How Does Dementia Impact Incontinence?Wednesday, February 21, 2024
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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. |
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4 Survival Tips for all Family CaregiversWednesday, January 17, 2024
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When you think of family caregiving which words come to mind?
BurdenStressfulSadDepressingExhaustingFrustratingHonour/devotionMeaningfulBlessingJoyfulHumourFulfilling
What creates the difference between the first column experience and the second column? How can family caregiving be both frustrating but joyful, a burden and a blessing?
Here are 4 survival tips to take your family caregiving experience away from the first column and into the second column.
1. Take care of yourselfIt may sound trite, but self-care is crucial. If you don’t care for yourself, you’ll have nothing left over to give to anyone else. You need to allow yourself time to refuel. How you re-energize will be unique to you; there is no right or wrong answer. Maybe you exercise, or take a warm bath, or play an instrument, or read a book. It doesn’t matter what you choose to do; it matters that you take time for yourself and prioritize your own self-care.
2. Allow yourself to be "off-duty"It is not reasonable to expect yourself—or anyone else for that matter—to work or be on-call 24/7. And yet, when in the midst of family caregiving, people often hold themselves to an unrealistic standard of doing it all, all of the time. You need time when you are not “on-call”.
This includes elderly spouses who have assumed the caregiver role and who live together. It can be tough for the caregiving partner to feel “off-duty” when they are at home together with their partner who requires care. Respite care is critical to help both halves of a couple remain healthy—both physically and mentally.
Feeling “off-duty” also applies to family members who are receiving constant phone calls from their elderly loved ones. They need time when they can turn off the ringer and not field any phone calls—a timeframe when they are “off-duty” from repeated calls.
3. Enlist support before a crisis emergesAll too often people will say: “Dad won’t accept help from anyone else, so I have no choice!” Then a crisis occurs and it is Dad who has no choice—he must accept help from another source because you, the family caregiver, are now experiencing your own health issue related to burnout. Sure enough, Dad does accept the help, although it might have been a smoother introduction to care had it not been a crisis situation.
It will be a kinder transition for your father to accept outside support in a graduated care plan, rather than abruptly. With advance notice and the luxury of time, caregivers can be selected to match your father’s personality and preferences. In a crisis situation, you might have no choice but to get a caregiver—any caregiver—in place the same day. A more ideal match could have been made with advance planning.
Best of all, your burnout can be prevented in the first place! It is far easier to prevent burnout by providing support early on than it is to recover after burnout has occurred.
4. Protect family roles and relationshipsCaregiving can upset the long-ingrained roles and family dynamics. A husband who is suddenly thrust into the position of caring for his wife may feel ill-equipped for the role of the family caregiver. He doesn’t feel like a husband. . . he feels like a caregiver. And she doesn’t feel like a wife. . . she feels like a patient. Their interaction as husband and wife has been interrupted and they begin to interact as patient and caregiver, which may start to stress their marriage.
It is important that key family roles and relationships are preserved. That couple needs to continue to feel like a married couple. A parent and child need to preserve their mother-son relationship. It may be best to let certain elements be provided by a professional caregiver so the family relationships can remain intact.
Family caregivers are SO important to the health and well-being of their loved ones. It is crucial that their health and sanity are protected. If the family caregiver burns out, then there are two people requiring care!
The only way to survive family caregiving and find the positive is to take care of yourself, have time that you are "off-duty", get help in place before it's too late, and aim to protect family roles and relationships for as long as possible. |
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Chloe Hamilton 112 February 27, 2024 |
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