How to get a urine sample from someone with dementia when your loved one doesn’t want to or is unable to as their caregiver, especially when you fear a UTI?
I’ve lost count of the number of UTIs mum has had over the years and how difficult it is to get a urine sample from her. A UTI is a Urinary tract infection that can affect your bladder, urethra, or your kidneys. And for someone with dementia can cause severe issues like delirium if not treated.
A simple urine test can determine whether you have an infection or not. Your doctor can do an on the spot test of your urine sample using a dipstick or ask you for a urine sample to test in a lab.
However, you should check with your local health body on their guidelines on whether a dipstick check would be appropriate e.g for example Public Health England in the UK has advised “do not perform urine dipstick as they become more unreliable with increasing age over 65 years”
So I’ve learnt a few tips to get a urine sample & help reduce your chance of having a contaminated one. Getting a urine sample from someone with dementia is complicated, especially if they are experiencing increased agitation or confusion – one of the signs of a UTI.
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The Basics – getting a Urine Sample
You need to get a clean sample of urine called a “clean catch”, which means it isn’t contaminated with bacteria from your hands or surrounding areas of your genitals. To get a clean sample, you need to:
- Wash your hand
- Clean the surrounding area – tip of penis (push back foreskin if needed) for men and in between the labia for women
- Start to urinate, stop if possible or wait until the first part of urine has passed, then using your container capture a midstream urine sample.
- Wipe, empty the urine sample into the specimen container and wash your hands.
It’s essential to clean the area and capture midstream where you can. I usually have to submit more than one urine sample because some samples are contaminated and show “mixed growth”, from bacteria getting in from the skin or washed away in the first part of the urine stream.
However, if your loved one is in the early stages of dementia, following these steps may not be possible. You may not be able to clean the area. Your loved one can refuse it, or not remember to tell you when they need to go. They may not have the dexterity, mobility to take a sample, or ability to follow directions.
They may be incontinent or, because their confusion worsens, become agitated from the pressure from you as a dementia caregiver trying to get a sample. So what can you do?
Tips for getting a Urine Sample as a Dementia Caregiver
First, you need to explain, ask, and offer them the support they need to give a sample. You may need to visit the bathroom with them and hold the container to catch a sample, offering reassurance and positive encouragement. Turn on the tap, splash someone water on the area, whatever works to encourage a sample. I’ve done that, held a container as my mum peed.
Otherwise, you’ll need to be discreetly vigilant to be able to get the urine sample and to avoid any contamination from tissues, faecal matter, hands and skin etc. Try the following:-
Urinary /Specimen Hat
- Try a Urinary/Specimen hat placed in the toilet bowl, so that when someone with dementia uses the toilet a sample is captured. Be careful it’s not contaminated by tissue or other deposits. Once collected it can be poured into a specimen container for submitting to your doctor.
Bed Pans
- Take a sample during personal care by using a bed pan
How to use a Bed Pan – Tips for Caregivers
Use a commode chair
- If you have access then a commode chair is happy medium between a toilet and a bedpan, more comfortable for your loved one and can be positioned in the living space and/or bedroom. It means that they can sit on the chair and wait until they’re ready to go watching TV or distracting through conversation. Mum was always happier to use a commode once we explained the reason why, reduced risks of falls (especially at night) and because of the height and foot holders more comfortable for her.
Newcastle urine collection pads / Insert Pads
- If all else fails you can use incontinence pants with an insert pad. Newcastle urine collection pads are placed inside the pants and once urine has been deposited removed and syringe used to extract the urine sample from the insert pad into the specimen container.
Squeeze a nappy
- Final option is to just squeeze a nappy/ incontinence pants. I know that sounds crazy, but if you cannot use an insert pad or your loved one with dementia refuses them but accepts wearing a nappy then you could try this. This was recommended by our District Nurse, and studies in infants have shown it to be successful collection method. However, this method is more likely to show contaminants so last resort option.
Use a separate container
- to catch the urine sample especially if the one supplied by your GP has a preservative in it. This should reduce contamination from contact with the container against the skin. By that I mean, catch the urine in one container and then pour it into the specimen container provided. Don’t try to catch the urine directly into the specimen container.
FAQ’s
Finally, always use positive encouragement, not negative comments. If someone with dementia cannot provide a sample, then just let it go. At the end of the day, if you suspect a UTI and cannot get a sample, explain that to the doctor.
You know your loved one best if they show symptoms of a UTI; your doctor needs to react to that. Be confident, not aggressive, your both looking out for the health of your loved one, and if they’re an excellent GP, they should be able to prescribe medication or assess your loved one. If they don’t, ask for a second opinion!
Thank you for your words of wisdom, i look after my mother who is 89 bed ridden and incontinent, she has had a string of uti’s in the 12 months, urine tests blood tests ct’s you name it they have done it, they have done every test they can on her to say she is old there isnt anymore they can do this is what happens when people get old and deteriorate or maybe you should consider residential care, she has recently come out of respite which was good for both of us but i could never let her go there full time.. your information on we know our loved ones is so correct i felt so much better after just reading it, we do we are around them constantly we feed them, wash them change, sort their medications put them to bed wake them up everything they need we do, it annoys me that I get looked like I’m crazy because i choose to help my mum and not put her in a home to be forgotten about !!
I’m so glad to hear you found the post helpful. I totally understand your situation, getting written off due to age or dementia is a bugbear of mine. It is hard to push for support especially when you know something is wrong. If your mum is getting recurrent UTI, ask your doctor about other treatments, preventions like cranberry, D-Mannose etc whether something like that would be suitable given your mum’s health condition, between you and the doctor knowing your mum’s health they may be able to look outside of the normal responses.
I know it’s a hard choice for many on whether to choose a care home for our loved ones, sometimes you don’t have a choice where distance, or care needs can only be met at a care home. It doesn’t make you any less of a caregiver to do that or to look after someone at home. It is obviously harder and more of a burden on home caregivers especially if you don’t have help. I hope that you have personal carers to help you care for your mum, and glad to read that you both got some respite from each other, that does make a massive difference. Thank you for sharing your own story I hope your mum’s UTI reduce and that your both cared for by loved ones as well.