Improving Continence In The Toilet
Suggestions to help with continence once you are inside the toilet include:
- 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.
What To Do About Swallowing Problems
As Alzheimer’s disease progresses to later stages, the person may no longer be able to chew and swallow easily. This is a serious problem. Difficulty with swallowing may lead to choking or cause food or liquid to go into the lungs, which is known as aspiration. This can causepneumonia, which can lead to death.
The following suggestions may help with swallowing:
- Make sure to cut food into small pieces and that it is soft enough for the person to eat.
- Grind or blend food to make it easier to eat.
- Offer soft foods, such as yogurt, applesauce, mashed avocado, sweet potatoes, and bananas.
- Don’t use a straw, which may cause more swallowing problems. Instead, have the person drink small sips from a cup.
- Offer drinks of different temperatures warm, cold, and room temperatureto see which might be easiest for the person to drink.
- Don’t hurry the person. He or she needs time to chew and swallow each mouthful before taking another bite.
- Encourage the person to feed themselves as much as possible during meals. If the person needs support, try using overhand, underhand, or direct hand feeding approaches.
- Don’t feed a person who is drowsy or lying down. He or she should be in an upright, seated position during the meal and for at least 20 minutes after the meal.
- Say “swallow” to remind him or her to swallow.
- Find out if the person’s pills can be crushed or taken in another form.
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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Stage : Very Severe Cognitive Declinesevere Dementia
At this stage, AD persons require continuous assistance with basic activities of daily life for survival. Six consecutive functional substages can be identified over the course of this final seventh stage. Early in this stage, speech has become so circumscribed, as to be limited to approximately a half-dozen intelligible words or fewer . As this stage progresses, speech becomes even more limited to, at most, a single intelligible word . Once intelligible speech is lost, the ability to ambulate independently , is invariably lost. However, ambulatory ability may be compromised at the end of the sixth stage and in the early portion of the seventh stage by concomitant physical disability, poor care, medication side-effects or other factors. Conversely, superb care provided in the early seventh stage, and particularly in stage 7b, can postpone the onset of loss of ambulation. However, under ordinary circumstances, stage 7a has a mean duration of approximately 1 year, and stage 7b has a mean duration of approximately 1.5 years.
In persons with AD who remain alive, stage 7c lasts approximately 1 year, after which persons with AD lose the ability not only to ambulate independently but also to sit up independently , At this point in the evolution, the person will fall over when seated unless there are armrests to assist in sitting up in the chair.
Diagnosing Senior Fecal Incontinence
If you or an elderly loved one is experiencing FI, talk to a doctor. Usually, a general practitioner will refer you to a specialist, who may ask questions about living arrangements, diet, and current and past bowel function, according to Rao.
A patient may also be asked to bring a record of fecal incontinence to their first visit, or to create one between appointments.
In this journal, they will likely record:
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How To Find Help For Caregiving
As the person moves through the stages of Alzheimer’s, he or she will need more care. You may not be able to meet all his or her needs at home anymore. It’s important to know your limits, take care of yourself, and to seek help whenever you need it. Learn more about getting help with Alzheimer’s caregiving and finding ways to care for yourself. If caring for the person has become too much for you, you can also learn more about finding long-term care for a person with Alzheimer’s.
Is There A Cure For Dementia
Researchers are searching for answers for cures, new treatment options, and more advanced knowledge of these conditions and more.
To date, there are many clinical trials underway and progress is being made. We have seen many advancements in the way of diagnostic and imaging technology in addition to identifying important biomarkers.
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Studying Urinary Incontinence In Alzheimers Disease Pre
To date, there are 206 rodent models available for AD research which include transgenic, natural, and intervention models . Non-primate mammals do not develop the same hallmarks of AD as seen in humans , however, they do develop other forms of tauopathies and senile plaques . These animals display Alzheimers-like diseases , mimicking many of the clinical symptoms of AD . To study human AD pathology in animal models, several transgenic rodents were developed by inserting human tau and amyloid beta, resulting in the development of human NFTs and plaques .
Information To Tell The Doctor
You can help the doctor to work out the cause of the incontinence. Information about the continence problems you can give the doctor include:
- the number of times per day the person is incontinent
- whether it is urinary incontinence or faecal incontinence
- when the problem started
- whether the persons clothes are saturated or whether the person is just producing a trickle
- any increase in confusion or any change in behaviour
- the presence of any fever or pain when going to the toilet
- any medication taken by the person with dementia
- whether the person passes urine in strange places.
