My mother has begun to have screaming tantrums when it is time to have her diaper changed. Any suggestions?

My 101 year old mother has dementia and tries to bite me, kick me and the caregiver and generally has a fit whenever we change her. I have tried holding her hands, soothing music, singing, talking quietly, explaining that we can't let her sit in dirty underwear; nothing works, so we just have to proceed and get it done without her cooperation. Afterwards, she is fine again.

I find that when changing mom's diapers, she gets so scared that she doesn't even recognize me. She feels attacked or potentially in danger of being raped. The fear takes over her brain, and I just have to carry through until it's done. It's very challenging to find caregivers who can handle that part. Most don't want to do any hard work.
I also find that if I change the subject with her and engage her mind with something completely different while asking questions, it does somewhat help. Good luck.

When in my mid 50's and my incontinence returned and several talks with my wife who insisted that diapers were the way to go and save on sheets.I was not easy to convince grown man back in diapers the male ego hit rock bottom.I finally gave in that was 30+ yrs ago.She was right.

My elderly aunt who was in my care tried getting her way by fussing about diaper changes. The nurses were very upset with her and she was throwing everything within reach at them. So, I took a different approach. I made humorous comments, got her laughing and she finally gave in.
I said, well, I guess you like sitting in your smelly pants! Then I made up a song (a little ditty) about it and sang it over and over again until she was singing it. "Here I sit, attracting ants while sitting in my smelly pants". I had my aunt laughing so hard, she could not be angry. The nurses were in disbelief as they returned to her room. She then allowed them to clean her up and change her. The nurses used that technique over and over again and there were no more problems changing her diaper.

My elderly aunt who was in my care tried getting her way by fussing about diaper changes. The nurses were very upset with her and she was throwing everything within reach at them. So, I took a different approach. I made humorous comments, got her laughing and she finally gave in.
I said, well, I guess you like sitting in your smelly pants! Then I made up a song (a little ditty) about it and sang it over and over again until she was singing it. "Here I sit, attracting ants while sitting in my smelly pants". I had my aunt laughing so hard, she could not be angry. The nurses were in disbelief as they returned to her room. She then allowed them to clean her up and change her. The nurses used that technique over and over again and there were no more problems changing her diaper.

first GOD Bless U for CARING!!!! 2nd ask the one GREAT aide to show the others how to do it!!!!!!!! Also find a treat ice cream ,,,,,,,that your mom loves and after changing the diaper she gets the TREAT! BE VERY VERY CAREFUL OF YOUR MOM GETTING SEPSIS FROM NOT GETTING THE CHANGING IMMEDIATELY!!!! That killed my mother!!!!

I've had many homecare clients who would go into a rip-roaring tantrum about having their diaper changed. When it came to personal hygiene work like showering, washing up, wiping them, or changing the diapers, I am always very careful to never say things like, 'I have to change you now'. I always leave the 'I' out because it gives the person needing the diaper change a sense of control in the situation too. Like the two of you are getting this done together and that it can't get done without the client's help. When there would be fussiness starting up about changing a diaper I always just speak plainly. 'It smells like sh** in here. We need to go and get cleaned up now'. This always worked for me when the client is generally being ornery and fussy about getting changed. There has to be a different approach when they're being aggressive and they're having a real tantrum. Sometimes you have to give them a drill sergeant yell in their face. This will immediately put the brakes on any tantrum about getting changed. It sounds harsh and it is, but leaving someone sitting in their own mess is by far more harsh and cruel. A yell in the face and a bit of a scare is a lot easier to recover from then skin breakdown, sores, and urinary tract infections that will happen when a person is incontinent and not cleaned up and changed immediately. When you're the aide in a client's house alone and their ass needs wiping or their diaper needs changing there is no place for someone who is emotionally fragile. Sometimes it is literally a battle to get the job done. I've been called every name in the book from A to Z by clients not wanting to get changed or cleaned up. I've had clients try to hit, kick, and even try to bite me when it came time for hygiene care. Only the first few times going to a new job. When I became familiar to a client the really bad tantrums would stop because they knew one way or the other, that diaper was getting changed and they were getting washed up. The swearing and name-calling would still go on, but not as much. I had one client and old woman who was the meanest, most vicious person you could imagine. She'd really rip into me when it was time to for a diaper change. I'd give it right back to her. It got to a point when the swearing and name-calling between us actually turned into a sort of comedy routine and we'd both be laughing like hell. You have to do what it takes to get the sensitive work done, but you cannot be sensitive yourself in getting it done.

