When the idea of using an adult diaper was first suggested to Narendra Mishra, now 75, his instant reaction was outright rejection. “Do you want to shame me? Am I so helpless? Is my life a burden?” he remembers asking his son.
Seven years ago, when the suggestion was first made, Mishra had no alarming health concerns. But a persistently low blood pressure made him dizzy if he got up suddenly, and chronic knee pain made walking to the toilet onerous. Nights were particularly challenging.
In a country where social conditioning has led us to believe that a marker of being a grown-up is the ability to control bowel urges, and to clean up after oneself, Mishra’s concern was not misplaced.
Dr Abhishek Shukla, senior geriatric physician who established Uttar Pradesh’s first and only dedicated elderly care facility, Aastha Geriatric Hospital and Hospice in Lucknow, said a number of psychosocial reasons stood in the way of diaper acceptance. “As we age, there is natural functional decline in our five essential organs―heart, lung, liver, kidney and brain. This becomes difficult to accept as our conversations around healthy and graceful ageing are still nascent. There is an urgent need for seminars, awareness building and the like,” Shukla said.
While incontinence, he said, could be age-related (for instance, the outcome of a natural weakening of the bladder and pelvic floor muscles), it could also result from a completely different cause such as hypocalcemia (too little calcium in blood), which when corrected would reverse the incontinence.
Dr Abhishek Shukla | Pawan Kumar
Incontinence itself can be either urge- or stress-induced. The first is when a person feels the need to use the toilet immediately; the second is caused by pressure on abdominal muscles. “For persons who are at the end of their life, the use of diapers becomes non-negotiable. For others, whose senses are functioning, acceptance is a great challenge, for they perceive it as an assault on their dignity and self-respect,” said Shukla.
Then there is incontinence that is not age-specific, caused by injuries or illness. As Shukla explained this, a patient walked into his chamber. When asked if he would ever consider using a diaper, the patient said he never would. “It is a psychological sign that I am becoming feeble and helpless. It is better to die than continue like this,” said the patient.
Ujjwala Shanker is the sole caregiver to her 88-year-old father and 76-year-old mother. The former has Alzheimer’s disease while the latter lost a majority of her senses after a brain surgery in 2020. The decision to begin using diapers was not an easy one. Shanker initially tried seating her parents on a commode every couple of hours, but when their physical frailty made this challenging, the shift to diapers was made.
For a couple of years, Shanker herself changed her mother’s diapers, sometimes every two hours at night. (She employed an attendant for her father.) It took a toll on her―she was permanently sleep deprived and unable to focus on the school and enterprise she runs. She became, in her words, a “zombie”. She now has two attendants to look after her parents round the clock, and spends Rs35,000 to Rs40,000 every month to care for her parents.
“I have very rarely had patients who are willing to use diapers, even for the off chance that they might sometimes soil themselves,” said Shrikant Srivastava, professor of geriatric psychiatry at King George’s Medical University, Lucknow. According to him, a major mental block is that people are conditioned to not let poop stick to the skin. “This habit is ingrained, and diapers feel unnatural,” he said. There is also the embarrassment of foul smell, and often lying for long hours in one’s own refuse if help is not readily available.
Research says it takes almost a year and a half for adults to accept diaper use. The various stages in this journey include denial, concealment, rejection and reluctance.
Thus, diaper manufacturers have to look beyond business. Said Kartik Johari, vice president of marketing and commerce at Nobel Hygiene, India’s largest manufacturer of disposable hygiene products: “We are not in the business of just creating quality products. Our goal is to consistently empathise with all our users, listen to them, and create products that may solve key issues they face. Our marketing strategy has been more about educating users, and de-stigmatising adult diapers.”
Nobel Hygiene has named its adult diapers ‘Friends’, underscoring the concept that these are not clunky products to be ashamed of, but ones that support quality living―much like a compassionate companion would.
Nobel launched its adult diapers in 1999, and later the country’s first pants-style adult diaper, and kept churning out innovations that include antibacterial absorbent gel that prevents urinary tract and related infections; odour-lock technology that controls release of foul smells; ultra-slim designs that are not revealing when dressed; and fibre waistbands for better fit and elasticity.
Yet, uptake remains slow.
Mishra, for instance, took more than five years to accept the pants-style diapers he now uses. “I have greater freedom to move about, and even go to the cinema with my grandchildren,” he said. “To be young and in control was wonderful; but now, I accept myself as I am.”