Third time that shift, I found Mr. Delgado in bed, his brief folded neatly on the blanket beside him. "Just tidying," he said. The bed was dry. It would not stay that way. Anyone who has done dementia care knows the loop: the product comes off, the bed gets wet, and by morning there is red, angry skin to treat as well.
Dementia does not simply change how a person controls their bladder. It changes how they experience the event itself — the sensation, the routine, a stranger's hands at the waistband. A product that works fine for a cognitively intact resident becomes a daily battle for someone with Alzheimer's. The Alzheimer Society of Canada urges caregivers to read resistance as communication: the person is confused, cold, frightened, or simply does not understand. Product choice, then, is about reducing the fight, not absorbency ratings.
The behaviour-first checklist
Four behaviours come up again and again. Each has a product answer and a technique.
| Behaviour | What the person experiences | Product response | Care technique |
|---|---|---|---|
| Pulls the brief off | The garment feels alien | Pull-on style with tear-away side seams | Redirect first; cover with pants |
| Fights the change | Being moved mid-task escalates | Heavy-absorbency underpads as a second layer | Change on their rhythm; return in ten |
| Toileting attempts fail | The bathroom is unrecognizable; the urge is gone | Underpads on chair and bed | Prompt, don't ask; light the path |
| Bedbound or low mobility | Transfers frighten; lying on wetness burns skin | 5-layer SAP underpads for bed and chair | Roll, don't lift; change in stages |
1. Pulls the brief off
For a person who tears at their product, tape-tab briefs are a magnet — the tabs are easy to find and satisfying to pull. I switch these residents to a pull-on style with tear-away side seams: less to grab, and staff open the seam instead of undressing the person, cutting the struggle in half.
Technique: never chase the product. Offer a redirect — a drink, a walk — then change.
2. Fights the change
Frontal lobe changes make transitions hard. Pull a resident to standing mid-task and you will get a swing or a shout. That is where underpads earn their place: one on the bed, one on the chair, so an interrupted change is no disaster.
Technique: change on their rhythm, not the clock. Warm the room and your hands, narrate each step. If they fight, halt and return in ten minutes. A calm second attempt beats a forced first one.
3. Toileting attempts that fail
Scheduled toileting still works for some, but dementia erodes the sequence: the person cannot find the bathroom, does not recognize the toilet, or forgets mid-transfer. Prompt, do not ask — "let's go to the bathroom" beats "do you need to go?" — and keep the door open and the path lit.
An attempt ending in a wet chair is not a failure when the underpad did its job. Skin stays dry; try again in ninety minutes.
4. Bedbound and low-mobility residents
Residents who no longer transfer face pressure and maceration. A five-layer underpad with SAP pulls wetness from the skin far faster than cotton. Change in bed with a roll, not a lift, and check the skin every time — red marks today are wounds next week.
Pull-up or tape brief? The honest answer
For dementia care I reach for pull-ups more often than tape briefs — but not for the reason most people assume. It is about behaviour, not continence level. Kimberly-Clark (Depend) and Attends built tear-away seams into many pull-on styles because care teams asked for them. The trade-off is real: pull-ups hold less and cost more per change, so a heavy tape brief still suits residents who keep their product on. Watch the person, not the packaging.
Three products I keep on the cart
These CliniEco products show up in my care plans again and again:
- CliniEco Disposable Underpads, Heavy Absorbency, 30 x 36 in — a dependable layer for interrupted-change nights.
- CliniEco Urology Care Kit — pads and underpads in one bundle for home caregivers.
- CliniEco Medical Underpad, 60 x 90 cm, 5-Layer with SAP, Vacuum-Compressed 50-Pack — the bulk option LTC units order by the pallet — a full cart of spares on one shelf.
One last thing — the person, not the product
Mr. Delgado folded his brief for three weeks before the behaviour faded. What helped was not a different absorbency class. It was a pull-on with side seams, underpads that made missed changes harmless, and a team that ceased chasing him and started waiting. In Canada, incontinence products are Class I medical devices under the Medical Devices Regulations administered by Health Canada — a reminder that what sits between a resident and their skin is medical equipment.
Choose the product that fits the person's behaviour today, and re-evaluate when it changes. That is the whole strategy.
Related reading: explore our long-term care and home care resources.
start with our underpad buying guide for absorbency, sizing and cost.
Related reading
0 comments