Your mother will care once her skin is eaten away from the urine and bowel movements. It gets as red as a tomato and weeps. Poor dear.
Is she embarrassed? Is her privacy insured? Could you give her a reward for completing the task without screaming? Does she like baby dolls? Could she change the dolls diaper ( we call them briefs) while the aids change hers. Does she respect her doctor? Could he tell her she’s misbehaving and these aids are his personal friends and she’s mistreating them! Mean spirited but a possibility. Could she do it herself and make a mess out of the effort and seek help? Would a small glass of wine before or after help the situation. Intimidation and shame? What would your ( pick a relative her father, mother, or husband ) think if they knew you’d rather stink than change your brief!!! Leave her alone, (but keep an eye on her) until she calls the aid back?
Or tell her she will have to sit in the hall til the principal comes. Thought I’d end on a lighter note. Good luck.
mom

I would not tolerate this behavior from your mother, regardless of what is wrong with her or why she does it. I would be firm and tell her the diaper is going to be changed NOW and she has no choice and do it. If you can find people who are tough enough to do this, then get them to take care of her. If all fails, I think you know the time has come to put her somewhere where she will be made to abide by the rules. She has no right to upset everyone and cause so many problems. Either take full control of her and tell her that her behavior must cease at once or there will be severe consequences - and be prepared to follow through. She cannot get away with this - no way.

Have read many responses and skimmed others - I see a lot of good suggestions, but the first thing I would note is for everyone not to call them diapers. Briefs or anything else is better. "Diapers" can demean the whole process from the get go.
(This may have been mentioned by others - if so, apologies for the redundancy!)

And all that aside, bless you for all you struggle through for her. I also have a difficult mom (most of the time), as I'm sure many of us do - caregiving is not for sissies! But when I am at my most frustrated, I try to think how frustrated she must be, and I realize I have the easier role.

Hugs to all!!

Perhaps your mom needs more medication.
Perhaps try some classical music during this time (before the time to change to relax her) - I see someone just below mentioned this.
Can you comfort her by touching her hair ? face ?
I wonder if your mom thinks someone is going to hurt her? We may never know what her motivations are to resist.
I do not have personal experience with refusal although I don't think there is 'one size fits all' in these situations.

It is difficult when care providers are 'good' in some areas and inexperienced or unable to manage situations when these behaviors erupt. It certainly is not easy for anyone. And, as your mom's behavior increases, you may need to hire others / let go of the caregivers you've had for a while. It is a progressive disease and changes have to be made to accommodate your mom's needs. I know you know this. It is just really hard. Gena.

Your mom is probably feeling humiliated/frustrated/insecure/
useless/like a burden and she is acting out because she can’t communicate those emotions. Or is it possible that she has painful sores? (Try Desitin or other diaper creams). Was she ever sexually assaulted and perhaps drawing some type of connection and feeling violated, but not able to communicate or even realize this?

Try both reassurance and distractions. Tell her she is loved and everything is okay. Hug her. Ask her advice or opinion to make her feel useful and needed. Distract her with her favorite music or TV. Give her something to look at during the change / something else to focus on. A postcard or photo to hold (ask questions about it during the change). Some other distraction from her era/past hobbies/interests? What other distractions does she like? Give her some kind of “treat” she likes when she’s done. Make this as spa like as possible. Diaper and fingernail polish change? Diaper and shoulder massage? Change it up so she doesn’t develop a negative association with something she loves.

This may be a “phase” and once she feels more comfortable, she may stop.

