Incontinence aids

Following a full assessment, including toileting regimes and perhaps some behaviour therapy, there will be a residual group of men and women who need aids to help them keep dry/clean and dignified. Very few people should be faecally incontinent after a full assessment, but in severe dementia this may be the case. It is possible to constipate the sufferer with tablets, e.g. codeine phosphate, and then give them regular enemas, usually twice a week, given by the carer or a district nurse. This seems to work well with many elderly people. Alternatively pads can be used to cope with both faecal (and urinary) incontinence.

District nurses and continence advisers are the experts in the field of incontinence and should be approached to discuss all the various products available. Carers should ask their GP to arrange a meeting and an assessment.

Difficult behaviour

Unusual restlessness and agitation may indicate that something is wrong, especially in cases where verbal communication is difficult. A need to go to the toilet or another physical reason may be the cause, and should be looked for. Sometimes however it is due to the Alzheimer’s disease itself and where it becomes exhausting for both sufferer and carer medication can be given. A useful drug for this problem is Melleril/thioridazine. Wandering however is not usually the same as restlessness or repetitive behaviour, and sedating a wanderer does more harm than good, making them drowsy, unsteady on their feet and often incontinent.

Aggression by a sufferer can be very difficult to cope with, especially if persistent and severe. There are no easy answers, but the carer should not hit back, where at all possible should avoid physical confrontation and in particular should not restrain the sufferer. If it is not an isolated incident then help should be sought by asking any of the professional agencies, especially the GP. Most outbursts are triggered by a reaction, often frustration, and a subsequent similar scene can often be avoided. Persistent aggression needs specialized help from a psychogeriatrician.

Occasionally in advanced dementia sufferers bite or have other spiteful behaviour, e.g. pinching, spitting, etc. This is extremely trying and demanding for the carer, but kindness and patience usually keep the situation manageable. In order to remain kind and patient the carer needs adequate rest, occasional breaks and access to professional help when necessary.

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Numerous accidents and substances can negatively affect the eye. Heavily chlorinated pools can cause a mild chemical burn of the cornea, resulting in scratchy feelings in the eyes. Eye infections come from public swimming pools and ponds which may be prevented by wearing watertight swim goggles or face masks.

Next to cataract, eye injury is the most common cause of visual impairment in the United States today, warns the National Society to Prevent Blindness (NSPB). Virginia S. Boyce, executive director of the 75-year-old voluntary sight-saving organization, points out that a million Americans are permanent causalities of accidental eye damage, most of it occurring in ordinary everyday activities. Forty-five percent of vision-impairing injuries occur around the home.

“Accidents will happen,” Mrs. Boyce said. “These often can’t be prevented.” Ammonia, lye, and other harsh chemicals found in household cleaners and garden sprays are particularly damaging to the eye, resulting in injury, burns – even blindness. She recommends that you read package labels and instructions thoroughly before using such products. Many give specific directions, and ignoring them can result in injuries. Use special caution with pressurized spray cans. Be sure the spray nozzle is directed away from you. Spray cans make tempting toys, so be sure to keep them well out of reach of children.

Wood slivers, rocks, metal pieces, and other particles thrown off by hand tools and power equipment like drills, welding equipment, and chain saws also cause serious eye damage. Lawnmowers, frequently a cause of eye injuries, can hurl a stone at high speed into your eye or that some unsuspecting bystander. Keep young children away when you’re mowing. Be sure that all tools and machinery are kept in good repair.

In 1983, 12,028 Americans were treated in hospital emergency rooms for injuries from fireworks, almost one-third more than the total reported for 1982. Nearly 15 percent of those injuries were to the eye, reports Mrs. Boyce’s National Society to Prevent Blindness. “Since there is no way to estimate how many were treated in doctors’ offices, at home, or by direct hospital admission, this figure is only a fraction of actual injuries,” said the NSPB executive director. “Punks, sparklers, firecrackers, bottle rockets, M-80′s – these and all fireworks endanger the eyes. They may seem harmless, but even sparklers burn at heat exceeding 1500 degrees F.”

For many years the Society has urged that fireworks be limited to licensed public displays. Although this is law in twenty-eight states, bootleg fireworks are still sold regularly on street corners and in many stores. The struggle goes on to save eyesight even though people do things to themselves. “Those nineteen and under suffered nearly two-thirds of the injuries last year,” Mrs. Boyce noted, adding that “the victims are frequently innocent bystanders. Keep your children away from all fireworks and from anyone who uses them. They may look like fun to youngsters, but fireworks are explosives that can cause injuries, even blindness”.

Three days after Independence Day 1984, on July 7th, it was announced by the media that 8,490 people, mostly children, were treated for injuries from the use of fireworks on the Fourth of July alone. Fireworks should be banned for private use and only shown in displays by authorized agencies hiring professionals to handle them.

Incidentally, Mrs. Boyce advises that if getting to the eye doctor is something you keep putting off, you can perform some simple eye tests at home with a kit from the NSPB. The Home Eye Test for Adults checks distance vision, near vision, and whether or not you have macular degeneration, a disorder of the eye anterior. If you fail any of the tests, you should visit an eye specialist.

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