Travelling around, as I do, I try to imagine how public spaces and facilities would be experienced by a person with dementia. I cannot know how someone with dementia might feel in these different environments, but I do think a lot about it and try to put myself in their shoes.
I know, of course, that each person with dementia is different; everyone experiences their dementia in their own unique way. Nonetheless, it is good reflective learning to try to picture how the world might appear to someone living with dementia.
Public toilets always strike me as particularly confusing places. I find them challenging myself; how much harder must it be for a person living with dementia?
On my journey from the west country to London yesterday, I stopped off at a motorway service station and visited the ladies’ toilet. I could not get the tap to work. I tried several taps, but no water came from any of them. Eventually I worked out the particular hand movement that was necessary to trigger the sensor to cause the water to flow.
This is not an unusual experience for me. From the picture of the tap and sink above, I am sure you will agree, the on/off mechanism is not obvious or intuitive.
Similarly, the toilets – which, for hygiene reasons, are fitted with a fixed lid – might be puzzling for people with dementia.
The worry is that, if people struggle to use the toilet, cannot find the toilet paper, are perplexed by the flushing mechanism, confused by the taps and cannot use the soap dispensers, going to the toilet in a public building will feel embarrassing and stressful. Technological advances and automation, designed to protect public health and make facilities easier and quicker to use, could have the opposite effect for people living with dementia.
From my own experience of being with people living with dementia, and their carers, using the toilet in an unfamiliar place is a source of huge anxiety. This is especially so when the carer and person with dementia are of opposite gender and cannot go into the toilets together. Having access to disabled facilities does help to alleviate the problem in some circumstances, however this can also curtail independence for people living with dementia.
In ‘Dementia-friendly public toilets’ published in the Lancet in August 2017 (Andrea Tales et al) it is noted:
In general, there is a gap between current public toilet provision and toilet design appropriate for individuals living with dementia, who might have behavioural change, poor level of motivation, loss of mobility and manual dexterity, or abnormalities in visual information processing.
Our quest should surely be to encourage and enable people to remain independent and in charge of their own lives – in every way – for as long as possible.
Using the toilet is an intimate personal activity. Without the right kind of facilities and thoughtful support, dignity and self-respect can easily be compromised.
Writing about the shortfalls in public toilet provision, the authors of the article (cited above) say:
Sometimes there are distressing consequences that can have a detrimental impact on confidence, levels of anxiety, and quality of life. These effects in turn negatively affect the ability or desirability of maintaining activities, such as shopping or social gatherings, leading to social isolation, loneliness, and loss of independence. These outcomes will also be experienced by caregivers of people living with dementia who can no longer leave their loved ones alone at home.
Simple signage could make all the difference, and a return to traditional type facilities in public toilets that everyone can recognise and use with ease.
If you have had distressing experiences of using public toilets, please share your story with me: barbara@liftedcare.com
I’m also keen to know if you are aware of some excellent public toilets, that are easy to use and dementia friendly. Maybe you have been able to influence your local council or a neighbourhood business to adapt their public toilets in recognition of the particular needs of people living with dementia? Please do get in touch. I would love to feature some good practice examples in our newsletter.
Unforgettable have written and published an eBook called Your Dementia Home, which offers practical solutions to challenges around the home, including the bathroom and toilet. You can request your free copy from here.
This article explains how you can obtain a RADAR key for a person with dementia. A RADAR key provides access to toilets that are designed for disabled people. Usually they are kept locked but can be opened with a special key supplied through the ‘National Key Scheme’.
Unforgettable sells a selection of products that promote safety and ease of use of toilets and bathrooms in the home environment. Browse the full range here.
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