Navigating incontinence care for a loved one living with dementia presents a challenge for caregivers. The repeated removal of protective garments is a common issue that complicates hygiene and increases the risk of skin breakdown. Addressing this behavior requires understanding the underlying causes, employing specialized clothing, optimizing care routines, and ensuring the product itself is the correct choice.
Identifying the Root Cause of Removal
The act of removing an incontinence garment is a symptom of an unmet need or cognitive confusion. Physical discomfort is a trigger, often caused by the garment being wet or soiled, or by underlying medical issues like a urinary tract infection (UTI) or skin irritation. Brain changes associated with dementia can also impair the ability to regulate body temperature, leading the individual to remove clothing or the brief because they feel too hot or restricted.
Confusion about the garment’s purpose is a factor, as cognitive decline diminishes the understanding of when and where clothing should be removed. Sensory processing issues can also play a role, making the texture or bulkiness of the product feel foreign or uncomfortable against the skin. Restlessness and agitation, sometimes related to Akathisia, can cause the person to fidget and try to remove anything perceived as restrictive. Caregivers must first assess for discomfort or illness before implementing behavioral solutions, as addressing the source of the distress is the first step toward resolution.
Physical and Clothing-Based Prevention Strategies
Physical methods focus on creating a secure, external barrier that limits access to the protective garment without causing distress. Specialized anti-strip clothing, such as jumpsuits or back-zip onesies, feature fasteners placed at the back, making them nearly impossible for the wearer to manipulate. These garments maintain dignity while restricting access to the incontinence underwear. Adaptive jumpsuits often use soft, comfortable fabrics and have reinforced plackets to prevent tearing, offering a secure yet comfortable solution.
Layered clothing can also serve as a simple, non-specialized barrier. Dressing the person in a one-piece undershirt beneath pants that are difficult to remove (e.g., complicated closures or elastic-waist pants worn backward) can deter removal attempts. For additional security, non-irritating security methods can be applied directly to the brief. Applying a small piece of medical tape over the brief’s tabs can make them harder to unfasten, or adaptive fasteners can be used to secure the garment further. These physical strategies must be implemented with a focus on comfort to avoid increasing the wearer’s agitation or sense of restriction.
Behavioral and Routine Management
Establishing a proactive toileting schedule reduces the likelihood of the brief becoming wet and triggering removal. Caregivers should track the person’s natural patterns and then offer toileting assistance approximately 10 minutes before the predicted time, such as after waking up or following a meal. This scheduled approach helps to reinforce a routine, which is comforting for individuals with dementia.
Maintaining a calm and consistent environment during changes is also essential to prevent distress and resistance. During the changing process, caregivers can use distraction techniques, such as playing familiar music or offering a favorite small object, to divert attention from the procedure. Effective communication involves using simple, direct prompts like, “It is time to go to the bathroom now,” rather than vague questions that require complex decision-making. If a removal accident occurs, responding with calm, reassuring language and avoiding any confrontational tone helps to preserve the person’s dignity and prevent future hiding or distress.
Selecting and Sizing the Right Protective Garment
The selection and proper sizing of the incontinence product directly impacts comfort and the motivation to remove the garment. A product that is too tight will chafe and be uncomfortable, while one that is too loose will feel bulky and leak, both of which encourage removal. Caregivers should measure the person’s waist and hip circumference and compare this to the manufacturer’s sizing chart to ensure a snug fit that contours to the body without gaps around the legs.
Evaluating different styles based on the person’s mobility level is also helpful. For those with higher mobility and moderate dementia, pull-up style protective underwear may be preferred because it feels more like regular underwear, promoting dignity. Conversely, for individuals with advanced dementia or limited mobility, a tab-style brief, sometimes called an all-in-one, is often more effective and easier for the caregiver to change, even in a lying position. Selecting an appropriate absorbency level is also important to prevent leaks and skin irritation, as a higher-capacity product keeps the skin drier for longer, reducing the urge to remove the soiled item.