Caregiving for People with Alzheimer's Includes Dealing with Incontinence
It is one of the hardest parts of caregiving, yet it’s something that many people don’t think or talk about unless they are in the midst of caregiving for an elder – urinary or bowel incontinence. However, this loss of control is common when someone who has Alzheimer’s disease reaches the later stages of the disease. Urinary incontinence often first emerges in Stage 5 and is soon followed by fecal incontinence.
Furthermore, incontinence among older adults (age 65 and above) is growing, according to a new report from the Centers for Disease Control and Prevention. “Incontinence presents a significant financial burden to the individual and to society,” the CDC report states, adding that the cost of bladder incontinence in 2000 was estimate to be $18.5 billion. Between 50-76 percent of these costs are comprised of resources to manage incontinence, such as absorbent pads, protection and laundry.
Incontinence in this age group is associated with a variety of factors that can overlap, such as cognitive impairment, chronic conditions (such as diabetes and cancer), stroke and mobility impairment. Additionally, bladder incontinence can be caused by age-related changes in the lower urinary tract as well as a urinary tract infection.
There are also risk factors for bowel incontinence. Besides cognitive impairment, these factors include diarrhea, inadequate fiber consumption, inadequate water intake, chronic constipation, diabetes, stroke, neurologic and psychiatric conditions and mobility impairment. The average cost for fecal incontinence was estimated to be $1,110 per individual in 2010 for those who had this type of incontinence for more than one year; these individuals also had at least monthly leakage of solid, liquid or mucus stool. In addition, there was an additional cost of $2,343 per individual for direct medical and nonmedical expenses and $1,549 for indirect costs due to loss or productivity.
Researchers have found an association between incontinence and declining mental health, as well as an increased possibility of psychological distress and depressive symptoms. In addition, incontinence serves as a predictor of functional limitations and has been linked to an increased risk of falls, as well as placement in a nursing home, hospitalization and death.
Not surprisingly, caring for someone who is incontinent adds to the mental and physical wear-and-tear on caregivers. For instance, culturally we are taught as children that having a bowel or bladder movement – which is a normal bodily function -- is actually a private, individualized moment. Therefore, dealing with this type of natural function in another – especially in an elder such as a parent – can cause the caregiver to be faced with a lot of emotions and physical reflexes. For instance, when I was first put in this situation, I started to gag terribly and had to stop cleaning up the area where an elder had accidently defecated. It took about 10-15 minutes to get my emotions – and my gag reflex – under control and be able to proceed.
Some treatments are available for incontinence, so it’s important to talk to your loved one’s doctor if the loved one begins to become incontinent. Furthermore, there are ways to help elders – even those with Alzheimer’s disease – slow the emergence of incontinence. For instance, making sure that the elder goes to the toilet frequently during the day can initially serve to control involuntary voiding of the bladder and bowels, thus avoiding the embarrassment that both the elder and the caregiver may experience. Still, as Alzheimer’s progresses, the loved one probably will become incontinent. At this point, the caregiver will need to provide absorbent undergarments and appropriate bedding, all of which will need to be changed frequently in order to maintain the love one’s hygiene.
Primary Sources for This Sharepost:
Centers for Disease Control and Prevention. (2014). Prevalence of incontinence among older Americans.
Fisher Center for Alzheimer’s Research Foundation. (ND). Stages of Alzheimer’s.
Mace, N. L. & Rabins, P. V. (1999). The 36-hour day: A family guide to caring for persons with Alzheimer’s disease, related dementing illnesses, and memory loss later in life. Warner Books.