Over the past several years, as I consult to care homes across the UK, I have observed elderly gentlemen patrolling a given area of their care home, and occasionally urinating along the walls, or in objects, in that same area. The staff see it as a continence issue and a ‘wandering’ pattern. Recently I witnessed two elderly men having a heated argument when one man tried to walk into the other’s patrolled area. The light bulb shone in my brain: is this a primitive territorial issue?
I asked five care homes to assist me on a project. Monitor the patrolling pattern of male residents and ascertain if they had a ‘territory’, document on the continence issues with these gents and also observe interaction with other residents in the patrolled area. After four months the results are in and a clear picture is presented. One that will not surprise anyone working in the care home setting. Here are the findings:
Mobile, dominant personality, males, take an area that will become their ‘territory’. These areas were 78% corridors,12% entrance/lobby 5% lounge, 3% entire care home, and 2% a outdoor space [garden/patio]
The area was patrolled on a constant basis when male resident was awake.
Urination to mark the area was present in 68% of the study group. Other marking rituals were drawing on walls, placing own items along the patrolled area, and spitting on walls.
Aggression was shown to ‘intruders’ to the territory, especially if intruder was male.
Territory was ‘policed’; elderly male on patrol would attempt to move staff on if they were in area, would push linen/housekeeping carts out of the way, did not like people standing and socializing in the area.
Female residents deferred to the territorial male and offered gifts. Gifts ranged from food items to the females underwear.
If patrolling was occurring in a hallway, the females who had rooms in patrolled area appeared calmer and slept on average an hour longer at night, then females in ‘unpatrolled’ areas. Often ladies would voice that they liked knowing the gentleman was ‘keeping them safe’.
Interesting that the female resident’s were benefiting from the patrolling! Staff often see the urination issue as a ‘challenging behavior’ but fail to look for positive outcomes that may also be occurring.
Obviously we want to encourage patrolling but mitigate the issue with urination. Some care homes had instituted plans which focused solely on the territorial males bladder routine but this approach was failing. The main point here is; the urination is marking and has no relation to toileting. Once staff recognized the difference in purpose; interventions altered.
Placing urinals along the patrolled area; in window sills, on handrails, on tables, making access to an appropriate object in which to urinate. This approached decreased urinating on wall or on floor by 37%. Adding a red circle to the wall/window/table to note the position of the urinal was also attempted and did increase use of the urinal by 10%.
Use of a planter, lined with cat liter and soil, placed in the patrol area and offered as an alternative place to urinate saw a decrease in wall/floor urination by 47%.
Removing the toilet door, if a toilet was on the patrol route, and substitution of a red curtain was attempted by one care home. They reported that the male did not increase his use of the toilet albeit that the toilet was more visible to him.
Allowing the male resident to place his items in the hallway such as putting his photographs on the walls of the patrolled area, saw a decrease in wall/floor urination of only 8%.
Giving the male a spray bottle of water as a substitute saw no decrease in wall/floor urination.
I do intend to continue this study for the foreseeable future and will report any findings that are remarkable. In the interim; I would suggest that if you do have a territorial male patrolling an area in your care home that you encourage him to do so, as it benefits other resident’s, and focus on interventions to assist marking in alternative, more acceptable ways versus looking at incontinence as the issue.