Dementia

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Dementia Managing incontinence and toileting
difficulties.

• Maria Moor

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What is dementia

• Broad term used to describe the symptoms of a
  large group of illnesses that cause a progressive
  decline in a persons mental functioning
• It is a permanent and progressive disease that
  eventually renders people incapable of looking
  after themselves.
• It is not a normal part of aging (common after
  age of 65.

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Symptoms

• Begins with forgetfulness
• Progresses to confusion and disorientation
• Effects problem solving
• Effects decision making
• Personality changes, irritable , agitated ,
  depressed

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Types Of Dementia

• Alzheimer's disease - this causes up to 60 of
  cases of dementia. It is characterised by memory
  loss and difficulties with language in its early
  stages,
• Vascular dementia - this is the consequence of
  strokes and/or insufficient blood flow to the
  brain and causes up to 20 of cases of dementia.
• Dementia with Lewy bodies - this causes up to 15
  of dementia cases and is characterised by
  symptoms similar to Parkinson's Disease as well
  as hallucinations, and a tendency to fall.

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Other types of dementia

• Fronto temperal dementia ( group of dementias)
• Creutzfeldt Jakob disease occurs in 1 in 1
  million. A rare and fatal brain disease
• Aids related dementia
• Huntingtons Disease
• Alcohol related dementia

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Dementia Incidence

• Approximately 600,000 people in the UK have
  dementia. 5 of the total population aged 65 and
  over, rising to 20 of the population aged 80 and
  over.
• Dementia can also occur before the age of 65
  there are about 17,000 people with dementia in
  younger age groups in the UK.

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Incidence

• Of the people with dementia, 154,000 live alone .
  It is estimated that by 2026 there will be
  840,000 people with dementia in the UK, rising to
  1.2 million by 2050. (Alzheimers Society 2011)

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Treatment

• There are no cures as yet
• A group of drugs called acetyl cholinesterase
  inhibitors may slow the progression of
  Alzheimers dementia and Lewy Body dementia
• Memantine, a glutamate blocker, may protect brain
  cells against damage.
• In Vascular dementia drugs may be of use in
  slowing the damage to brain cells
• Aspirin
• Medication to control high blood pressure

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Dementia and Incontinence

• Incontinence is the loss of control of bladder
  and bowel
• Incontinence occurs in people with dementia for
  many reasons
• A decline in intellect and memory as a result of
  dementia can result in incontinence

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Causes of Incontinence

• Infection
• Constipation
• Medication
• Physiological bladder and bowel problems
• Prostate enlargement
• Vaginal Prolapse

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Other causes due to changes in persons ability

• Inability to recognise toilet
• Inability to find the toilet
• Inability to recognise the need to go
• Inability to use the toilet
• Inability to communicate needs
• Inability to formulate words
• Mobility and Dexterity

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Common occurring actions.

• Parcelling (eg wrapping and concealing the
  evidence in drawers etc
• Wetting or soiling clothes
• Wetting or soiling the bed
• Using an inappropriate receptacle
• Smearing

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Other causes

• Depression
• Fear
• Embarrassment

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Suggestions for managing toilet problems

• Ensure the floor and toilet are of sharply
  contrasting colours.
• Coax forward, help to aim. Sit down
• Shiny floor can be perceived as wet
• Use reflective tape to direct to the toilet
• Night lights
• Use pictures where possible
• Personalised toilet routine,music,raised seat,
  grab rails

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Use a raised Loo
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Location of Toilets
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Inconsiderate siting of commodes
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Continued

• Clothing. Simplify clothing. Elastic waistbands,
  Velcro.
• Toilet. Music to calm them. Make sure toilet
  securely fastened. Raised loo seat. Grab bars.
• Toilet routine.
• Skin care. Prevent soreness

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Continued

• Intake. Adequate fluids. Reduce caffeine
• High fibre diet
• Prevent constipation
• Exercise
• Effective Communication

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Changes in Communication

• May have difficulty finding a word
• They may not make sense
• Cant understand what you are saying
• May ignore you
• Difficulty expressing emotion

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Communication is key

• Communication is made up of three parts-
• 55 is body language
• 38 is tone and pitch
• 7 is the words we use

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How we can help.

• Use short simple words
• Remain calm
• Non verbal clues.
• Do not rush them.
• Give them plenty of time
• Avoid competing noises
• Consistent approach

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Respect the patient

• Losing control can be humiliating and
  embarrassing and care givers need to be sensitive
  to these feelings

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• Thank you
• Any Questions?