I've been away for a while after the move of my parents from Independent Living to the locked dementia unit... as an update, so far, so good. My dad is doing OK since my mom's better, although they do still have their moments of marital discord.
My mom, while overall doing really well, is having some issues with going to the bathroom. It's not that she's incontinent, it's that she's mistaking chairs and sofas for a potty. I got a call yesterday from the director who is also an R.N., and she said that mom had apparently urinated on the chair in their room and while they could send the cushion out to be cleaned, that wouldn't happen until Tuesday. So I took care of that. The nurse had mom tested for a UTI just in case this confusion is being caused by that, so hopefully on Monday we'll get those results. I'm not counting on it being a UTI, though.... just a little pessimistic about that.
I visited today and they told me that she'd had some diarrhea (sp?) this morning and I saw some spots on the carpet. Unfortunately I also noticed a suspicious stain on the love seat, and took a quick whiff, and, you guessed it. Later i went into the bathroom and it was very smelly and I found some feces in the trash can. What I surmise is that she used the loveseat as a potty and when she found the feces, she just threw it away.
So, has anyone had any experience with this? I mean, I'm not sure that Depends would even help, since it's not that she can't tell that she's about to go, it's just that she's very very confused about what is and is not a toilet.
My heart so goes out to my mom, who has always been extremely ladylike, and would be mortified if she were aware that this was going on.
I hope y'all are having a good weekend so far, and I look forward to any responses!
We went through exactly the same things with DH, and I see others in the NH doing the same thing. There's a lady right now on DH's ward who is going through this.
In DH's case, he became completely incontinent within about three months after these types of accidents started. He still had some connections about sitting and things that looked like toilets (chairs). DH was unable to use a toilet by himself. He would go into the bathroom if prompted and flush the toilet repeatedly, but he wasn't able understand all the steps (removing clothes, using the toilet, using toilet paper, flushing, etc.). He didn't appear to know when he needed a bathroom. He would also pee in the bathroom garbage can.
As the weeks went on, he seemed to lose the ability to know when he was soiled. We could obviously tell that his Depends were soaked or that he had an accident, but he seemed oblivious. We tried to manage him on a schedule for awhile, getting him to a bathroom every two hours. Sometimes it was a struggle, and he would resist like a small child. Realistically though, I cleaned furniture, rugs (he would sometimes pee on the floor) and the bathroom (he would poop and pee in the shower) over and over again. Our washing machine ran constantly. I cut up those mattress protectors that they use for children and put them on the chairs and the bed to try to minimize the cleanups.
DH resisted the Depends for a few weeks. He pulled at them as if they were uncomfortable but eventually appeared to get used to them.
After DH was admitted into the NH, I got rid of a lot of the furniture. It wouldn't have made sense to replace it when he was still home, for the obvious reasons. This was a tough phase. In our case, it was my breaking point and was one of the main reasons that I felt I could no longer handle the situation at home.
The NH chairs are all vinyl for obvious reasons.
Last edited by Beginning; 08-13-2011 at 04:14 PM.
The Following User Says Thank You to Beginning For This Useful Post: SandwichLady (08-13-2011)
Sarah, I went through the very same thing with Mom as well. It was not long after she entered the locked unit. She knew she had to go. She just didn't know where to go and what to do. One thing we did was remove everything that might be confused with a toilet. Dad had a shower chair in the shower and they made sure the shower curtains were closed at all time. Out of sight out of mind. We also removed the trash cans and laundry hamper. We also put a cut up plastic mattress pad over the cloth seat of her chair. Like beginning we scrubbed a lot. Mom was put in depends and also put on a toileting schedule. This phase lasted for a couple of months and then Mom was on her toileting schedule doing well. Now she goes when they take her and though there are occasional accidents, for the most part she follows the schedule. So you never know what will work... but what you can know is that this will not last forever.
There is a great product called Natures Miracle that you can find at your local pet store. It was actually developed by a hospital but found it's home in the pet industry. It eliminates the odor of any biological fluid. It's amazing for the odor
I do believe the biggest surprise was the day I opened the drawer her underwear were in and there was a big brown blob. Made sense to Mom
Hang in there.... and know your Mom is not the only one!
Same with my Mom. It worried her a lot she didn't know where to go and so tried to hide the results in many unusual places. Now she is not ambulatory but still knows she has to go. Most times now if you try to take her she forgets what she is expected to do and gets upset so we don't try anymore. It is a stage that you have to get through and it seems to be the same with most. I hope it helps to know that is is a common thing and this too will pass.
My FIL who has stage 7 AD is no longer like that now. However, back in late 2007, after he got sick with overdose of caumadin, he came home with the urine problem and he was almost incontinent. He peed on the carpet as he didn't walk fast enough to the bathroom. Back in March, 2007, he also peed in the sink thinking the old toilet had something wrong (that toilet was not flushing well so he played with it and flooded the bathroom floor. He also covered it up with the lid....) The caregiver had to clean it very well. Somehow since he had one on one caregiver at home, he was guided more to use the toilet from that time.
