Use Absorbent Pads And A Waterproof Mattress Cover
A water-resistant mattress cover will keep your mattress clean, while big bed pads will protect your bedding, other furnishings, and even your vehicle seats. Incontinence pads, disposable or washable/reusable, can be found in multiple sizes. If nighttime accidents are a problem, talk to the doctor regarding an Occupational Therapist referral to see if they would recommend a bedside commode near the bed for easy toileting.
Why Is This Happening
Some reasons why a person with dementia might experience problems using the toilet include:
- The person might not be able to find or recognise the toilet.
- The person might have difficulty communicating their need to go to the toilet.
- The person might not be able to get to the toilet or undo their clothing in time.
- The person might experience difficulties with one or several stages of the process of successfully using the toilet.
- The person might have a urinary tract infection or some other kind of physical problem.
- The person might be experiencing side effects from medication.
- The person might have given up trying to use the toilet because they have not been receiving the help they need.
- The person might be incontinent as a direct symptom of their dementia.
Dental Skin And Foot Problems
Dental, skin, and foot problems may take place in early and moderate stages of Alzheimer’s disease, but most often happen during late-stage Alzheimer’s disease.
Dental problems. As Alzheimer’s disease symptoms worsen, people will need help taking care of their teeth or dentures. Brushing and flossing help to maintain oral health and reduce bacteria in the mouth, which may decrease the risk of pneumonia.
Make sure the person’s teeth and teeth surfaces are gently brushed at least twice a day with fluoride toothpaste. The last brushing session should take place after the evening meal or after any medication is given at night. You may find that using a child’s size toothbrush is easier for the person.It is also best to floss once per day, if possible. If this is distressing to the person, an interdental brush, which is a small brush designed to clean between the teeth. Try to check the person’s mouth for any problems such as:
- Food “pocketed” in the cheek or on the roof of the mouth
Be sure to take the person for regular dental checkups for as long as possible. Some people need medicine to calm them before they can see the dentist. Calling the dentist beforehand to discuss potential sensitivities may also be helpful.
Skin problems. Once the person stops walking or stays in one position too long, he or she may get skin or pressure sores. To prevent them, you can:
To check for pressure sores:
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The Early Stages Of Dementia: Noticeable Cognitive Decline
A person is not typically diagnosed with dementia until theyre at stage 4 or beyond. This is when medical professionals and caregivers notice personality changes, as well as cognitive impairment.
Dementia stage 4: moderate cognitive decline
At this point, a person has clear, visible signs of mental impairment. While its considered mild or early stage dementia, the medical terminology for the fourth of the seven stages of dementia is moderate cognitive decline.
Doctors and caregivers will likely notice a worsening of stage 3 dementia symptoms, such as difficulties with language, problem-solving, and travel.
Stage 4 dementia symptoms
Dementia And Changes To The Lower Urinary Tract
Dementia is an umbrella of neurodegenerative disorders which cause degeneration of the CNS. The Alzheimer’s Disease Association estimated that currently, there are 46.8 million people living with dementia worldwide and this number will double every 20 years to 74.7 million in 2030 and 131.5 million in 2050. Much of this increase will be in the developing world.
Central control of detrusor activities includes the frontal cortex, basal ganglia, Pontine Micturition Centre. The central control provides an inhibitory input on the detrusor to reduce contractions during the bladder filling phase. Dementia, particularly vascular dementia, normal pressure hydrocephalus, Frontotemporal lobe dementia, Alzheimer’s Disease present with features of detrusor over-activity where urgency is the main symptom. Among the elderly with Alzheimer’s disease, urge incontinence is the commonest presentation and UI is proportional to the dementia severity and impairment of ADLs .
Diffuse Lewy Body Dementia , Multisystem atrophy, Parkinson’s Disease Dementia and AD have additional component of autonomic dysfunction, in addition to the central causes. The autonomic dysfunction presents with detrusor over-activity as the main type of UI. The synuclein deposition in PDD and DLBD is present in central nervous system and postganglionic sympathetic nerves .
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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.
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 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.
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.
People with dementia may be unable to communicate the need to use the restroom.
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.
Urinary Issues In Advanced Parkinsons Disease
Urinary dysfunction and symptoms in PD are most commonly caused by overactivity of the detrusor muscle, or the muscle of the bladder, which contracts excessively despite the fact that it is not filled with urine. This causes an increased urge to urinate and/or an increased frequency of urination, which can be especially prominent at night. In advanced PD, this could culminate in urinary incontinence, or involuntary release of urine. Mobility issues which make getting to the bathroom slower and more cumbersome, compound the problem.
Always remember that people with advanced PD may have other medical problems that affect their urination such as an enlarged prostate. Make sure to have a complete evaluation before assuming that the problem is only related to PD. It is also essential to keep in mind that if changes in urination occur suddenly, there could be a urinary tract infection present.
