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Can Hygiene Accidents Be Behavioral?

My brother afflicted with Alzheimer's is incontenent with 1 and 2. After a struggle and assistance I was able to transition him to Depends. It seems that when he is agitated or seeking attention he will just decide to do either duty anywhere, on the floor or in a waste can, in front of others. I've been told, "He's just forgetting," but I do find it occurs more when he's not getting one on one attention or if I suggest something to him which he doesn't like, immediately he'll find a place and do a #2, if you catch him and say something, he'll say, "Not me." As primary caregiver he gets angry if I attempt bathroom reminders, removal of glasses at bedtime, even fixing his covers. I'm feeling I can't help him. I did have a professional say he still wants to make decisions, that I get, so, I have started to allow that to see if it resolves the behavior. Another said, "Less is more," so less I'm trying, meaning I am letting him do more what he wants or when he wants. I will prepare dinner, he's awake, laying down. "Have some nice chicken here," he'll respond, "No I'm sleeping," if I continue he'll get angry, "Leave me alone, get out of here." So, I know he had lunch, his weight is fine, so I am not begging or making him have dinner, giving him a choice, a decision. Less anger from him felt less stress for me, but I did feel that I was giving up, yet I pride the caring I do, know I've cared since day 1. Any input appreciated and thank you fellow caregivers!🙏
Status: Open    Sep 19, 2016 - 07:47 AM

Caregiving, Dementia

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Sep 24, 2016 - 06:52 AM

Dear "Bless Caregivers",

Bless you indeed! Your brother is quite fortunate to have you!

I am a Registered Nurse. I started out as a Certified Nurse Assistant and have worked with the elderly and memory impaired for about 30 years. I have worked in private homes, long term care facilities and hospitals. Currently, I am teaching CNA courses in a local college and I am caring for my mom that lives with me.

As to your question: No, I do not believe that your brother's incontinence of bowel and/or bladder is the result of purposeful behavior during episodes of agitation. Here are my thoughts (for what they are worth).

#1) Perhaps he already needed to go to the bathroom and THAT is causing the agitation, rather than the other way around. Perhaps he feels physically uncomfortable (full bladder, pressure in the bowels) but his brain doesn't understand what is causing those physically uncomfortable feelings so he begins to get agitated. Perhaps he does recognize the feeling but he's embarassed to admit that he doesn't know where the bathroom is, or doesn't know how to remove his clothing, etc.

A possible solution: When you notice that he is beginning to get agitated, say something like, "I need to go to the bathroom. I think there's one around here somewhere. Will you help me find a bathroom?" or "I need to go to the bathroom. Do you need to go too?" or "I need to go to the bathroom, will you help me?" Pretend like you are the one that needs help and ask him to help you.

#2) Perhaps his agitation stimulated his bladder or bowel and this caused him to be incontinent. When the brain percieves a stressful situation it releases hormones that tells the body to "speed up" in preparation for an escape or a fight. These hormones cause the bladder to be stimulated and cause the entire gastrointestinal tract to either speed up or slow down (depending on the hormones that have been released). Which can cause nausea, vomiting, diarrhea, constipation, loss of appetite, etc.

A possible solution: Continue to attempt to establish a "toileting pattern". Continue to encourage him to go to the bathroom at least every two hours even if he doesn't feel like he needs to go. This can be difficult, but keep trying. Be patient. Try to establish a routine (i.e. upon rising in the morning, after breakfast, before lunch, after lunch, once or twice in the afternoon, before supper, after supper, before bed ...) and be consistent, always follow the same schedule as much as possible.

And finally, please understand that the late-early stages and the early-middle stages of dementia are the most difficult time for the patient and the caregiver.

In the early stages of dementia it's fairly easy to "remind" the patient of their situation. You can "bring them back to reality" when needed. Remind them of where they are, why they are there ... Remind them that they have a disease that is causing their forgetfulness, etc.

In the late stages of dementia it's fairly easy to "distract" the patient from their reality. They are "so far gone" that you can pretty much convince them of just about anything. Or you can just "go along" with whatever they are saying. You "join them on their journey" rather than trying to "bring them back to reality".

But the middle stages are really tough. They still have enough of a grasp on reality to understand that their life is changing for the worst, but they have lost enough brain function so they have a really hard time understanding or remembering why their life is the way it is.

Just try to rememer this: Your brother is suffering from brain damage. If he had been involved in a motor vehicle accident and had suffered a traumatic brain injury, would anyone be questioning his behaviors? If he had a cancerous brain tumor, would anyone be criticizing his functioning? Alzheimer's and other diseases that cause dementia damage the brain. Sometimes fairly quickly, sometimes rather slowly. But the brain is being damaged and your brother cannot help it, has no control over it, and it just plain xxxx ! For both of you! Don't wear yourself out. Find friends or family that can come over and stay with your brother for a few hours a week so you can go to a movie, or go get your nails done, or something.

God bless you and your brother! I hope this helps.

Sep 24, 2016 - 10:57 AM

It's my understanding that different stages of dementia mean that a person regresses, rather than progresses. My dad is now in the stage where he is like a 3 year old. Three year olds are known to be stubborn and combative. Yes, it can be behavioral.
I'm not sure what the relationship to your brother is like, but my dad is someone in whom I owe a debt to being a wonderful father all these years, soI love taking care of him (well...most of the time).
I write a column in a newspaper and it has helped to put my feelings and what I've learned in it. It's called Out of the Ozone. My name is Tammy Osier and the online paper is [LINK NOT ALLOWED]. My columns are in blogs and columns. Writing has been theraputic for me and the thought that what I'm going through can be of help, helps me.

The next thing I wanted to ask is if you have someone else to help you? I pay a caregiver $10 an hour to come and help. If it were not for her, I wouold be completely nuts by now. Please let us know. I feel for you as we have had incintinence issues here. My dad won't wear Depends, and the house smells. It's a man thing, I think, and men tend to be more controlling and difficult because of their loss of control in their younger years. You need to learn where to draw the line on what you'll nag about and what to let go in order to give him some of his independence. Please let us know how it's going and any decisions you've made that work. We're in this together! Tammy
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