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Supportive Cues

Supportive Living


Although there are many physical, social, and emotional changes that patients with Alzheimer’s disease experience, many caregivers agree that incontinence is often the most demoralizing aspect of the disease. The ability to locate the toilet is an important part of retaining toileting skills and reducing the frequency of incontinence episodes. In order to enhance the remaining abilities of Alzheimer’s disease patients, toilet accessibility should include a legible environment with cues and information which aid purposeful navigation to the toilet. Incontinence may be reduced if the prospects of finding the closest toilet are enhanced.


This study compared the effectiveness of different identification signs to evaluate which ones were more helpful in encouraging Alzheimer’s patients to use the bathroom facilities. Large signs with various colors, words, and picture cues were employed to help patients locate public toilets. Forty-four patients in two Alzheimer’s disease units participated in this project.


Research findings indicated that patients with Alzheimer’s disease were attracted to signs with dark lettering which contrasted sharply with a lighter background. A single, concrete noun such as toilet was more effective than a compound word such as restroom, or a picture of a home-like toilet. Signs on the floor which combined the word Toilet with short directional arrows were the most effective method of encouraging residents to enter and use the public toilet facilities in the common living areas.


In order to support Alzheimer’s disease patients’ ability to find and use the toilets in common areas, long-term care facilities should evaluate the surroundings to see how small environmental changes can help Residents find the toilets. Alzheimer’s disease patients in the middle and later stages of the disease may be less able to conceptualize abstract pictures such as silhouettes of the male or female figure or to understand that words such as Men, Women, Restroom, or W.C. indicate there is a toilet behind the door. Signs which identify public facilities should use a direct and simple word like Toilet. Signs which identify the location of toilets should not be placed on the upper portion of a wall or above the doors since the visual orientation of many individuals in the later stages of the disease makes it impossible for them to locate signs in this position. Short way-finding arrows on the floor appear to be the best indicators in directing Residents to the correct location. At places where the patients must change directions and turn a corner, the cue word such as Toilet should be repeated. This may help patients find toilets independently and decrease the frequency of incontinence episodes.



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“As long as people have a need, and I can provide a place, I’ll keep doing it.”

-Tim Dolan, Founder

A person residing in a dementia care center near Clayton, MO