While incontinence of any form can be embarrassing, uncomfortable and an unpleasant chore. Before running for the medicine cabinet, take a look at eliminating food culprits.

Foods and drinks that can contribute to incontinence:

  • Limit the use of acidic foods and drinks. Acid irritates the lining of the bladder causing incontinence. While many use cranberries to prevent urinary tract infection, the acidity of cranberries as well as many other fruits can contribute to incontinence. Citrus fruits, such as oranges, lemons, grapefruit and even pineapple are acidic. Other fruits can be acidic as well, and it pays to practice elimination, to identify the troubling fruit.
  • Chocolate is also an acidic food, while also containing caffeine, this increases the connection to incontinence. A good alternative is white chocolate which doesn’t contain the caffeine.
  • Any bubbly beverage, can increase the chance of incontinence.  Alcohol as well is known to contribute to incontinence. The combination of alcohol and carbonation increases the incidence of incontinence.
  • When it comes to a beverage, cola, tea, those fizzy drinks and of course coffee are the most well know causing incontinence. Switching to low acidic drinks while avoiding sugar and sugar substitutes can reduce incontinence.
  • Even more forms of acidic foods are those with a tomato base, spicy foods and condiments.

While you are identifying the type of incontinence and the food/drink trigger, using incontinence products is important. Keeping clean and dry during this time of investigation will lead to a better outcome. The longer a person is incontinent the longer it will take to reverse the problem.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing


  1. Many people as they age have to get to get up during the night to use the bathroom. The question is how often does a person have to get up. If the elder is getting up more than two times a night it is called nocturia.
  2. How often, is too often, when it comes to trips to the bathroom? What is considered too often, or “frequency” is eight or more times in 24 hours. Frequency is often accompanied by urgency, the sudden need to go to the bathroom. Many times a person with frequency and urgency, does not make it to the bathroom in time, and is incontinent.
  3. Stress incontinence, is dribbling urine when a person laughs, sneezes, coughs or has stomach cramps.
  4. A urinary infection  can cause pain during urination. Classic symptoms of urinary infection are increased confusion in the elderly as well as painful urination.
  5. Women who have given birth multiple times (4 or more births) will more likely experience difficulty when starting to urinate. They can as well, experience a weak stream.

When a person suddenly becomes incontinent of urine, you need to check out any new medications. Many medications have incontinence as a side effect. The bladder is made up of smooth muscle tissue, the same muscle tissue in the heart and stomach. So medications prescribed for heart or stomach disorders will at the same time affect the smooth muscle of the bladder.

Medications that affect the smooth muscle of the bladder can also be antihistamines and certain drugs for asthma, anti-parkinson’s drugs, and so many more. As the elderly begin to practice poly-pharmacy, or the routine use of four or more medications, the chance of developing incontinence increases. Many of the elderly in nursing communities are taking nine or more medications a day, causing many side effects.

Urinary incontinence is a very upsetting condition for the elderly. You can hardly visit a nursing facility without hearing someone calling out “I need to go to the bathroom.” This alone, not responding when a person has a urge to void, can eventually cause incontinence. Incontinence is not only stressful for the elder, but also for the caregiver, making care giving more difficult.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing



Every year the average nursing home will have between 100 to 200 patient falls. The people who fall the most often are men, and patients who are confused. Men fall almost twice as often as women because they are less likely to call for assistance, because it is more difficult for them to admit needing help. Patients with Alzheimer’s disease or another form of dementia fall frequently, because they no longer have safety awareness.  Statistics tell us that 35% of those patients who fall are unable to walk, yet they try.

Most patient falls happen in the patient’s room, when the person is attempting something without assistance. Few falls happen in places like a dining room or at a nurses station where many staff members are available to monitor for unsafe behaviors. The majority of those falls in patient rooms have to do with needing to go to the bathroom. Being incontinent of urine, having diarrhea, and having to urinate frequently at night all contribute to the high number of falls.