After he was "trained" to use the adult diaper in late 2007, he no longer peed outside. He had never pooed outside at all. One time he was too slow with diarrhea but it was in his pants, and it didn't go outside. He always knows when he as to go to the toilet and say so.
Now he is incontinent at night and the caregiver change his diaper more often. The bed has some cover under his sheet.
Actually your post makes me wonder. The residential home where my FIL is does not have the covers on the sofa and chairs. Maybe they are doing a good job to prevent it.
The key is to start adult undergarment earlier so they won't pee or poo outside of the bathroom.
Also, don't tell her it is diaper. She would think it is underwear. My FIL hates to wet his pants and he still thinks they are regular underwears.
The fabric in Mom's unit does not appear plastic but it does have a plastic barrier backing. It is easily washed and disinfected. I often see it drying in the sunshine out in the court yard. I did the plastic on Mom's chair because it was just a cloth upholstery and I know she loves her chair.
Again each is different Nina. Some will never have these types of episodes and some will have many. Mom always wanted to clean up the mess so hers were always a little more extreme. Some will walk off and leave it where it is which is what you wish for! Some respond well to frequent toileting or schedules and for some it doesn't make any difference. It's all trial and error to find out what works best for your loved one
I am going through this very thing with my husband. We have been throught the phase where he mistook the trash cans and bathroom sinks for the toilet. I think he was just looking for something that was the right "color" for the toilet! He uses Depends now, but we call them underwear. The problem is, he doesn't always want them changed. I have to get him to sit on the toilet and take them off while he's sitting and slip on a new pair. I definitely doesn't like you to pull them down while he is standing, even if you ask permission, and sometimes will hit you if you try. We have had very few poop incidents, but those are definitely not fun. Usually I can get him to go in the toilet. But we don't even try on the urinating anymore. There is a website call the Bedwetting Store where I ordered some larger pads to put on the bed. I got 3 - two to alternate on the bed and one for the couch. I also have two smaller ones for the living room chairs. I also keep a bottle of febreeze handy. I just tell myself that someday I can reupholster the furniture, but in the beginning of this stage it was EXTREMELY hard for me to realize that my husband's dignity was more important than pee on the couch. It's hard to tame your reactions (kind of like having a new puppy!), but you just get to the point where you accept that accidents will happen no matter how hard you try to avoid them. You loved one would never do this if they didn't have this disease.
Hope you know you are not alone, and THANKS for bringing up the subject because I really value the responses, too.
Well put Sooner We can get so wrapped up in what is expected that we overlook what is needed.
I have learned over the years to rip the sides of the pull ups. They are relatively easy to tear at the side seams. Then you can easily remove it from the back. It seems to work better than pulling them down which is an action that most elderly recognize as wrong. Especially with the bowl accidents I will rip both sides, grab from the back and pull them off that way, bunching what I can in a hand full of pull up. Makes clean up a lot easier than trying to pull it down the legs! Then you can seat them on the toilet to replace them.
My FIL's home just said they want to add another lining to the bed. He now pees more at night and it seems to be overnight. They sometimes wake him up for it and I guess now it may be better to keep him sleeping. This might have to do with incontinence.
It is new. He cannot walk on his own anymore. He did ask my husband if he can sleep Ok overnight (my FIL always thinks his son "shares" the same habits...) My FIL still has the ego that everyone else should be like him!!
I realized the chairs in the homes have the same touch and it may have something on it. It is a smooth feeling. I have to go back to check it out again. The home does check on the residents every 2 hours overnight.
Not sure why he now pees more at night, not in the day... Probably there is some change there in his body.
One thing that might help is for them to give him fluids earlier in the day and much less later at night. Tea and coffee are actually diuretics. If consumed in the evening they can cause excessive urination at night. They can also cause dehydration so it is not a good idea for those that are prone to dehydration to have these at all.
I did learn an interesting fact about dehydration related to swelling. Chronic dehydration teaches the body to retain fluids. The cells will not release what they have into the blood so the kidneys can grab and eliminate it. So if there is swelling present it could be a function of dehydration. Sounds just opposite of what you would expect but it makes sense.
There is also a list of foods that are diuretics including asparagus, lettuce, tomato, cucumbers, carrots, cabbage brussels sprouts... some others. Asparagus is one that keeps me up at night. It might help to eliminate large amounts of these foods at night.
And yes there are changes in the body that can cause this. If he is "holding" his urine during the day then it will release at night. Perhaps if they take him to the bathroom more often during the day it would help.
As long as his skin integrity is good, staying wet in a brief for a period of time is not a huge problem if he can sleep through it. If he is combative when they try to change him it is easier to just let him sleep. But if he begins to have skin issues then he definitely needs changing more often. So it's an individualized solution Just like so much of this disease.
Yep, any time that they can not make their way to the toilet then it is considered incontinence.
I doubt it can be completely fixed but maybe they can come up with a plan that works. Just keep a watch on the skin integrity
The Following User Says Thank You to Gabriel For This Useful Post: ninamarc (08-17-2011)