Incontinence is a critical problem for both caregivers and patients with Alzheimer’s disease. In the early and middle stages of the disease, there may be occasional incontinence episodes, but later on, as the disease progresses, the probability of incontinence increases. In many cases, incontinence can be managed with medical treatment or behavioral modifications. However, many Alzheimer’s disease patients could also benefit from changes in the environment which would help support toileting skills.
This study was based on an assumption that for patients with Alzheimer’s disease, “out of sight” may mean “out of mind.” At the Corinne Dolan Alzheimer Center, privacy curtains allow the resident the option of opening or closing the curtain to the toilet area in his or her private room. The research compared the differences in use between toilets which were highly visible and accessible and toilets which were concealed or hidden from view behind a curtain.
Results after 2,592 observations of closed and open curtain conditions show that fourteen participating residents in the early and middle stages of the disease were eight times more likely to use the toilet when it was visible than when it was concealed. Also, the time between usage decreased when the toilets were visible. Under the closed curtain condition, toilets were used on an average of every 70 minutes, whereas under the open curtain condition, toilets were used every 9.8 minutes. The results indicate that a visible toilet encourages use, and increased use of the toilet, in turn, reduces incontinence episodes.
Bathroom doors should be left open so that the toilet can serve as a cue for the Alzheimer’s disease patient. Doorknobs or other opening devices should be easily recognizable and simple to operate. Consideration should be given to removing the door and replacing it with a curtain or folding door so that visibility of the toilet can be enhanced. This simple alteration may also be appropriate for long-term facilities that are planning to design or remodel special care units. Privacy curtains and dividers are as appropriate as doors for use in the public toilet areas. Since the ability of residents to locate and use toilets decreases with the severity of the disease, designers of new facilities should position bathrooms or toilets in central areas so that visibility is maximized. The configuration of the floor plan and the position of interior walls must also accommodate the characteristic behaviors of Alzheimer’s disease patients, and adapt to their changing needs.