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.
- 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.
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!