How about having the one aide who handles her better come on a day when the others are there so she can show them how she does it.

Mom has the others bluffed for now. She screams and they back off. You need the General!!! (and I'm not talking about General car insurance!!)

A neighbor had the same issue going on. Mom would dirty diaper on purpose as soon as one aide showed up to work. Demand to be cleaned up in the bed and making the woman do all of the lifting. Just dead weight laying there. The other aid shows up and says stand up, cleans her up, changes the linens and it's done. First lady was just too nice and was terribly afraid to make the patient mad so she caved to her every whim.

Maybe a bidet attachment on the toilet would make this less traumatic for your mother. She may feel like she is being violated. Other countries use bidets as their usual way of cleaning the perineum after bowel movements.

Maybe consider a warm, spray bottle to rinse off her bottom with every diaper change to cleanse urine and bm off. Start with a clear water one to rinse off most offending substances. Use a warm soapy one to cleanse more thoroughly. End with another warm, clear water rinse to get soap off. pat dry and put on a new diaper. Of course, this one is trickier to manage with more water being involved.

If your mother is usually difficult to manage, she may benefit from a mild anti-anxiety agent. This may only be needed during the daytime or in the evenings if she tends to get Sundowner's Syndrome.

Imho, it will probably do no good to rationalize with your mother, as you already know. The aide that gets the job done is exceptional. Prayers sent.

Agression and agitation can be part of the aging process in people with dementia/alzheimers. Is she just having tantrums at changing time, or does it happen at other times as well or a particular time of day or week?

When was the last time she was seen by a doc? She may need an appt to be seen for pain, an update on meds, arthritis, etc. These are just things to consider. She might not be due for an appt. As for anxiety meds no one said to give her one before every brief change. That would be too much in a day. They might give some in the afternoon or lunch so she can get thru the day and doesn't have sundown-ing. Doctors don't throw meds at residents either. Their medical needs are considered. She may not even need that. These are just things to consider as well.. She may just need redirection and calming and quiet at a change.
You just have to see what works. Good luck.

Sometimes my mom, who has alzheimer's, isn't always cooperative when it come time to change her diapers or give her a bath. Used to be this only happened with the PSW's who she didn't know, but now it occassionally happens with me because she doesn't always remember who I am. At times, she'll scream, cry, hold on to the clothing/diaper or even squeeze her legs shut so you can't take off/put on the diaper much less clean her.

At first when this started with the PSW's I was alarmed and thought they were hurting her but then it started with me and I realized they, like me, weren't doing anything and the screaming/crying/difficult behaviour was just her way of expressing her displeasure. No abuse was happening but to anyone listening on, they would think she was being murdered (smile).

One PSW works through the tears and difficult behaviours - pushes through and gets the job done. The other PSW doesn't - she gives up at the slightest resistance. I think she is afraid of hurting her and also, she doesn't want anyone whose hearing the commotion to think she's hurting her. Remember their job is on the line and the last thing they want is to be accused of being abusive.

For my mom, I try to put myself in her shoes. She doesn't think anything is wrong with her, she things she can walk when she is bedridden and hasn't walked in over a year. She also doesn't always remember or recognize the PSW's, even though they are there everyday, or me for that matter.

Imagine you're sleeping/resting comfortably and some strange person comes into your room and immediately tries to take off your clothes/your diaper..... or tells you that you've had a bowel movement or pee'd and they have to clean you up......wouldn't you know if you did (and in your mind you haven't), further more why would you do that in bed when you can just get up and use the toilet like a normal person..........I'd be thinking what the hell, I'd be screaming and crying too (smile).

What works for me most times is the appoach..... I start with a little converstation, see where she's at mentally, begin with something not too intrusive like massaging her scalp or brushing her hair.... then I move in for the kill..... why don't I wash your hair with this soothing shampoo..... or instead of saying it's time to reposition you so you don't get pressure sores (what the hell is a pressure soar and why would I get them) I say why don't you turn over so you can see me and we can talk......in the midst of repositioning mention I notice the diaper needs changing and will do that for her quickly. I work my way up to diaper changes, maybe give her the diaper or wipes to hold and ask her to help me.....

