Tips For Caregivers: Management
Medications are available to calm an overactive bladder, if overactive bladder is the cause of the incontinence. But some have side effects that can make dementia worse. Talk with the doctor about options that apply to the person youre caring for. In some cases, where incontinence is caused by an underlying medical condition, treating the condition may help.
Stage : Mild Cognitive Impairment
Clear cognitive problems begin to manifest in stage 3. A few signs of stage 3 dementia include:
- Getting lost easily
- Noticeably poor performance at work
- Forgetting the names of family members and close friends
- Difficulty retaining information read in a book or passage
- Losing or misplacing important objects
- Difficulty concentrating
Patients often start to experience mild to moderate anxiety as these symptoms increasingly interfere with day to day life. Patients who may be in this stage of dementia are encouraged to have a clinical interview with a clinician for proper diagnosis.
Paranoia In Alzheimer’s Patients
“Paranoia is a misperception in their mind of an actual event occurring,” Rubinstein explains. Alzheimer’s caregivers shouldn’t argue, she suggests. Instead, look for a seed of truth. For example, if today’s accusation is that you stole a favorite item, and you actually do have a history of borrowing things, consider that there is some validity to your loved one’s feelings. “They need reassurance that everything is okay,” Rubinstein says. Instead of getting defensive when facing this Alzheimer’s symptom, apologize for “losing” the item and promise to replace it soon.
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Understanding The Impact Of Urinary Incontinence In Persons With Dementia: Development Of An Interdisciplinary Service Model
1Bristol Brain Centre, Southmead Hospital, Bristol, UK
2Bristol Urological Institute, Southmead Hospital, Bristol, UK
3University of Bristol, Bristol, UK
The psychological and socio-economic impact of urinary incontinence can be very burdensome for patients, families, and carers. These effects are magnified when dementia is also present. Dementia will affect over 1 million people in the UK by 2021 and the prevalence of concomitant urinary symptoms such as incontinence is estimated to exceed 50% . The prevalence is likely underestimated given that many are believed to not report it. Urinary incontinence , defined as the complaint of involuntary loss of urine, negatively affects quality of life . It is now widely recognised as a key risk factor and precipitant for premature admission to nursing home residency . Independent of any physical comorbidities, dementia is also a risk factor for hospital admission . However, despite the reality that bothersome urinary symptoms in this population represent a pressing research priority, as recognised by the World Health Organisation , such activity is lacking and available evidence to direct treatment pathways remains under-reported .
1.1. Action Plan for Implementing the Intervention
1.2. Services Offered
Bladder And To A Lesser Extent Bowel Problems Are More Common As We Get Older
They are not a normal feature of aging. However, having a dementia can make these problems more difficult to cope with and, as dementia progresses, new problems can occur. A person with Alzheimers disease may either leak pee by accident or have bowel accidents , or sometimes both may occur.
Our brain is very important in sending messages letting us know when our bladder or bowel needs to be emptied, but, with dementia, these messages might not be received. We may also lose the ability to recognize messages or understand what to do when these messages are received. Losing control over a bodily function can be degrading. It is also potentially embarrassing and difficult for both the person and care partner.
When incontinence happens Think about the possible reasons for the accident. These thoughts will guide how you might deal with or prevent incontinence from recurring. Keeping a diary of bladder or bowel habits can help to establish a pattern and can be very useful to health care providers in deciding if there is a treatable medical cause. Try also to remember that as the dementia progresses, accidents will happen regardless of your best efforts to prevent them.
Things to consider Many bladder or bowel problems can be treated, such as bladder infections, constipation, stress or urgency incontinence, and prostate problems which make bladder emptying difficult.
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The Seven Stages Of Dementia
One of the most difficult things to hear about dementia is that, in most cases, dementia is irreversible and incurable. However, with an early diagnosis and proper care, the progression of some forms of dementia can be managed and slowed down. The cognitive decline that accompanies dementia conditions does not happen all at once – the progression of dementia can be divided into seven distinct, identifiable stages.
Learning about the stages of dementia can help with identifying signs and symptoms early on, as well as assisting sufferers and caretakers in knowing what to expect in further stages. The earlier dementia is diagnosed, the sooner treatment can start.
Understanding Dementia And Toileting Issues
Toileting refers to an individuals ability to independently get to the toilet, use it properly and clean themselves effectively. Although this is second nature for most people, dementia patients face a variety of challenges that interfere with their ability to use the toilet.
There are several types of incontinence that have different underlying causes. Dementia patients typically experience functional incontinence their urinary system and/or digestive system works normally, but they experience a loss of bladder and/or bowel control due to an inability to get to the bathroom or use it properly. Cognitive deficits cause toileting difficulties because the individual doesn’t recognize the urge to go, can’t communicate their needs, has difficulty accessing the restroom and can’t remember the toileting process.
