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Consequences of Incontinence in Dementia The consequences of incontinence may be magnified for people living with dementia.
Both physical and psychosocial consequences can have significant impacts on health and quality of life, especially for people living with dementia. Incontinence and increasing dependence on others for care is considered a factor in nursing home placement for elderly patients with dementia as well as an increase in caregiver burden. Cognitive decline and incontinence can include a lapse in self-care or neglecting personal hygiene to clean up the incontinence. This can lead to skin issues, such as pressure ulcers, rash, and skin infections. Urinary incontinence is also associated with an increase in urinary tract infections, requiring additional treatment and care. Mobility problems can lead to incontinence accidents due to the inability to get to the toilet in time. This situation may increase the risk for falls and fractures that further compromise health and quality of life for people living with dementia. Psychological and social consequences can be most important for this group of people who are interacting with others. Incontinence can lead to embarrassment, low self-esteem, depression, and withdrawal from social settings that are important to maintaining overall wellbeing. Incontinence can make it more challenging to assure the patient is afforded some amount of privacy, able to maintain their dignity, while maximizing their quality of life. Overall, problems that are associated with the development of incontinence, and the increasing dependency on others for care, increases both the caregiver burden and cost for care.
Treatments for Incontinence Treatments may include a range of medications, dietary instruction (sometimes to add soluble fiber to the diet to reduce the potential for fecal incontinence), strategies to control blood sugar in patients with diabetes, and lifestyle changes.
Advice on hygiene and general management may be provided by the primary care nurse or physician, advice on exercise or other adaptations and equipment may be provided by a physical therapist, and dietary modifications may be counseled by a registered dietitian. Caregivers may also find it useful to connect with other caregivers to share their experiences and solutions to similar situations. Management of urinary continence may fall into non-pharmacologic and pharmacologic interventions. Non-pharmacologic treatment may include behavioral interventions, bladder training, pelvic floor exercises, lifestyle modifications, and even catheterization. Pharmacologic treatment may include medications, such as anticholinergic drugs for overactive bladder, treatment for benign prostate hyperplasia, or surgery.
General Strategies for Incontinence Management If no reversible or medically treatable cause can be found during a medical evaluation that is, hopefully, performed during a period when signs of incontinence are first seen, then there are several actions that can help patients and their caregivers to manage toilet and incontinence issues in their home.
If the patient does not have severe cognitive deficits and is able to work on lifestyle modifications, there are several potential strategies to employ. These may include kegel exercises and general regular exercise, scheduling bathroom breaks to train the bladder on a time schedule, scheduling bathroom breaks according to typical timing of defecation, weight loss (if overweight), double voiding to assure that the bladder is completely empty, and medications or devices that may help to avoid leakages. Dietary intervention for urinary incontinence includes instructing patients to avoid carbonated beverages, caffeine or diuretic beverages, drinking before bed, spicy or acidic foods and beverages that may irritate the urinary tract, or drinking too much liquid at one time. For fecal incontinence, assurance of adequate daily fluid and fiber intake may help to assure formed stools and avoid diarrhea and constipation.
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