Aged to Perfection

Your mother hasn’t been going out as much lately. She even declined a few outings with you recently, which is unlike her. Then you noticed a pair of soiled underwear shoved behind the toilet…and another soiled pair under the bathroom sink.

What she may be hiding is trouble with urinary continence.  She may be feeling embarrassed and is trying to hide it, or if she has dementia, she may be confused about how to cope with this new change.

There are many possible reasons and treatments for urinary incontinence.  Ensure your mother sees her doctor and speaks openly about what she is experiencing.  Many causes of incontinence can be addressed medically, and those should be addressed immediately.

You may be able to suggest some lifestyle adjustments that will help to support your mother’s bladder, rather than irritate it. Read our other blog that addresses natural ways to support the bladder. If your mother has dementia though, the source of her challenge may be related more to her functional abilities than to her bladder directly.

As your mother’s dementia advances, she may not be as responsive to the signals her body is sending.  By the time she realizes that her bladder needs relief, it may be too late to respond and she may not be making it to the washroom in time.

Another challenge can be complicated clothing. Buttons, snaps, zippers or belts may be proving a challenge in the washroom. The more barriers there are to quick washroom use, the more likely your mother is to be slowed down and not make it in time. Be especially aware of skirts or dresses with back closures since it may not be self-evident how to undo the zipper. Modified and accessible clothing may make it easier for your mother to be quick and self-sufficient in the washroom. Drawstring or elastic-waistbands are often the easiest to manage.

If your mother’s dementia is advanced, it is possible she is confused about where to find the washroom.  Washrooms are not always easy to find, especially for someone with dementia.  Often, washroom doors remain closed, even when unoccupied.  Someone with dementia may not think to open closed doors to see what is behind the door. They may not have an intuitive sense of where a bathroom is likely to be located within a home or apartment. Although she may have lived in the same home for years, or decades even, dementia can cloud her memory and obscure what was once familiar. If she cannot easily find the washroom, she will not make it in time when nature calls.

Once she is able to locate the washroom, she may be confused about what to do once she’s in there.  For some people with advanced dementia, the washroom can feel very confusing and overwhelming.  If the toilet seat lid is down, the toilet may not look familiar. A white toilet and a white sink may look very similar and can be confusing.  A wastepaper basket may seem more familiar and is often mistaken for the toilet itself.

Sometimes people attempt to sit down facing the toilet, rather than with their back to the toilet tank, as it is typically used. Because it feels so unusual when facing backwards, there is no long-term memory to cue what to do next.  It can also be dangerous since balance is impacted and there is a risk of falling.

If someone needs cueing through each step of toileting, their apparent challenges with incontinence may be more related to functional abilities and less so to their bladder or bowel function. They may be able to hold their bladder or bowel and may even be aware of when they need a washroom, but the confusion sets in with how to use the washroom.  If someone is experiencing functional decline, various support measures can be implemented to promote independent washroom use.

Cue cards can be helpful for those who can read and interpret directions. If your mother is inclined to read instructions and follow the directions, a cue card in the washroom to cue each step may be helpful.  In some cases, colour coding the toilet seat vs. the sink can be helpful. Contrasting colours can make it easier to see which item is which. If cue cards and colour coding are insufficient, your mother may need a caregiver to cue her through each step of the toileting process. 

When the functional ability is preventing someone from toileting successfully, look for which step is causing the confusion, or which component of mobility is posing the challenge. 

By solving that specific component, you can help support someone to the toilet as independently as possible.  Engaging the support of a professional caregiver may also help in identifying precisely where the needs exist. For more ideas on supporting independent toileting and continence, contact us at Warm Embrace Elder Care.

Falling is a serious concern for the elderly.  Falling can cause a fracture which leads to a whole series of problematic health outcomes. 

What about someone who has dementia? At quick glance, it would seem that dementia and falls are not related.  Yet, the data indicates that those with dementia are at a higher risk of falling.  In fact, according to the Canadian Institute for Health Information, 15% of all Emergency Visits by seniors with dementia are fall-related (compared to only 9% of other seniors).

Why is that?

There are a number of risk factors that are exacerbated for those who have dementia. Here are a few:

Medications: some of the medications associated with dementia can have side effects which cause drowsiness, dizziness, or instability.  Antipsychotic medications sometimes have a side effect of orthostatic hypotension, which is a sudden drop in blood pressure when you stand up.

Visual Perception Changes: dementia can affect someone’s ability to process what they are seeing. Depth perception, in particular, is affected and impacts fall risk.

Spatial Judgement: dementia can impact someone’s spatial awareness and ability to judge distances making it difficult to navigate around hazards or prevent bumping into obstacles

Fatigue: many people with dementia are keen to walk incessantly, but sometimes they fail to notice when they are tired and they don’t rest when needed. 

Mobility Aids: when a walker is introduced for safety, someone with dementia may have trouble remembering how to use the walker, or remembering to use it at all.

Washroom Needs: the sudden urge to use the washroom may cause someone to rush for the bathroom, especially if help is not on the way quickly enough.

Boredom: when feeling bored, lonely, confused, uncertain, or in pain, some people with dementia tend to get up and start pacing, but it may not be safe to do so.

How can you help to prevent a fall?

There are many items to consider for fall prevention, especially among those who have dementia. Here are a few modifications or suggestions you can implement to increase safety for your loved one.

ENVIRONMENT

Someone with dementia may not be able to scan the environment and take note of risks or hazards. They may not be able to process something as risky, and they may not be thinking about safety and fall prevention. 

Aim to make the environment safer on your loved one’s behalf by:

• Decluttering
• Removing floor mats and other tripping hazards
• Keep frequently used items within arm’s reach

VISIBILITY

Since your loved one with dementia may be experiencing perception changes, try to see their environment through their eyes. 

Some recommended adjustments:

• Increase the lighting—people with dementia require brighter lighting to easily see their surroundings
• Use contrast colours to make items more visible (i.e: a beige door on a beige wall may be hard to see; paint the door a contrast colour for easier way-finding)
• Clearly mark the edges of steps

SOCIAL NEEDS

Boredom is the cause of many so-called behaviours in dementia, pacing included.  All humans have a desire to be productive and to be doing something meaningful.  Someone with dementia may be confused about what that activity should be, and in the absence of something obvious to do, they may create an activity that can be a fall risk.

To prevent this concern:

• Keep your loved ones busy with an activity that is meaningful to them. If they are content and engaged in an activity, they’ll be less likely to wander away and be at risk of falling
• Maintain social connections

PHYSICAL ACTIVITY

Someone with dementia may attempt to walk faster than their current physical ability permits, which can increase their risk of falling.  Failing to use mobility aids can add to that risk as well.

To help mitigate these risks:

• Continue strength-based exercises to maintain strength and mobility for as long as possible
• Constantly remind and demonstrate how to use mobility aids correctly until it becomes a new habit
• Provide ample opportunities to be up and walking with support when someone is present to assist, reducing the impulse to pace later.

The risk of falling increases as someone ages, but that risk accelerates when dementia is added to the mix. By identifying some of the additional risk factors faced by someone with dementia, a family can aim to mitigate those risks and put preventative safety practices in place. Protect your loved ones by following fall prevention safety guidelines!