I find the direct approach doesn't work sometime because she genuinely doesn't think there is a problem and what needs to be done, has to be done.

With medication, I stopped telling her I'm giving it to her because then she asks what it's for and I have to explain all the aliments she has that she doen't know she has. That confuses her because in her mind she is not sick. I just crush them up and put them in her juice or tell her they are vitamins.

It's hit or miss... some days this all works other days it's a no go. For me, what works best is never rush. Sometimes the PSW's just want to get in and get the job done, since they have other clients and are working with time. Work your way up to the tasks they find unpleasant or too intrusive, timing is everything. Make note of their mood and that will give you an idea of where to go. Be chirppy and pleasant always even when you're stressed - pretend. Talk....let them know what you're going to do, doing as you do it.

Hope this helps. Good luck and best always.

I know that most aides and NH places deal with screaming fits when getting diapers changed.  it could be that she feels the cold air after having the warm adult diaper being taken off.  OR maybe she is stiff and hurts when they go to move her.  I know my dad (while in NH) would sometimes get mad and holler (and he could holler) , but he was wheelchair bound and I am sure that he joints were stiff when being moved around to take off the adult diaper.  maybe the aides can ask your mother questions about what she did when she was younger, what type of job did she have, did she have pets, etc.......something to keep her mind occupied while they change her.  wishing you luck.

You didn't give many details about your mother so for the sake of this discussion I'm going to assume she has a touch of dementia.

There may be several reasons why your mother screams at being changed. First as pointed out by others, the word "diaper" is inappropriate for adults. It is degrading and demoralizing. Pick another word and instruct your caregivers to use that word, period.

It is upsetting to see some of the comments above about getting caregivers to "push through", "bull through" etc. and making sure you have caregivers that will do it. Those tactics are unproductive and bullying or medicating an adult to change a brief without exhausting every other remedy could be considered mistreatment/abuse depending on the tactics used. Additionally, not sure what kind of memory unit had screaming residents when they were being changed but how horrible that we allow such treatment of our seniors.

The primary external cause of agitation and behavior is caregiver approach. Others have mentioned abuse, pain, privacy and good calming approaches and music. I hope you will insist on caregivers that are empathetic, trained in Validation techniques and who understand that behavior is a form of communication.

Your caregivers should be looking for the unmet need that causes her behavior. Even if she knew the reason she probably couldn't tell you. Is she in pain, afraid of falling as she sits on the toilet, difficulty in bending knees to sit. Was she sexually abused, teased as a child, she feels exposed, is it painful to urinate, etc. It wasn't her idea, she'd rather do what she was doing instead of being interrupted for a brief change, her dignity and privacy are being mishandled? She resents loosing her independence, she hates her caregiver, she hates being bossed around, ..... just a few thoughts and there are many more.

The caregiver needs to gain her trust. Toileting should begin with a quiet suggestion in her "language." What terms does she use; pee, poop, bathroom, freshen up, toilet, sandbox, tinkle, etc. "Looks like it might be time to....." "Before we have dinner, snack, (whatever) let's stop by the bathroom. "I almost forgot, you probably need to (her word) . So sorry, I can help you now. "I don't need help" Of course you don't. I'll be there just in case. Does she want to be in charge, such as wiping with toilet paper, then the caregiver can finish with a wipe, assuring her that she did a good job, "just a little touch here and you're good to go" Patience and a sense of humor are essential. If the first idea doesn't work, try another one.

Please remember that these individuals aren't children that can be pushed around. They are individuals who still have feelings, needs, and rights. It is our job to preserve their dignity, self esteem and to be the detectives and voice they need so they can receive the best possible care. It isn't a contest of wills, we don't have to be right, we are not the boss. We can skillfully get them to do what is needed for their care using the right approach.

No one said it is an easy job but done right, it is one of the most rewarding jobs you can have.