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What Increases The Risk For Incontinence
Certain factors can also increase a persons risk for incontinence. These factors include:
- being overweight, as weight puts pressure on the bladder
- age, as older adults tend to have weaker bladder muscles
- pregnancy and childbirth, which can affect the pelvic floor and bladder muscles
- menopause, as hormones affect the bladder
- enlarged prostate or prostate surgery
- certain medications
How Can Dementia Affect Physical Health
Most people do not realize the physical impact that dementia has on the human body. As any experienced dementia caregiver can tell you, the more your loved ones dementia progresses, the more their physical health will decline. Familiarizing yourself with what to expect can help you prepare for the future.
Here are 5 ways dementia can affect physical health:
1. Jerky movements. It is common for individuals in the later stages of dementia to move in a jerky manner. This is particularly true with patients suffering from Alzheimers disease. Doctors are unsure why this happens.
2. Loss of appetite. Dementia patients often become quite picky about the types of food they eat. It is not uncommon for a person with advanced dementia to forget how to use utensils or how to chew or swallow.
3. Difficulty swallowing. The act of swallowing is surprisingly complicated, and it is not unheard for a person with dementia to forget how to swallow. This puts patients at a risk for dehydration. If a patient with dementia becomes dehydrated, it will only worsen their other physical symptoms, like the jerky movements.
4. Difficulties using the bathroom. Unfortunately, one of the more debilitating physical effects of dementia is losing control of ones bowels. Incontinence is one of the primary indicators that this has happened. For example, aides who work in dementia home care will often encourage their charges to go to the bathroom every 1-2 hours.
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What Are The Signs Of End
It is important for caregivers to know when an individual with dementia is close to the end of their life, because it helps ensure they receive the right amount of care at the right time. It can be difficult to know exactly when this time is due to the variable nature of dementias progression, but understanding common end-of-life symptoms of seniors with dementia can help. Below is a timeline of signs of dying in elderly people with dementia:
Final Six Months
- A diagnosis of another condition such as cancer, congestive heart failure or COPD
- An increase in hospital visits or admissions
Final Two-to-Three Months
- Speech limited to six words or less per day
- Difficulty in swallowing or choking on liquids or food
- Unable to walk or sit upright without assistance
- Hands, feet, arms and legs may be increasingly cold to the touch
- Inability to swallow
- Terminal agitation or restlessness
- An increasing amount of time asleep or drifting into unconsciousness
- Changes in breathing, including shallow breaths or periods without breathing for several seconds or up to a minute
Patients with dementia are eligible to receive hospice care if they have a diagnosis of six months or less to live if the disease progresses in a typical fashion. Once a patient begins experiencing any of the above symptoms, it is time to speak with a hospice professional about how they can help provide added care and support.
Improving Continence In The Toilet
- running the tap or giving the person a drink of water if they are having trouble urinating
- allowing them to get up and down a few times if they are restless or hyperactive, and will not sit on the toilet
- giving something to distract them while they are on the toilet music may have a calming effect.
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Tips For Caregivers: Reducing Accidents
Incontinence often happens due to timing. It may help to recognize potential signs that a person needs to go, such as straining, turning red in the face, and tugging at their clothing. If you help them get dressed, use clothing thats easy to remove such as pants with elastic waistbands instead of buttons and belts.
One successful technique is prompted voiding. This is a type of bladder retraining that helps people to maintain a regular bathroom schedule. For example, every two hours, ask if theyve had an accident, have the person use the toilet, and praise successes.
Phase : Defining The Scope Of The Reviewconcept Mining And Theory Development
In phase 1, the project team , will draw on their collective expertise in continence and containment, working in care homes, dementia, frailty and interventions that support integrated working and review methodologies to work together to develop programme theories or hypotheses about why FI management programmes for people with advanced dementia living in care homes work or do not work. This phase will provide a provisional account of the impact of interventions by linking key areas of knowledge that inform how interventions are developed for this particular population.
A preliminary review will be undertaken by four members of the project team of a selection of key literature identified by the project team through key word searches and discussions with stakeholder groups, and interviews with practitioners, family carers and user representatives. Five key stakeholder groups have been identified. These are:
Providers of care: care home managers ,
Recipients of care: user representatives, for example, carer representatives and continence charities .
Academics and practice educators/developers who work in care homes and/or with older people
Clinicians with a special interest in FI
Continence specialists, commissioners and providers of continence services .
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Surgical Options For Fecal Incontinence Management
If other treatment methods dont work, surgery may help reduce or eliminate FI. Surgical options to discuss with a doctor include:
- SphincteroplastyThis is the most common fecal incontinence surgery, which reconnects the ends of a sphincter muscle torn by childbirth or another injury.
- Artificial anal sphincterThis surgery involves placing an inflatable cuff around the anus and implanting a small pump beneath the skin that the person activates to inflate or deflate the cuff.
- Nonabsorbable bulking agent injectionNonabsorbable bulking agents can be injected into the wall of the anus to bulk up the surrounding tissue. This makes the opening of the anus narrower to help the sphincters close more easily. This is a less invasive outpatient procedure, performed without general anesthesia.
- Bowel diversionThis operation diverts the lower part of the small intestine or the colon to an opening in the abdominal wall the area between the chest and the hips. An external pouch, or colostomy bag, is attached to the opening to collect stool. The colostomy bag must be regularly emptied and cleaned.
