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Urinary tract infections (UTIs) can cause a lot of trouble – more than you might think. For people living with dementia, something as simple as collecting a urine sample can be a challenge for any number of reasons.

To put it in perspective, in just the general geriatric population, UTIs are responsible for 25% of all geriatric hospitalizations. These infections can sometimes present as delirium, with a sudden change in behavior being the only symptom. Even though your loved one is experiencing cognitive decline, their decline should never be sudden. Sudden, significant onset of anxiety, anger, or even fatigue is enough reason to visit your doctor.

People with dementia are at higher risk for UTIs due to incontinence, poor bathing habits, dehydration, and a host of chronic health issues, from kidney to heart-related diagnoses.

UTI symptoms include:

• Discolored or cloudy urine
• Odorous urine
• Pain with urination (may present as your loved one not wanting to use the restroom or having a pained expression while urinating)
• Increased urination
• Increased urgency even when not much urine is expressed (may present as your loved one walking to the bathroom repeatedly without using it)
• Fever
• Significant changes in cognitive functioning or behavior

If you suspect a UTI, you will need to collect a urine sample. The dreaded urine sample! So many families express frustration and are not sure how to get a urine sample. They try for hours, or even days.

Perhaps your loved one does not understand what is happening. They could be embarrassed about undressing and their need for assistance in the restroom. Perhaps it’s as simple as they do not need to use the restroom and are frustrated because they cannot communicate that with you. It is normal to have “stage fright” when asked to urinate at a certain time and in a certain way. If you think about it, urination is not usually something demanded of you at any time by anyone, much less in a strange environment like a doctor’s office.

Tips for Getting a Urine Sample

Try a more familiar setting.

Unless your loved one has a track record of being agreeable to tasks like this in a medical setting, collecting a urine sample in a doctor’s office will be a lost battle. Save your loved one and yourself some frustration. Ask the doctor to let you take the cup home and bring it back to the office for testing. A comfortable, familiar setting will increase the chances of success and decrease anxiety for your loved one.

Work it into the normal routine.

Think about when your loved one usually uses the restroom throughout the day. It is best to stick to their natural timetable rather than rushing them. Asking them to go to the restroom repeatedly in a short time frame will increase frustration. Stay calm and patient, so they don’t have added anxiety about the situation.

Place a nun’s cap in the toilet when your loved one is not watching.

Suggested supplies:
Nun’s cap (urine hat collection device)
Sterile container or jar to collect the sample
Gloves
Towel to wipe up spills

Place the nun’s cap on the toilet, as instructed by the particular kind you purchase. Do not mention the cap or try to explain it to your loved one. Your success rate will be best if you act like nothing is different in the restroom. After your loved one has used the restroom, collect the urine in a sterile container or jar. You can get a nun’s cap online or at most well-stocked pharmacies. Search for “urine hat collection” online. Here is one on Amazon.

This method might not be successful if your loved one notices the nun’s cap. At times, your loved one may see it and refuse to use the restroom because they cannot understand. However, if they are used to your assistance in the restroom, you may be able to distract them. Try speaking to them about something else the entire time to keep them engaged with you and not thinking about what is different.

If the nun’s cap doesn’t work, try plastic wrap.

Suggested supplies:
Plastic wrap
Sterile container or jar to collect the sample
Gloves
Scissors
Towel to wipe up spills

You probably already have plastic wrap in your kitchen. Plastic wrap can work well because it is see-through and easy to mold to shape. Again, this should be done without your loved one seeing what you are doing. You may need to close the door and run water to hide the sound when you set up.

Place the toilet seat up. Eyeball the width of your toilet and cut strips of plastic wrap that are wide enough to cover the toilet bowl from left to right (or top to bottom, whichever you prefer) with slack in the middle to create a bowl shape. Cut enough strips to cover the entire bowl in two layers.

Wrap your first strip around one side of the bowl and stretch to the other side loosely to form a shallow bowl shape. Affix it securely to the other side. Keep doing this until you have a shallow bowl formed from plastic wrap that completely covers the toilet bowl. Repeat to make a second layer.

Put the toilet seat down and wait. Once the urine is left in the toilet, get your sterile cup or container. Very gently unwrap the edges of the Saran wrap, systematically pulling the edges equally on both sides so you do not spill urine into the toilet. Gather all the edges together to make a sack. Bring the sack to where it is hanging directly above your open collection container. Use scissors to carefully make a small cut, so the urine flows into the cup from the sack. Gloves and a towel can be helpful in case you spill any.

Take the sample for testing ASAP!

Some important things to keep in mind about urine samples:

• The general guideline is that room temperature urine is only good for testing within 2 hours of collection or test results could be inaccurate.
• If you need to wait longer than 2 hours to take the urine to the doctor’s office, refrigerate it! Urine should not be refrigerated for longer than 24 hours.
• Keep your doctor’s office hours in mind when obtaining a sample.

If all else fails and your loved one attends an adult day program or facility, ask if the staff can help you with collecting a sample. If they cannot help, they may still have some helpful insight into your loved one’s bathroom routine during the day.

If this is something you have struggled with, you are not alone. UTIs are a common struggle. Be proactive and have a plan for when you are faced with this challenge so that you can reduce stress and get your loved one the medical care they need.

Written by Katie Fowler, RN