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My grandfather is 92 and has vascular dementia. He's been incontinent for over a year but mostly he would poop in the toilet on his own. In the last 3-4 months though, he has started pooping his pants almost every time he goes. He only goes once he smells it and I can't tell if he's just being lazy, or is completely unaware that he's soiled himself. Because he has stated in plain English that he won't get up to change his diaper if its just urine. Lol I love my grandpa.

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As JoAnn said, they can lose the sensation of the need to go or that they have gone. My mom also lost the ability to make herself go when she was on the toilet, even though she wanted to try because I asked her to.
IMO the best you can hope for is to catch it some of the time, so make it routine to detour to the toilet every time he is up on his feet.
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Someone with dementia really can’t fairly be expected to be consistent or able to predict bodily reactions consistently.

If you are his primary caregiver, does he go into the toilet when you ask him to?
If you take his arm and say “Let’s go in and use the toilet” will he cooperate, go with you and sit on the toilet?

If he will, you can try him on a schedule, toileting every 2 hours, more or less often if you can observe a pattern to his needs and habits with the toilet?

Once the diagnosis has been established, I’m not personally comfortable accusing someone of being “lazy”, especially if they’re 92 (or above!)
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Its part of the desease. No, they are not aware they have gone. Brain doesn't send messages anymore. Muscles don't work anymore. I suggest u try to figure out when he is likely to go. Sort of like potty training a child. If its morning, put him on when he first gets up. After a meal? Take him every 2 hours.
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