Aggression In Alzheimer’s Patients
“Oftentimes, aggressiveness is just frustration because they aren’t getting their point across,” Rubinstein explains. Dementia results in increasing difficulty with communication, so figuring out how best to communicate with your Alzheimer’s patient will help. Alzheimer’s caregivers might create a picture book or photo menu to help your loved one point out what they want to eat or drink or who they are thinking about. Keep air horns around the house and blast them to stop physical aggression in its tracks, and don’t hesitate to call 9-1-1 for help if this Alzheimer’s symptom turns dangerous.
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Information For The Doctor
It is useful if you can provide the doctor with the following information:
- How often is the person incontinent?
- Is it urinary and/or faecal incontinence?
- When did the problem start?
- Is the person saturated or is it just a dribble?
- Has there been an increase in confusion or any change in behaviour?
- Has there been any fever or does the person appear to find it painful to go to the toilet?
- Is the person taking any medication?
- Does the person pass urine in strange places?
If medical assessment does not indicate that there are any other medical reasons for the incontinence, then the cause is most likely to be the persons dementia.
In What Stage Of Dementia Is Incontinence A Problem
In the middle stage of dementia, patients often experience increasing disorientationeven in familiar settingsand tend to get confused more easily while carrying out multi-step processes. A senior with Alzheimers may forget where the bathroom is located in their own home, what the toilet is for, and the steps needed for proper toileting. This can result in a dementia patient failing to locate and get to the bathroom in time, struggling to remove and put on their clothes, urinating and/or defecating in places other than the toilet, and neglecting personal hygiene. Cognitive and functional declines cause toileting problems to worsen throughout the middle stage of the disease, even with increased assistance and supervision.
As a dementia patients impairment becomes more severe, occasional accidents eventually progress into a full loss of bladder and bowel control that is not related to toileting difficulties. Late stage Alzheimers is marked by an inability to respond to ones environment, identify bodily urges, control movements and communicate needs. In the final stages of dementia, patients become completely dependent on others for their personal care.
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How To Handle Incontinence With Alzheimers Disease Patients
One of the bigger issues with the Alzheimers patient as the disease progresses is that she may become incontinent, no longer being able to control their bowel and bladder muscles effectively. By preparing for this ahead of time and being aware of the issue, you should find this problem much easier to deal with. Just keep reading to learn more about the problem and how to handle it.
When Does Alzheimers Incontinence Begin?
Experts say that around stage seven of Alzheimers, your loved one can start to lose control of their bowels and bladder muscles. Of course, every person who has the disease is different. It is not unusual for someone in the earlier stages of the disease to also have this problem.
What Causes Incontinence in Alzheimers Patients?
The causes can be various. It may be a temporary problem because of the drug that your loved one is taking. Or, the problem might be a urinary tract infection. It also could be because the nerve impulses that usually are sent to the brain that tells a person to use the restroom are no longer working. Also, your loved one just may not be able to understand she needs to use the bathroom any longer. This problem also could be caused because she cant find the bathroom, or cannot get her clothes removed in time.
What To Do About Bed Wetting?
How Can I Help My Loved One to Locate the Bathroom?
Helpful Alzheimers Supplies for Toileting
The URSEC Spillproof Male Urinal
Living With Limited Bowel Control
For some individuals, more significant muscle and nerve damage from diseases like diabetes, multiple sclerosis, stroke and dementia can make treating and managing incontinence much more complicated. For seniors and their caregivers, adequate planning can help decrease the likelihood of accidents and ensure you are prepared in the event one does occur.
Taking a Plan B Bag that contains extra clothing, wipes, disposable underwear or pads, and a sealable bag for soiled items is always a good idea while youre out and about with a loved one who is incontinent. Mapping out public restrooms and being diligent about using them as they are available and before they are needed can also prevent mishaps.
If possible, try to avoid any known triggers. For example, each person is different, but eating tends to be a natural trigger for increased bowel activity. Organizing outings around meals or taking an antidiarrheal medication before eating can help your loved one avoid issues. You may need to help them pay closer attention to their body and learn to pick up on subtle signs yourself. This is difficult but can be done.
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Signs Of Dying In The Elderly With Dementia
Dementia is a general term for a chronic or persistent decline in mental processes including memory loss, impaired reasoning, and personality changes. Alzheimers disease is the most common form of dementia, accounting for 60-80% of all cases of dementia. It is also the 6th leading cause of death in the United States, and over 5 million Americans are currently living with Alzheimers disease.
Alzheimers disease and most progressive dementias do not have a cure. While the disease inevitably worsens over time, that timeline can vary greatly from one patient to the next.
Caring for a loved one can be challenging and stressful, as the individuals personality changes and cognitive function declines. They may even stop recognizing their nearest and dearest friends and relatives. As dementia progresses, the individual will require more and more care. As a family caregiver, its important to be able to recognize the signs of dying in elderly with dementia. Hospice can help by offering care wherever the individual resides, providing physical, emotional and spiritual care to the patient and support their family.