I had this same situation with my 93-year-old mom who had dementia. Sometimes she was receptive to the change, sometimes not. I urge you to proceed cautiously. I had one aide who was very competent, but bound and determined and sometimes she really made matters worse by her insistence to change my mom. Yes, I understand UTIs and everything, but you have to keep in mind the needs, feelings, and fears of the individual as well.

Sometimes bribery would work. "How about if we have some juice after we get this taken care of," "OK, how about if I give you 10 minutes and then we'll do it." Sometimes distraction...just chatting as you make the change. As someone else suggested, maybe music. Bottom line: Don't do any thing that will just make the situation worse and escalate things, and please, please, be sensitive and do not use words like "diaper" and "wet the bed" and phrasings that will make your loved one feel mortified and embarrassed. Best wishes!

My advice is to try to draw her out, to listen to what feelings she has, related to the necessity of wearing "depends" and having them changed. Could be shame mortification, anger, for my mother it was a profound feeling of embarrassment as she was a very private person, and did not want all those strangers seeing her bottom. Paying more attention to privacy helped. also I noticed the really good aides never called them "diapers" they always called them depends no matter what brand they were. You might call them "protection" or "time to change your protective panties!" If your mother is experiencing dementia then other techniques might work, like for instance standing her up at her walker, and saying "now you just watch your favorite show, while I get you all clean and fresh as a daisy" and reassuring encouragement like " this is only going to take another minute!". some people experience being laid down on their back as a violation or reminds them of sexual imposition past trauma.
Also different styles of coverings are important, for example use scissors to cut the sides so you can bring the old one off cleanly and quickly, and don't use the panty style that she has to step into. as they feel very wobbly and vulnerable trying to step one foot into pants. have a heating pad nearby, so the washcloths or disposable wipes are warm and enjoyable, not cold and shocking, and that the air in the room is warm enough or have a nice little space heater blowing on her. Use music, for mood and distraction. . And establish a pattern with it, for example "every time I turn this music box on, we are going to freshen you up, just the way they do the Queen of England!" Consistency is helpful, and reduces opposition. Also a reward directly after... Like "after you are freshened up that's when you get a spritz of your favorite perfume," or "a cookie" or... A small peice of her favorite old time candy. I found creme stick candy in a candy store of a local historical farm, and wow it took mom back to happy childhood memories... I hope some of these are helpful.

I think one person stated this already. Music. Put on the CD and sing. Dance goofy. A good song from her era or Christmas music from that era. Big band was a hit at the nursing home and Sinatra. It might work. Music brings back pos memories and promotes positive thoughts. That might distract her. Sing and smile at her. Worth a shot.
Also heat the wet wipes. No one and I mean no one wants very cold and clammy wipes on their bottom. That could be enuff to set anyone off. They are microwaveable. Just check temp b4 using. That could be the culprit. Cold wipes are a shock to the system. Thats enuff to make anyone yell. Good luck

You answered your question. 'One aide handles the situation like a pro'. An elderly person shouldn't sit in their soil due to a frightened staff. Every person on your care team needs to be a pro. That's your first step. Speak to the crew, explain your needs and replace those who don't fill them. With their training and experience your professional staff should be guiding you thru most of the common hurdles. As part of a strong care team you can produce more & more compliance from your mom.
It took a little time but once I put together my super crew my old mom does the potty, bathing and grooming with milder resistance, less often. And milder resistance less often makes life much, much better!!

Im sorry that is happening to her and to you. That must be extremely distressing. Is she able to stand or is lying in bed?
Can someone distract her with an object, shiny toy, doll. stuffed bear, an object, something? Or even talk to her about something? I think an interesting object might be better help and a positive focus Even a child's toy that rattles, or moves might help. Only a couple bucks. They do that for children to distract them so they dont kick out, fidget etc when changing diapers. They get annoyed as well. Altho with adults its called briefs for dignity reasons. They know enuff when someone says time to change diapers. That could make them mad. Just a thought.