Added risk factors are poor vision, going bare foot, clutter on the floor, poor lighting and possible a slippery/wet floor from the patient becoming incontinent. As well as the patient forgetting to reach for their cane or walker in their rush to the bathroom.

A nursing home fall prevention program includes assessing each and every patient for their fall risk. All of the above mentioned problems are identified. A plan of care is developed and all staff members are informed of the plan. Safety devices are put in place, most of those devices are in the form of alarms. A good web site for safety devices is Their site is very user friendly and they have a large selection of safety alarms.

Looking at the environment, follows the assessment. Are the grab bars placed correctly? If the patinet is getting out of bed, is the bed in a low position, with an alarm? Is the lighting adequate, are there motion sensors in place? Is the patient on a regular toileting schedule before bed? How often does the staff check on them during the night?

A big deterrent for falls is a busy, engaged patient, a patient who has activities to go to that they enjoy. A patient who is really tired when it is time for bed, that they enjoy a good nights sleep.

Virginia Garberding RN

Certified in Restorative Nursing and Gerontology


Grandma Lucy always has a big smile on her face. She is already in the late stage of Alzheimer’s disease. Grandma no longer talks or seems to understand what others are saying to her. She now needs total assistance bathing, dressing and eating.  Yet, Grandma Lucy can still walk and while she cannot go through the many steps of dressing. Once dressed she is able to pull down her slacks, as well as  incontinent brief, and then go to the bathroom.

The problem arises because Grandma no longer can identify the correct place to toilet. When she feels the urge to go to the bathroom, any flat surface she can sit on, will do. She no longer plans or anticipates that she will be needing a bathroom. In the moment when she feels the urge, she answers the call in a public place, secret place, anywhere she finds an opportunity to sit.

Missing the toilet, and using either another object such as a waste basket, or a flat surface such as a chair, sofa, or recliner is common, in a dementia unit, in a nursing home setting. Especially common, for those elderly who continue to be able to walk independently. Grandma Lucy always was a great walker, and has continued to be able to walk, even though now she walks without a destination. She just appears to be wandering as she keeps retracing her steps, all day long.

But contrary to the many who are no longer this active, she has no problems with constipation. On the contrary, Grandma is as regular as clock work. And this fact provides the solution for Grandma’s problem.

When a confused elder like Grandma Lucy can’t plan or anticipate needing to use a toilet, the caregiver needs to provide this service. Her caregiver knows that Grandma Lucy has a bowel movement everyday, about a half hour after breakfast.  As many people know, having a cup of hot coffee in the morning, and chewing breakfast, stimulates the colon and bowel.

Now the caregiver keeps a close eye on Grandma Lucy after breakfast, and right on time walks her to the bathroom. Grandma Lucy is now greeted with smiles and welcome during her wanderings instead of looks of suspicion.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing



An elder loses their abilities in the reverse order that they gained the ability.  Just as young children will become continent of a bowel movement before bladder; an elder with Alzheimer’s disease will become incontinent of bladder before bowel.

And so also the elder who may always be continent during the day, starts to become incontinent during the night and needs an incontinent product when in bed. Changes happen in somewhat a predictable order. But what if the incontinence is due to something besides a dementing illness?

A good place to start is to look at the urine. If the urine is a dark color and cloudy it may mean that the elder is dehydrated or may have a urinary tract infection. In the elderly a urinary tract infection may cause confusion in an elder who normally has no signs of confusion. In the confused elder a urinary tract infection will make the elder much more confused.

A strong smell to the urine might again mean that the elder is dehydrated or it might mean something more significant. A sweet or ammonia smell needs to be reported to a doctor, as well as cloudy urine.

Providing very good hygiene for the incontinent elder can be a very delicate subject. This can be a great time for a distraction. Telling the elder “We need to leave right now to meet Grace for lunch. I am so sorry I didn’t give you enough time to go to the bathroom; I know how you like to be clean. Here let me help you.”

