lights to avoid these. The toilet, sink and shower, in particular, should be clearly lit. Movement sensors can ensure lights switch on automatically when the person is in the room and switch off again when they leave, rather than depending on their memory. A timer can be included to ensure the room does not suddenly go dark whilst they are still there.
As in many parts of the home, colour is one of the most valuable tools for helping people with dementia navigate potentially unfamiliar environments. The use of bold, contrasting colours can differentiate between walls and floors and highlight important features such as the toilet seat, toiletries and handrails. Fancy or complicated patterns can be distressing to a person with dementia and should be avoided throughout the floor, walls, shower curtain, toilet seat and any other parts of the room.
Reflections are another potential source of confusion and distress for a person with dementia. If this is the case, mirrors should be covered when not in use, as should reflective shower screens. Alternately, shower screens can be made of frosted glass or other non-reflective surfaces. A matte coloured floor can prevent the surface from looking wet or reflective and reduce the risk of confusion.
A person with dementia may be less cautious around hot water or forget to check or adjust the temperature. This can lead to scalding. Thermostatic controls in the shower and taps can ensure that the water will never become too hot. Other potential sources of burns, such as pipes and radiators, should be covered or concealed.
Avoiding slips and falls
There is obviously a higher risk of slipping in the bathroom because it can become so wet. This makes handrails and non-slip mats even more important. The shower should be level with the floor, so there is no need to step up into it. A shower seat with arms can keep a person secure whilst leaving them able to clean themselves thoroughly.
Reflections, shadows, patterns and changing colours can make the floor seem uneven to people with dementia. They may try to avoid steps, holes or obstacles that do not exist, again increasing the risk of tripping. A bathroom floor that is one colour with no shine is the best way to avoid this.
If falls do happen, try to remove sharp edges and corners from counters, avoid glass shower screens that may shatter (use PET plastic instead) or use shower curtains with breathable fabric. This means if they are pulled down during a fall, there is minimal risk of suffocation. You should also take steps to avoid flooding, which obviously can make surfaces slipperier.
Another thing a person with dementia may forget to do is switch the tap off before the sink or bath overflows. Showers can be set to switch off automatically after a certain length of time, whilst sink plugs are available that will make the basin start to empty if it reaches a certain level.
Familiarity is a crucial way to help people with dementia feel comfortable in a space and reduce confusion and distress. This means trying to avoid sudden, dramatic changes or modern gadgets that may be confusing to them. For example, taps and toilet flushes should have traditional handles rather than infrared sensors or modern push buttons. The hot and cold tap should be separate and clearly labelled. The overall layout of the bathroom should be simple, designed in a way that will make intuitive sense even to someone whose perception is clouded.
What helps dementia patients with toileting?
Incontinence can be a common problem for older people, including those with dementia, but it can still be an embarrassing if not aggravating experience. Patience and understanding are necessary, but there are also some practical ways to making using the toilet easier and avoid accidents. There are several ways to make the bathroom and toilet as easy to find and use as possible.
It can help to think ahead, incorporating potential visits to the toilet into plans for the day. This may include regularly checking with the person if they need the toilet, always carrying a radar key and avoiding too many drinks in the hours before bed, so they are less likely to need to relieve themselves in the night. Always make sure you know where to find the nearest toilet.
Establishing a routine, including toilet habits, is an excellent way to make a person with dementia feel more comfortable generally.
Finding the bathroom
Make sure the toilet door is clearly labelled and easy to identify, perhaps by using both words and pictures on the sign. If the room is not in use, leave the door open, so it is clear that it is available. Mirrors may lead a person with dementia to think the room is already occupied because they can see their reflection, so be careful when positioning reflective surfaces or keep them covered when not needed.
It is also vital that the person can reach the bathroom, so ensure that there is a clear path to the door that is not blocked or obstructed by furniture. Check that there is adequate lighting from the bedroom all the way to the toilet for times when the person needs to use the facilities in the night. Motion sensors can ensure lights will switch on and off at the appropriate times. The toilet itself should be obvious, which can be achieved by making the colour of the toilet seat a contrast to the rest of the room.
Various mobility aids are available to make using the toilet easier for people with dementia who are unsteady on their feet or otherwise find manoeuvring difficult. For example, handrails can be installed at appropriate points to help walking and standing. A raised toilet seat may be more accessible. In some cases, a commode may be easier to use, but this will require the person to be both willing and capable of utilising it.
The person with dementia may also need help with basic hygiene when using the bathroom or after an accident. This could include providing warm water and gentle soap to clean after a mishap and making sure any clothes or bedding are immediately put in the laundry (as well as supplying clean clothes and pads). They may need reminding to wash their hands after using the toilet. Some people may prefer a bidet instead of toilet paper.
Failure to keep clean can lead to UTI’s, discomfort and skin irritation which, in turn, can lead to an increased risk of bedsores. Any toilet paper, toiletries and other hygiene products should be gentle on the skin and account for any particular sensitivities the person might experience. The person's comfort remains a priority along with their safety.
Other things to bear in mind
Some people with dementia may struggle with locks. Privacy is essential in the bathroom, but you do not want the person to become trapped inside. This does not necessarily mean removing the locks, but you should make sure they can be disabled from outside relatively quickly and easily.
Clothing is another area where people with dementia may struggle to use the toilet. Buttons and zips can be hard to manipulate, causing confusion and delays. There are clothing ranges available adapted especially for the use of people with dementia, which include Velcro as an easier to use alternative. Another option is to wear trousers with an elasticated waist that does not require fastening.
Catalyst Interiors have extensive experience in designing dementia friendly care and nursing homes. This includes making bathrooms safer and easier to navigate for people with dementia. Our practical guidance can allow you to keep bathrooms accessible, making the person with dementia feel more comfortable and secure in their environment.
A dementia friendly bathroom does not just incorporate design features to make the person safer, accounting for any problems with perception, memory and mobility. It also allows them to maintain their dignity even when facing challenges such as incontinence. This, in turn, allows them to continue to live independently for a long as possible, respecting their needs and wishes and taking steps to minimise any confusion and maximise comfort.