Determining the type and intensity of cognitive prompts necessary to support your elder's toileting continence is often a complex process that changes from one moment to the next. Too little prompting can leave your elder lost and confused while too much can be irritating -even provocative.
Cognitive prompts can be as simple as looking over at the elder and nodding toward the bathroom (high-level prompt) or so complex that it hardly seems worth the effort. For example, elders who are severely cognitively impaired may require very detailed prompts such as the following:
"Do you need to go to the toilet?"
"OK, stand-up."
"Walk this way."
"Step-up here."
"Turn around."
"No, (don't walk away). Turn around. Yea, that's it."
"Un-button your trousers. Good."
"Pull the zipper down."
"OK, now pull-down your pants."
"Sit-down."
"Its OK to go now."
"Wow, that was a lot of work! You made it! Great job! I'm going to give you some privacy. Let me know when your finished (peeing / pooping). I'll be in to check on you in a few minutes."
If your elder is at-risk of falling and is not likely to call for your assistance when he/she finishes urinating/BM, then you will likely need to keep your eyes on your elder and remain immediately (physically) available to them.
Equally detailed prompts maybe needed to wipe / clean-up, re-dress and return to their previous activity and location.
One difficulty often encountered by family caregivers is that the elder's cognitive prompting needs may vary from one day to the next, even from one moment to the next. Because elders with impaired mobility and existing cognitive impairments are more vulnerable to a condition called DELIRIUM, it is important that you report any acute (fast-onset and substantial) changes in your eleder's mental status.
For example, if your elder is normally able to answer your question about whether they need to use the toilet, but today they cannot seem to understand you, this maybe an indication that your elder is suffering from delirium. You will need to investigate further. Rapid detection of delirium is key to a rapid recovery from delirium.