Giving the elder a reason, offering a sincere apology, blaming yourself, giving the elder a compliment (everyone likes to think of themselves as a clean person) and then offering help, will work to reduce the embarrassment of the elder.

Virginia Garberding RN

Certified in Restorative Nursing and Gerontology



We now have such a large selection of incontinent products, all sizes and for all purposes. We even recently have had a well know dancer, demonstrating in a commercial, how she can dance and no one would even know she was wearing an incontinent product. So when this problem can be taken care of so much easier than ever before, where is the problem?

I often think the most hurtful problem for the aging adult is incontinence. The elderly will try to deny it and often hide it. I well remember a woman Grace, when she first entered the nursing community. Grace had early Alzheimer’s disease, was very alert and pleasant. She had come from her home and arrived in her own wheelchair.

The first noticeable thing about her was her strong smell of urine. Many elderly people enter this way because it has become so difficult for the family to care for them. But this was different because it was just so intense an odor. We soon found that Grace was sitting on a pile of urine soaked newspapers in her wheelchair.

Her family told us that for the last few years their mother had become incontinent of urine and refused to wear any incontinent product. She collected and sat on piles of newspapers at all times. This had become her normal to a point where she became very angry when anyone suggested that she was incontinent.

We soon came to realize that Grace and her family, when referring to a product called it a “diaper.” Of course Grace did not consider herself a baby, and would not be treated like a baby by wearing a diaper.

For Grace things ended well.  We successfully convinced her to wear a pull-up product that we always referred to as her “under wear.” Grace accepted this, yet continued to sit on newspapers. This had been her habit for so long, that she didn’t want to give it up, but she no longer smelled of urine.

Virginia Garberding RN

Certified in Restorative Nursing and Gerontology


(Part II)

In the past when an elderly person experienced changes in behavior or increased confusion, the health care community collectively thought that this was normal; after all you’re getting old. How many times has a doctor said to a family member “What do you expect at his age, he’s getting old.”

Addressing the behavior or the increased confusion was the focus, not the underlying physical change in condition. Identifying that physical or pathological change will require the persistence to search for a cause and the ability to clearly communicate your findings.

Signs of a urinary tract infection:

  • Going to the bathroom more frequently
  • Complaining of a burning sensation on urination
  • Increased temperature
  • Bladder or kidney pain
  • Blood or pus in the urine
  • Concentrated, dark/cloudy urine
  • Rambling talk, disorganized thinking
  • Unstable emotions
  • Increased problems with judgment or thinking

The elderly with dementia are more likely to be hospitalized for a fracture, lower respiratory infection, urinary infection or a head injury than an elder without dementia. Once admitted, the elder with dementia will usually remain in the hospital twice as long an elder without dementia. The elder with dementia will also be more likely to be re-admitted within 90 days after discharge than an elder without dementia.

Virginia Garberding R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance



Marty was holding on to the handle of the car door threatening to “jump.” No matter what his wife Betty said, nothing seemed to be able to quiet Marty down. He had been pacing the small home they had lived in for the past 40 years, till Betty said, “Let’s go for a drive.” Thinking the car ride would be soothing for whatever was bothering Marty these last few days. He seemed to have a problem that he didn’t seem to be able to put into words. And now here he was threatening to jump from the car.

Marty had always been a very calm, dependable sort of man. Even when he started getting confused, he laughed it off never showing frustration or anger. This kind of outrageous behavior was so unlike the normal manner of this 78year old man. Not knowing what to do, Betty drove directly to their doctor’s office and luckily they took Marty right into an examination room.  Marty would not have been good at waiting, not today.

Marty was well known to the doctor and his staff and after what seemed only a short time to Betty the doctor started writing notes. Betty could just make out the doctor’s note reading it upside down. It read, Altered Mental Status, increased confusion probable cause urinary tract infection.

