Urinary incontinence, UTIs, and dementia

Incontinence inscription isolated

There are lots of reasons that people develop incontinence. This blog focuses on people with dementia: their care and ways to prevent urinary tract infections, a serious consequence of incontinence in the elderly.

People with Alzheimer’s disease and dementia often have problems with urinary incontinence. This can be a result of not realizing they need to urinate, forgetting to go to the bathroom, not being able to find the toilet, or limited mobility.

Ways a caregiver can help

  • Avoid giving drinks like caffeinated coffee, tea, and sodas that may increase urination. It is important, however, that healthy liquids including water, smoothies, and fresh fruit juices are not restricted. Hydration is vital to overall health and to prevent urinary tract infections.
  • Keep pathways clear and the bathroom clutter-free, with a light on at all times.
  • Make sure you provide regular bathroom breaks–at least every 2-3 hours.
  • Mark the bathroom door with a large sign that says “Bathroom.”
  • Provide a portable commode or a toilet frame with handrails or grab bars to make getting on and off easier. Make sure it’s the right height.
  • Supply underwear that is easy to get on and off.
  • Use absorbent underclothes for trips away from home and/or adult diapers.
  • When going to a restaurant or public place such as a movie theater, try to sit as close to the bathroom as possible.
  • Limit liquid intake after dinner

Talking to the doctor

  • Ask if it’s possible to cut back on prescribed medications such as water pills that increase urination
  • Does the patient have undiagnosed diabetes? Diabetes increases urination.
  • Is an enlarged prostate the problem? Rule out any medical issues that increase urination or block urination.

Preventing urinary tract infections

Urinary tract infections, commonly called UTIsare more common in people who are elderly, bed-ridden and incontinent. Symptoms can include general weakness, confusion, nausea, dizziness, sudden incontinence or increased severity of incontinence. Often these symptoms seem connected to other conditions that are unrelated to a UTI, and can make it difficult to determine that the cause is an infection.

  • The most important method of prevention is to keep the genital area clean and healthy. Wipe from front to back to avoid transferring bacteria to the urinary tract, especially in women.
  • Remove used diapers from front to back.
  • Dry the skin when changing or after bathing since bacteria grows better in moist areas.
  • Use recommended hygienic products for washing that are not drying to the urogenital area.
  • Keep the patient hydrated since urination can flush out unwanted bacteria from the urinary tract.
  • Try to make sure your loved one gets help to empty their bladder entirely, since urine remaining in the bladder can help bacteria thrive and multiply.
  • Help to prevent constipation by providing plenty of fruit (applesauce, apples, berries, prunes, figs) and other foods high in fiber, such as oatmeal, legumes, peas, chia seeds, carrots, beets, broccoli, Brussels sprouts, popcorn, nuts, and whole grains.

The dangers of UTIs

Urinary tract infections are notorious for causing delirium and delusional behavior in the elderly. When younger people get a urinary tract infection, they typically experience painful urination, an urgent need to urinate, lower abdominal pain, back pain on one side, and fever and chills. However, an older adult might not experience those symptoms. As we get older our immune system changes and it responds differently to infection. Instead of pain symptoms, seniors with a UTI may show increased signs of confusion, agitation or withdrawal. In older adults with dementia, these behavioral changes may come across as part of that condition or signs of advanced aging. If the underlying UTI goes unrecognized and untreated for too long, it can spread to the bloodstream and become life-threatening. In fact, I have a dear friend who died from a UTI that quickly became septic.

If you suspect a UTI

  • Get medical help, especially if your loved one has fever or complains of nausea or back pain. An antibiotic will be prescribed. Make sure the entire prescription is taken even if the symptoms subside. Otherwise, the infection can come back with a vengeance.
  • If it is appropriate, have the patient drink unsweetened cranberry juice on a regular basis, and/or take a cranberry/D-Mannose supplement to help stave off future infections.
  • Give the patient plenty of water to flush out the harmful bacteria
  • Apply a heating pad to the lower abdomen and/or back to help with discomfort
  • A pain reliever such as Advil can help alleviate pain and fever

Urinary tract infections are nothing to mess around with. Please get your loved one medical help if you suspect an infection.