Once other medical issues and urinary tract infection are ruled out, there are a number of approaches to the issue of urinary incontinence in a person with advanced PD:
Unfortunately, for some, the above available options may not be sufficient to effectively treat urinary incontinence in advanced PD. If this is the reality, it becomes extremely important to keep the skin dry with frequent changes of incontinence products to prevent skin breakdown and the potential development of skin infection.
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Ensuring Timely Visits To The Bathroom
Caregivers must be vigilant in scheduling toileting breaks when those living with dementia have lost the ability to talk and convey the desire to void. Keep an eye out for nonverbal indications that suggest the desire to use the restroom. Encourage your loved ones to use the bathroom when they first wake up, after every meal, and before bed. Toilet visits at regular intervals during the day may also assist in reducing accidents.
Are There Any Treatment Options For Dementia Patients Suffering From Incontinence
The first thing to do would be to determine as best you can the type of incontinence that is being experienced.
Your doctor should be able to help assist with any underlying medical issues that might be a factor.
This could translate to a change in medications or even addressing a possible urinary tract infection.
An example of possible medical interventions could be as simple as recommending pelvic floor exercises to undergo corrective surgery.
You may also find that you or your loved one qualifies for use of a medical device or procedure designed to strengthen pelvic floor muscles and to retrain the bladder.
These represent some of the more modern methods of managing bladder control. These and other treatment options are best explored with the help of your personal physician.
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Surgical Management Of Ui
Data on surgical management of UI among the frail elderly is scarce. Outcome measures are often confounded by comorbidities and postoperative complications among the elderly. Age related physiological changes like pelvic floor weakness and impaired bladder function also affect the success of surgical treatment. The elderly is at a higher risk of postop morbidity and mortality than the younger patients, and the elderly with dementia have a high risk of developing postop delirium. Recent recommendations by the American College of Surgeons and American Geriatric Society for preoperative assessment of the elderly patients include assessment of comorbidities with optimization, medication management, nutritional improvement, screening for frailty, cognitive impairment and function preoperatively .
For the elderly women with stress incontinence, options include injection of bulking agents at the proximal urethra, midurethral sling, colposuspension, transvaginal/retropubic/transobturator tension-free vaginal tape are all recognized surgical interventions for stress UI. They are effective for women well selected to enroll in large trials with good gain in quality of life, with a risk of postop complications like infection. However, the more frail, disabled elderly with cognitive impairment have not been well studied .
Last Stages Of Dementia Before Death
Caring for an elderly loved one can be challenging and stressful, as their personality changes. They may even stop recognizing friends or family members around them! As dementia progresses the individual will require more care which is why its important to know when someone has died with this disease because hospice offers a range of services where they reside providing physical emotional spiritual support in addition giving instructions about how best future- selves handle certain tasks .
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Where To Live With Dementia
Eventually, caregiving for someone with dementia wont be appropriate anymore. The needs of a person with progressive dementia become overwhelming, and moving into a full-time residence with trained staff becomes necessary. You should plan for this well before it becomes necessary, by visiting communities and asking the right questions.
Depending on your loved ones stage of illness, different living options are available:
Assisted Living in Early StagesAssisted living residences combine room and board with medical and personal care, and are often sufficient for someone in the early stages of Alzheimers disease or related dementia. Full-time supervision means residents are safe, with living units like private studios or apartments so someone with mild dementia can still feel a sense of independence.
Services offered in assisted living include meals, help with activities of daily living , social activities, and transportation to and from doctors appointments. Before moving in, the residence will assess your loved one to make sure its a good fit.
Memory care residences have physical designs that are appropriate for people with dementia. Someone with Alzheimers, for instance, may become upset when encountering a wall, so memory care buildings have circular hallways. Because people with dementia are prone to wander, memory care residences have increased security and supervision, and special locks on doors.
Did You Know?
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.
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What Are The Final Stages Of Dementia
As seniors progress to late stage dementia, full-time care may become necessary, whether you choose memory care or professional dementia care at home. The symptoms of the final stages of Alzheimers include behavioral and personality changes, inability to perform ADLs, and severe cognitive decline.
Dementia stage 6: severe cognitive decline
Stage 6 marks a need for caregiver help to perform basic daily activities such as dressing, eating, using the toilet, and other self-care. Seniors with late stage dementia may have difficulty regulating sleep, interacting with others, or behaving appropriately in public settings.
Management Strategies For Ui Among The Elderly With Dementia
It is often important to ask about UI in the presence of caregivers, as UI is frequently not reported voluntarily by the caregivers. Many of the elderly who are frail and demented have other comorbidities and the aetiologies for UI are often multiple. Even though UI cannot be cured, it can be managed and contained with appropriate continence aids to achieve a social/acceptable continence .
Figure 1: Summary of management of UI. View Figure 1
It is important to establish goals of treatment with the caregivers and the elderly with dementia. The goals include decrease in specific symptom burden, dryness or using less continence aids for protection, enable social activities to maintain/enhance quality of life, maintain the current place of residence and reduce caregiver burden .