Urinary tract infections are the most common infections in the elderly and the most likely to lead to increased confusion. The second most likely infection to result in increased confusion is an upper respiratory infection or pneumonia. However just about any infection in an elderly individual may result in increased confusion. Many times the increase in confusion is the symptom that leads the caregiver or physician to the cause which may be infection.

Virginia Garberding R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance


M. T. writes: My Dad is a stroke patient for more than 6 years. He is in a wheelchair, and is 72 years old. Your advice has been very useful, but I have this problem. Dad does not accept diapers, what do I do?

I well remember a lady some 30 years ago who moved into the nursing community sitting in a wheelchair on a stack of urine soaked newspapers. Myrtle was very offended when ever anyone suggested that she needed to wear a “diaper.” She angrily denied that she was in any way incontinent of urine. After she moved into the nursing community she constantly moved through the common areas looking for newspapers. She never changed the papers, just placed the new ones on top of the old ones.

In those days they didn’t offer pull ups or a variety of sizes. Staff at that time was used to laying the elder down on a bed and changing them much like you would change a baby. No one talked or thought about issues of dignity or even privacy.

Healthcare has come a long way since then, and we have learned how hurtful words can be. Please look on this sight for “Words that Hurt” from 4/2/2009 and also the blog from 1/30/2009.

Whether living in a nursing community or with a family caregiver, when the elder is incontinent and not using an absorbent product, much of life can revolve around this issue.  Keeping the elder clean, comfortable and preventing skin breakdown becomes a fulltime job.

Being a caregiver continues to be the hardest job there is.



Virginia Garberding R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance


Results of Laxative abuse in the elderly.

Many elders abuse laxatives without realizing their regular use is abusive. The elder may be under the assumption that in order to be “regular” they must have a bowel movement every day. Regular use of laxatives makes the intestinal muscles flabby or referred to as a “Lazy bowel.” The ongoing use of these products eventually makes a person dependent on a laxative in order to have a bowel movement.

Laxatives work by irritating the walls of the intestines and causing an increase in the contractions of the muscles in the intestinal wall. The most gentle of these products contain milk and increase the amount of water in the intestine causing a softer stool. The nursing home usually favors the use of one of these milk products (Milk of Magnesium or MOM) for the elder with a constipation problem.


Glycerin suppositories have a more gentle action than Bisacodyl products. Glycerin works by attracting water through the intestinal wall into the bowel and will flush out the waste within 10 minutes. All suppositories are bullet shaped and designed for insertion with the pointed end first and placed next to the wall of the bowel.

A Bisacodyl product acts by irritating the muscles of the bowel, causing contractures (at times extreme) which expels the waste.

When Hypothyroidism is the cause of constipation.

When the elder has an ongoing problem with constipation despite eating a good diet, drinking water through out the day and getting regular exercise, the possibility of hypothyroidism should be looked into. Although hypothyroidism causes dementia, as well as a host of other conditions, physicians are more likely to address each symptom then the cause. A diagnosis of hypothyroidism is very difficult to receive from a physician.

The patient who presents with slow reactions, and moves slowly, you can then assume their digestive system is also moving slowly. A slow moving colon gives the intestinal wall more opportunity to remove fluid and create hard dry stools.  Even when the physician suspects Hypothyroidism, unless their lab tests confirm it, the patient will not receive the diagnosis. Hypothyroidism used to be diagnosed strictly by the symptoms reported by the patient and the observation of the physician. Once the medical community determined that the only way to determine this debilitating condition was with the correct labs, many people were no longer diagnosed.

Although hypothyroidism is relatively easy to treat, with low cost thyroid medication and iodine the typical physician is going to dismiss this possibility if the labs don’t back him up.

Although constipation is a difficult condition to live with, the missed diagnosis of Hypothyroidism has the potential to cause many more conditions for the aging population in the future.

Virginia Garberding, R.N.

Director of Education, The Wealshire, Lincolnshire, Illinois

Author: Please Get To Know Me – Aging with Dignity and Relevance