If medical assessment does not indicate any other medical reasons for the incontinence, then the cause is most likely to be the persons dementia.
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Causes Of Bowel Incontinence
There can be many causes for incontinence in someone with Alzheimerâs disease. It can be related to the dementia itself. The person may not recognize the urge to go or may have trouble finding the bathroom or taking off clothing.
Other reasons for bowel incontinence include:
- Medical reasons including chronic bowel disease, diabetes, Parkinsonâs disease, and urinary tract infections
- Weakness from surgery
- Diarrhea from a virus or bacterial infection
Why The Problem Exists
Firstly, when dealing with issues of incontinence it is important to rule out health reasons that may have little or nothing to do with dementia. Difficulty going to the bathroom can be a sign of a urinary tract infection , dietary or hydration issues , prostate problems in men, or side effects from medication . Consult with your loved ones doctor to be sure none of these are factors, even as you follow the following steps to make toilet use easier.
Alzheimers disease itself, of course, makes using the toilet more difficult. Alzheimers affects brain function, and signals between the brain and parts of the body break down. For this reason, someone with a full bladder may not feel the physical sensation of needing to go.
Mobility becomes a problem for people with Alzheimers, particularly in later stages, meaning the basic act of getting up and walking to the bathroom, taking down your clothes, and cleaning up afterward, are all harder.
Fortunately, there are behavioral steps and around-the-house tips and upgrades that can simplify toileting and cut down on incontinence and accidents.
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Make The Toilet Accessible
As a persons dementia progresses, it may become harder for them to remember where the toilet is. They may also have difficulties getting to the bathroom in time to use it.
Some steps that may help someone with dementia get to the bathroom in time include:
- removing potential hazards and obstacles that may be in the way
- placing a portable toilet in the bedroom or making sure to light the bathroom at night
- installing safety features, such as a high seat or safety bars
It may also be beneficial to put a picture of a toilet on the bathroom door. Caregivers should use a bright, contrasting color to paint the door or keep the door to the bathroom open.
How To Connect With The Person
Communicating with a person with late-stage Alzheimers disease can take effort and patience. Though that persons ability to respond may be limited, it is important to continue to interact:
- Continue to visit with the person even if responses are limited.
- Try to speak calmly and slowly be aware of the tone and volume of your voice.
- Consider sharing familiar stories with the person.
- Make eye contact, say the persons name and smile.
- Use other methods of communication besides speaking, such as gentle touching or massage.
- Have the person listen to music or calming nature sounds.
Learn more about how to communicate with a person who has Alzheimer’s disease.
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Stage : Moderate Dementia
Patients in stage 5 need some assistance in order to carry out their daily lives. The main sign for stage 5 dementia is the inability to remember major details such as the name of a close family member or a home address. Patients may become disoriented about the time and place, have trouble making decisions, and forget basic information about themselves, such as a telephone number or address.
While moderate dementia can interfere with basic functioning, patients at this stage do not need assistance with basic functions such as using the bathroom or eating. Patients also still have the ability to remember their own names and generally the names of spouses and children.
Stage : Subjective Memory Lossage Related Forgetfulness
Many people over the age of 65 complain of cognitive and/or functional difficulties. Elderly persons with these symptoms report that they can no longer remember names as easily as they could 5 or 10 years previously they can also have trouble recalling where they have recently placed things.
Various terms have been suggested for this condition, but subjective cognitive decline is presently the widely accepted terminology. These symptoms by definition, are not notable to intimates or other external observers of the person with subjective cognitive decline. Persons with these symptoms decline at higher rates than similarly aged persons and similarly healthy persons who are free of subjective complaints. Research has shown that this stage of subjective cognitive decline lasts 15 years in otherwise healthy persons.
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A doctor will perform a physical exam to evaluate your mental processes. He or she will also ask you about any medications youre currently taking and any stressful situations youre facing. Your memory loss provider may also ask you about your symptoms and ask you to take notes on how youre feeling. The doctor may recommend that you get an appointment with a neuropsychologist. A neuropsychologist can help you figure out the best way to treat your memory loss.
