My DH with AZ is recently incontinent and not cooperative when it comes to changing urine soaked undergarments (Tranquility pull-ons). It is an ordeal for us both that needs to be done each morning and night and at least once during the day. He is ambulatory but requires my assistance with changing and fights the process nearly every time. Respecting his personal space, I have tried “talking” him through each step to pull down his sweat pants, then his pull-ons, and step out of both, but he won’t/can’t follow the steps independently. I have to initiate the process and then he rebels. Once the soiled items are off, he is cooperative with putting on the clean dry pull-ons and sweats. I remark how fresh he looks and how good he must feel after each change. Then, I ask for a hug that he generally reciprocates so we can get our usual caring relationship back on track until the next time…… He has needed and accepted my help with clothing changes even before he became incontinent. At that time however, he would pull down his underwear on his own but still needed my help with putting clean ones and his sweats on over his feet. Even seated, he cannot bend over far enough to reach his feet.
I suggest making it as routine as possible. The morning and evening are the easiest to start with, but a mid-day routine of going potty and changing the pull-ups (whether they need changing or not) is also very doable.
Try very hard not explain and/or argue about it. Keep the words to a minimum and simply hold out your hand, make eye contact, and say something like "Lets go to the bathroom." No more explanation than that! He will see the love in your eyes, so just wait for him to take your hand and lead him to the bathroom. Make it a routine to take everything off below the waist for every #1 or #2 and put on a new pull-up every time. I know this is kind of wasteful, so it would be o.k. to put back on a clean pull-up, but take it completely off every time.
If he wants to do it himself, but can't reach all the way down to his feet, then pull the garments up to his thighs, and let him do the rest. He'll feel much better about himself if he can do it himself, so learn his limitations and only help to the point where he can take over.
This all worked for me and my mom, but every relationship is different, so the exact methods will be different for you. However, I do think that these three points apply to anyone helping someone with advanced dementia:
(1) Routine, routine, routine.
(2) No arguing, convincing, or explaining.
(3) Be a guide not an orator. Keep words to a minimum and use hand gestures and facial expressions.
Best of luck!
Hoping others will have solutions for you.
I recall that as her dementia progressed, my LO was not able to move her limbs to do much of anything. The signal from the brain no longer worked, so, that she would be trying to move herself into a car, but, her feet and legs would not cooperate. It would take a half hour just to get her from her wheelchair to sit in the car seat. There was a disconnect between the brain and the limbs. I know that when they changed her diapers at MC, she laid down on the bed.