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People with dementia are also more likely to have problems with incontinence: they are three times more likely to have urinary and four times more likely to have fecal incontinence compared to people of similar ages. This can have a profound impact on the dignity and quality of life on people with dementia and their carers.

There is a general lack of understanding and stigma around incontinence. Professionals also lack knowledge and training when it comes to incontinence in people with dementia. Poorly-managed incontinence also has severe negative impact physically, psychologically, economically and socially on people with dementia living at home and their informal carers.

Guidelines suggest that treatment should always be preferred to containment as pads and catheterisation can be uncomfortable and negatively affect the person's dignity. However the continence problems of people with dementia are different than of those without and the care strategy should take their and their carers' different perspectives into account. There are guidelines for the continence care needs of people with complex health conditions such as the Continence Care Framework.

THE EVIDEM-C research programme looked at how to improve care for people with dementia living at home. They identified priorities for action: the importance of early clinical assessment (rather than using pads); promoting continence through a a balanced diet, exercise and hand hygiene; encouraging and helping toilet use; and a sensitive management of incontinence to secure the person's dignity.

Among people with dementia living in care homes the rates of fecal incontinence are between 30% and 50%. This generally occurs alongside urinary incontinence but around 30% of people in care homes have only urinary incontinence. According to research in the UK, continence care should be indivisualised with the aim of promoting personal dignity. New measures should take into account the preferences and personal history of the affected person. Appropriate diet and mobility can help and prompts to go to the toilet should be preferred over using pads. For supporting and encouraging toilet use, staff needs practical training and understanding how dementia affects continence.

In a hospital context, the care of continence is often poor. This can lead to worse clinical outcomes for people with dementia, a higher risk of infection and the development of urinary and fecal incontinence. A personalised continence plan should be created after clinical assessment. Reversible causes and contributing factors need to be identified. Continence problems in people with dementia are at the same time communication challenges. Staff need to be sensitive to the affected people's specific, verbal and non-verbal cues as they might have difficulties expressing their needs around continence. The language used should respect dignity and shouldn't cause embarrassment. An ethnographic study in the UK pointed out the existence of "pad culture" which means that the main care strategy was the use of continence pads even in cases where people were continent. The main reasons for this strategy were fears about safety and falls which kept people in their beds and did not support independence. This mode of caring often lead to undignified situations and the use of demeaning language.