Toileting: a biobehavioral challenge in Alzheimer's dementia care

As the trajectory of Alzheimer's disease (AD) progresses, problems with toileting become evident. This research addresses the range and variation of toileting problems, management strategies used by family and employed caregivers, and interactive and contextual conditions associated with toileting. Qualitative ethology was used to analyze data from over 120 hours of participant observation at an Alzheimer's Day Care Center, in clients' homes, and support groups; and interviews with families (n = 16) and staff members (n = 13). Toileting emerged as a complex event with many stages, as unaesthetic and unpleasant for caregivers and clients, and as occasionally resulting in catastrophic reactions. Caregivers read cues and interpret toileting behaviors. They provide physical and cognitive assistance while attempting to avoid accidents and catastrophic events. Client, staff member, and contextual variables affect toileting events. Recommendations for practice and research are proposed.