Do people make a production about changing her? Like saying ok Christine (i picked a random name) its time to change you, as they gather supplies and get ready. That might be enuff to set her off. Because it was announced, and then it takes a min or 2 to gather supplies, and she has time to think about it and react. Maybe gather supplies first or have them near her, not saying anything. Then quietly do it? It might help, it might make things worse. You'll have to try diff methods to see what works. Maybe say - after your clean, we shall have lunch, snack time? Discuss the yummy food she will have. Maybe she will focus on that. Might help, might do nothing.

Id also call doc. She might need anxiety med. Now its not to drug her, its to help her with her anxiety. We want the senior to be calm and happy. They shouldn't be distressed and upset and miserable. Not multiple times a day. Remember their brain is not functioning properly. So what would be an annoyance could now provoked great anxiety.

Id also see if she is doing it with 1 person but not another, just in case. 1 person might be rougher with her to get it over with. It could be something/nothing. She might not like the way it is done with that person. Or their underlying annoyance with having to do it while she is getting anxious.. She could pick up on that.

My dad had problems with 1 cna he detested.. That was so unlike him. big warning sign. Turned out it was something to be very concerned with. She was fired. She treated elderly like an object to be manhandled. An annoyance to be dealt with. Just something to consider. I never thought about that until I saw his reactions when she was near. Im glad I watched closely.

She could also understand that her privates are out and she wants modesty. Doesnt know how to voice that any more. Especially bc its a carer. A stranger.. You have to be a sleuth. It could be something, it could be nothing.

There was a lady at the nursing home that would easily get anxious and sound off for a long time.. very distressing to her & staff. Her family gave her a doll and a teddy bear, (switched out at different times so it seemed new) and she was very happy hugging it. Never heard a peep out of her, and people stopped to chat about her doll. She loved that and just beamed ear to ear. With guys it might be something with trains. That was huge when they were young.

It could also be that they are in pain when rolled onto their hip. The hip might have arthritis, bone spur etc. That might cause anxiety.. or just being rolled on their side might be scary. The anxiety med might help. Talk to doc. Good luck let us know what works.

My father had the same thing with tantrums while he had Dementia. We discovered that if we have him his medication first that he was much more cooperative. Have your mother checked out by a doctor ( if she has not been already ) and see what can be done.

Went through the same thing. We stopped calling it a diaper (it was demoralizing for my mom, made her feel like an infant). We now call them briefs and undergarments and no problems!

Maybe losing control of everything in her life, your mom has the need to hold own to at least one thing she is in control of which is saying when her diapers get changed.

UTHIS can happen from many causes and one just not drinking enough water.

UTHIS can be cured easily enough.

Tell the Caregiver to try just letting your mom know ahead of time when she needs to have her diapers changed but tell the Caregiver to tell the mom to let her know when she's ready.

Just use a good night time brand of diapers to keep the urine away from the skin.

UTI's can also happen from too much moisture and diapers leave no breathing or airing out.

You should have your mom lay on pads and not have a diaper on for a few to several hours a day so her private area can air out.

You didn’t say if your mom has dementia or not, so I cannot tell if your mom can talk to explain why she screams. My guess is that she does not like her private area touched by a stranger.

My husband has advanced dementia and cannot talk. He too screams when it is time to change his diaper. It does not matter who does it: the caregiver or me. He screams! And he is not bedridden yet, so putting a blanket over the area won’t work. I’d like to hear advice for those who can still sit on the toilet.

First off is there any possibility that someone abused her and that’s why she is started having the screaming tantrums. On to the changing, do they maintain her dignity in the process, putting a cover over her private area while in process of removing diaper (like you would for a baby boy). My grandma was embarrassed when hers was changed and we were in the room. She could be associating pain (uti) with diaper change and be fighting that. Lastly is there any part of the process that she could participate in that might make her feel somewhat in control of the process

Thank you, thank you, thank you, all of you kind people for responding to my problem! I'm dealing with a sudden influx of mice in her home at the moment, and that's why I haven't responded sooner... I will write more when I have this situation under control! Very, very best wishes to you all, xoxox