A doctor will conduct a physical exam to determine the exact cause of your memory loss. He or she will also ask you about your medical history and whether youve experienced other forms of memory loss. After your medical history, your provider will discuss your options for treatment. If youre experiencing severe symptoms of memory loss, you should seek out a professional. It will help you get the right kind of care for your specific situation. So, take action today.
A healthcare provider will perform a physical exam to assess the condition of your memory. He or she will ask you about your family and friends and any medications youre taking. Once he or she has established the root cause, a proper treatment will be given. If you have a mild form of memory loss, you can still function independently and perform everyday tasks. If your symptoms are more severe, you may need to see a medical professional.
Stage : Moderate Cognitive Declinemild Dementia
The diagnosis of Alzheimers disease can be made with considerable accuracy in this stage. The most common functioning deficit in these persons is a decreased ability to manage instrumental activities of daily life, which may hinder their ability to live independently. For the stage 4 person, this may become evident in the form of difficulties in paying rent and other bills, not being able to write out checks with the correct date or amount without assistance the inability to market for personal items and groceries or order from a menu in a restaurant. Persons who previously prepared meals for family members and/or guests begin to manifest decreased performance in these skills.
Symptoms of memory loss also become evident in this stage. For example, seemingly major recent events, such as a holiday or visit with a relative may not be remembered. Obvious mistakes in remembering the day of the week, month or season of the year may occur.
Persons at this stage can still generally recall their correct current address they can usually correctly remember the weather conditions outside. Significant current events, including the name of a prominent head of state, will likely be recalled easily. Despite the obvious deficits in cognition, persons at this stage can still potentially survive independently in community settings.
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Causes Of Incontinence In People With Dementia
Although the brain changes of dementia can lead to incontinence, other medical conditions can also cause continence problems in people with dementia, such as infection, constipation, hormonal changes and prostate enlargement.Many of these conditions are treatable, so the first step is always to consult a doctor to obtain a full medical assessment and find out why the incontinence is occurring. Talking with a continence nurse may also be helpful.
Behavioral And Cognitive Symptoms Of Dementia
Behavioral Symptoms
Michelle Niedens, L.S.C.S.W., in The Neuropsychiatric Symptoms of Alzheimers, states that 80% of individuals with dementia will experience neuropsychiatric symptoms.
Personality changes such as anxiety, depression or irritability are common in the early stages of the disease. Later, agitation, physical or verbal outbursts, pacing and restlessness are more common.
Behavioral symptoms have been identified as the most challenging and distressing for caregivers and family members. They are oftentimes the determining factor in deciding to move a family member with Alzheimers into a structured living environment.
Cognitive Symptoms
Cognitive symptoms start out mild in the early stages of Alzheimers and gradually worsen as each stage progresses. In the late stages of Alzheimers, the person with the disease is no longer able to form new memories or access old ones. Language abilities become worse until the person is no longer able to communicate. Judgment and reasoning skills continue to diminish and eventually, the person with dementia loses the ability to reason altogether.
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Why Do People With Dementia Become Incontinent
People with dementia may become incontinent for a variety of reasons and often, for several at once.
Stress Incontinence
Many older women experience stress incontinence.
When the weakened bladder muscles are stressed by a sneeze or a laugh, they may leak small amounts of urine.
Urge Incontinence
Urge incontinence is a common condition among elders, characterized by a sudden and intense need to urinate, followed by the loss of a large amount of urine.
Functional Incontinence
Mobility challenges can make it hard to get to the toilet on time.
Difficulty Managing Clothing
Unzipping or unbuttoning pants can become a challenge due to various reasons, including arthritis or cognitive changes.
Communication Deficits
People with dementia may be unable to communicate the need to use the restroom.
Cognitive Changes
A person may forget how to complete the sequence of events needed to successfully remove clothing and use the toilet.
The brain may become less able to recognize the signal from the body that it needs the bathroom.
Difficulty finding the bathroom, recognizing the toilet, or comprehending how to use it can present a major barrier.
Behavioral Effects Of Alzheimers Disease On Urinary Incontinence
Fecal incontinence is prevalent in the elderly but like UI, little is known about the physiological connection between them. One study found dementia as an independent risk factor for significantly increased likelihood fecal incontinence . The only treatments used for fecal incontinence is increased fiber intake, laxatives, enemas, and increasing quality of care to ensure a toilet schedule is followed .
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