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

12 ways to make sure your loved one is safe in a nursing home

 

Nurse serving food in nursing homeIt’s horrific and tragic that eight residents of a nursing home in Hollywood, Florida died this week as a result of dehydration, respiratory distress, and heat-related issues.  The nursing home administrator Jorge Carballo said “The Center and its medical and administrative staff diligently prepared for the impact of Hurricane Irma. We took part in emergency management preparedness calls with local and state emergency officials, other nursing homes and health regulators. In compliance with state regulations, the Center did have a generator on standby in the event it would be needed to power life safety systems. The Center also had seven days of food, water, ice and other supplies, including gas for the generator.”

But clearly something was wrong, very wrong. One man who learned about his mother’s death from a report said communication with the staff had always been difficult, so it did not strike him as unusual that his calls were not returned. Lack of communication is a big red flag.

My husband spent a little over two years in an assisted care facility, and my mother lived in a continuum care facility for seven years. Here is what I learned from my experience as the primary family caregiver responsible for making decisions about their care.

  1. If you anticipate that your loved one will be going into a nursing home or assisted living facility in the near future prepare months in advance. Visit a number of facilities in the area where s/he will live. Once you shorten the list to two or three, drop in unannounced so you can observe how the patients are treated. Supposedly, the best time to “drop in” is Saturday evening when there are fewer staff members around and visitors are not expected. Your senior services ombudsman will know which facilities have had complaints filed against them and can give you an idea of which ones to look at based on your family’s needs.
  2. Notice if residents are crying out for help, are in distress or appear dehydrated, and if their needs are attended to quickly. Be aware of odors (especially ammonia or urine) and whether the halls, dining areas, and residents’ rooms are clean.
  3. Once your loved one makes the transition into a home, get to know the staff—as intimately as your time allows. By making a personal connection with the people who care for your loved one, you will become more than a familiar face.  Professional caregivers make little income, have a huge responsibility, and are often the people who know best about the patient’s needs and status. These are people with families of their own. Ask about their child’s sports team or dance class. Ask about their grandchild’s birthday, etc. Your personal interest in their life will be appreciated and they will naturally develop an interest in your loved one and your family.
  4. A friend of mine visits his wife in a nursing home every single day, bringing her fresh berries or cut-up melon because the home doesn’t provide fresh fruit. It’s not practical for everyone to visit a loved one every day, but when you do, bring something nutritious such as fresh fruit instead of sweets. Fresh fruit is usually easy to eat and provides vitamins and antioxidants that help prevent colds and flues.
  5. Make sure water is provided throughout the day–not just that it is available but that it is offered. Seniors often lose the signal that they are thirsty and dehydration can be a serious problem for the frail and elderly.
  6. If your loved one is incontinent, make sure there are plenty of adult diapers in the room and that s/he is being changed regularly. Urinary tract infections are a serious problem with this population and staying dry and clean is a key to preventing them!
  7. Be on the alert for bruises or sores. A bed sore can lead to a systemic infection and death. Speak to the attending doctor or nurse immediately if you notice a sore that is not healing. A bruise can indicate that your loved one has fallen or, in the unlikely but not unheard event, that s/he has been abused.
  8. Sit with your loved one while s/he eats in the dining room. Is she able to feed herself or does she sit there not knowing what to do with her sandwich? If it is a problem, make arrangements with one of the staff to help her.
  9. Does your loved one require oxygen? Nursing homes are required to have generators in case of power outages such as during a hurricane. Familiarize yourself with the provider of the oxygen that your loved one receives and make sure the company is equipped to provide liquid oxygen for use when there is no power.
  10. Remove all loose rugs and obstacles in the room that your loved one might trip on. Also, place a lamp in easy reach of the bed so s/he doesn’t fall while trying to turn it off or on.
  11. My husband lost numerous pairs of glasses when he was in the assisted living home. Leave at least one extra pair with the floor nurse, and keep an extra pair at home.
  12. Know who to talk to if you have a question or concern. Over the years, I had to speak with the director of the facility where my mother lived several times. Don’t be shy and don’t be afraid of making a nuisance of yourself. Your family might be paying big bucks for the care you expect. If something is not agreeable to your loved one or your family speak up. Most of the time the director will be appreciative to hear your concerns and the matter will be quickly remedied. If not, contact the regulatory agency in your state to file a complaint. On this page you’ll find contact information for each state and territory. We provide information (where available) so that you can: 1) file a complaint about a nursing home; and 2) find additional nursing home information provided by a state.