|
|
COPING STRATEGIES
TOILETING
Caregivers may feel embarrassed and awkward when assisting with toileting. For some the task of wiping and cleaning afterwards may be particularly difficult. It is important to remember that these are normal reactions and that the person being assisted may feel just as awkward, especially in the earlier stages of the disease. Losing control of bladder and/or bowel is a very humiliating experience for most people and many dementia victims are aware of and embarrassed by the lack of control. It is not uncommon for people to deny early stages of incontinence and hide soiled clothing. Adult incontinence pads are available, but it is important to try to maintain as much independence and sense of control for as long as possible. Catheters should be avoided unless there are overriding medical reasons for their use. It is important to develop strategies to avoid "accidents" in the early stages of the disease and to cope with incontinence when it becomes an ongoing problem.
Establish a daily routine
- Make sure that the person is drinking sufficient liquids. Sometimes the sense of thirst is lost and people may forget to drink.
- Avoid too much coffee, tea or alcohol.
- Try to set up a regular schedule of drinks.
- Observe toiletting pattern and try to start toiletting routine just before the expected time.
- Toilet before and after meals and immediately before going to bed.
- If a person is particularly restless or anxious, try calming them by gently rubbing between the shoulder blades or distracting them with something to hold (a knotted pair of socks for example).
- Monitor bowel movements and consider using fibre-based products to avoid constipation.
- Check skin regularly to ensure there are no rashes or sores.
Medical and other considerations
At some stage of the disease, the signal to the brain about the need to urinate or empty the bowel may not be received and properly interpreted. Irreversible incontinence is the result.
This tends to occur in the later stages of the disease and a number of other factors that can contribute to problems with bladder and bowel control are worth taking into consideration when incontinence problems first arise
- prostate problems in men can cause retention of urine
- constipation can block the bladder and urine can leak past the blockage point
- weaker pelvic muscles in older women often causes "stress incontinence" or leaking when sneezing, coughing or laughing
- urinary tract infections can cause loss of control
- certain fluids like coffee, tea, cola and beer can increase frequency of urination and can affect control
- diuretic medications like Lasix can increase frequency of urination
- some tranquilisers, sedatives, barbituates and/or antidepressants can affect bladder muscle function and/or reduce sensitivity to signals to the brain
- insufficient fluid intake and dehydration can cause irritation to the bladder and may cause incontinence by lowering the signals to the brain about the need to urinate
- mobility and/or visual problems may make getting to the toilet on time a problem
Environmental considerations
When incontinence becomes a problem, protective covering on furniture may become necessary. Disposable pads or rubberised flannel sheets can be used to protect bedding. Chairs with removable, and washable covers may be necessary. Plastic bags can be used as protectors under cushion covers.
Often elements of the physical surroundings need to be modified to assist people to maintain relative independence for as long as possible. Factors which could be taken into consideration include
- distance between the bedroom and toilet - a commode or chamber pot by the bed may help if the distance is too far
- height of the bed - a high bed may make it difficult for a person to get out of bed without assistance
- lack of visual cues - consider making the door to the toilet clearly visible and different from other doors by painting it a different colour; consider too, making the toilet seat a different colour from the floor and surroundings
- poor lighting - ensure that both the pathway to the toilet and the toilet allows for easy vision without glare
- lack of orientation cues - consider labels on doors
- lack of a sense of privacy - ensure that the toilet door can be shut easily and safely , that it opens outward and that it can be removed easily in case of emergency collapse (special hinges are available for this)
- fear of falling - grab rails and raised toilet seats can help overcome difficulties in getting on and off the toilet; consider a bell or buzzer in the toilet.
Communication considerations
- Look for non-verbal signs such as restlessness, tugging at a belt or zip. Sometimes people lose the verbal ability to communicate a need to go to the toilet.
- Listen carefully for times when the person may use the wrong word but be trying to communicate the need for a toilet.
- Simplify the task by breaking it down into stages - taking down the pants, sitting down etc. Keep instructions short and simple.
- Try as much as possible to allow a sense of privacy and dignity.
- Be patient. Make sure that the person has actually urinated before getting them off the toilet.
- Try to avoid appearing angry or frustrated when accidents occur.
Clothing
- Keep clothing simple - consider replacing buttons and zips with velcro; try elastic waistbands or wrap-around skirts.
- Select clothing that is easily washable and needs no ironing.
- Choose shoes that can be washed or easily cleaned.
- Change clothes when they are wet or soiled; do not let the person become used to wet clothing.
- A variety of adult incontinence garments are available including washable briefs with a snap-lock plastic layer and/or disposable pads.
|