From an elderly with dementia’s point of view, treatment options are rather limited because of the impaired cognitive function and pharmacological treatment may cause worsening of the cognitive function. Treatment options for UI consist of non-pharmacological means and pharmacological.
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Symptoms Specific To Frontotemporal Dementia
Although Alzheimers disease is still the most common type of dementia in people under 65, a higher percentage of people in this age group may develop frontotemporal dementia than older people. Most cases are diagnosed in people aged 45-65.
Early symptoms of frontotemporal dementia may include:
- personality changes reduced sensitivity to others feelings, making people seem cold and unfeeling
- lack of social awareness making inappropriate jokes or showing a lack of tact, though some people may become very withdrawn and apathetic
- language problems difficulty finding the right words or understanding them
- becoming obsessive such as developing fads for unusual foods, overeating and drinking
Read more about frontotemporal dementia.
Common Medical Causes Of Incontinence
Many people with dementia are also dealing with co-morbid illnesses that can compound their distress, discomfort, and incontinence issues. Here are some of the most common medical causes of incontinence.
- Enlarged prostate Urinary incontinence is a common side effect for some men who have an enlarged prostate . The BPH starts to cause the involuntary leakage of urine.
- Constipation While constipation seems to be the opposite problem of faecal incontinence, it can actually cause such incontinence. As hardened stool is painful and difficult to pass, it can become lodged high up in the bowel. Watery faecal matter can begin to flow around it, voiding without any warning. This is common in older people.
- Neurological complications, often caused by a stroke Complications caused by a stroke or other neurological illnesses can interfere with the mental signals to the bladder and bowel, causing incontinence.
- Parkinsons Disease, Multiple Sclerosis, and Prostate Cancer These conditions can prevent the physical signals involved in bladder and bowel control. A person with Parkinsons or MS may not feel any urgency, even when voiding is imminent.
- Certain medication side effects Certain medications can relax the muscles of the bladder and reduce overall awareness. This is most common with -the use of sleeping pills and tranquillizers.
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What Is Dementia A Quick Overview
Dementia is a common affliction characterized by a group of conditions related to brain impairment.
A person experiencing dementia experiences a host of conditions that coincide directly to the loss of memory and cognitive judgment.
A statistic from the CDC indicates the condition of dementia affects as much as 5.8 million Americans.
Dementia is caused by the degeneration of the cerebral cortex region of the brain. This occurs by head injury, stroke, brain tumors, and other factors not yet fully understood.
Of note: Alzheimers Disease is noted to be responsible for 60-70% of dementia in adults.
Common traits and symptoms for adults diagnosed with dementia include:
- Limited desire or ability to socialize with others
- Trouble speaking
- Difficulty performing daily tasks and responsibilities
- Compromised muscular function
- Disorientation or Confusion
What Stage Of Dementia Is Incontinence
Incontinence can be a very embarrassing and uncomfortable situation for those living with Alzheimers. While there is not one specific cause of this issue, it often occurs in the middle or late stages when society has abandoned them because they are unable to take care on themselves anymoreThe following tips may help you cope: Find ways that preserve dignity such as saying An accident might happen at any time instead of focusing on accidents someone had earlier today try using pant absorbers under your clothes .
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What To Do About Body Jerking
Sudden twitching or jerking, known as myoclonus, is another condition that sometimes happens with Alzheimer’s. The person’s arms, legs, or whole body may jerk. This can look like a seizure, but the person doesn’t pass out. Tell the doctor right away if you see these signs. The doctor may prescribe one or more medicines to help reduce symptoms.
Read about this topic in Spanish. Lea sobre este tema en español.
Basic Neurophysiology Of Micturition
The bladder is innervated by the autonomic nerves as well as the somatic nerves. The sympathetic innervation originates at T11-L2, supplying the bladder via the Hypogastric nerve. The parasympathetic nerves originate at S2-S4 and innervate the bladder via the Pelvic and Pudendal nerves.
The sensation of bladder fullness as it fills ascends via the spinal cord to be conveyed to the Pontine Micturition Centre, which promotes micturition via the parasympathetic supply to the urinary bladder. However, micturition may not be appropriate at all times. The central nervous system determines the “correct timing” of micturition, taking into account the social and behavioural part of micturition. Micturition is coordinated and triggered through simultaneous activities of the bladder contraction with relaxation of the urethral sphincters via the somatic and autonomic nerves.
In addition to the complex neuroanatomical and physiological reflexes to maintain continence, there are other faculties needed to maintain continence. An intact cognition is important to perceive the sensation of bladder fullness with the ability to postpone micturition after the first sensation, motivation and desire to pass urine, sufficient mobility and coordination to reach the toilet with hand dexterity to manipulate clothing items in order to do so. In addition, the ability to locate the toilet with clear direction and access also contribute to continence .
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