UTI and keeping clean

H1235

Mom is toward the end of stage 4 dementia. She can’t drive, handle finances, handle her own medication. She is still able to make a sandwich, get dressed and shower on her own. She is very independent and often thinks she can do things she can’t (mow the lawn). The dementia has also effected her moods. She gets very grumpy if we try to give her direction or help with anything. She wears depends and changes them on her own. The problem is she has had a couple of UTI’s now. I’m worried she is not keeping herself clean. Wonder if she is changing her depends often enough. I have bought wipes for her and I think she is using them but not sure how often. When I stress the importance of using them she got mad and said “I know” with an eye roll and an attitude. Being upset is not good for her (also causes confusion). Continually bringing it up will not be good for her mental health, but UTI’s are not good either. Feels like there is no good option. As far as medication for her moods, she is already on 10 different medications, really don’t want to add another. Any suggestions?

Quilting brings calm

She might need to be drinking more liquids too.

DCCEPEK

There came a time when we had to assist with after toilet clean up to stop uti. It's a hell of a journey

harshedbuzz

Ugh. UTIs are the devil.

It can be really hard to get to the bottom of recurrent UTIs. She probably needs supervision in toileting if she incontinent to the point she needs Depends. FWIW, per Tam Cummings, urinary incontinence is a an "early" Stage 5 symptom. She may be further along than you suppose.

Tam-Cummings-LLC-Handouts.pdf (tala.org)

It could be changing the Depends infrequently, this is more likely if she's not effectively cleaning after a bowel movement. E.coli. and other bacteria can wick and cause problems. She could be avoiding fluids or forgetting to drink enough. She could be wiping improperly. It could be that the medication prescribed didn't wipe out the previous infection. (it's best to supervise meds and ask for a culture to make sure she's on the proper abx) The wipes you bought could be causing the irritation that leads to the UTIs. Even the Depends could be a culprit; a man in my IRL support group found his wife could not use any brand of disposable incontinence product on his dear wife and ended up essentially cloth diapering.

Often incontinence coexists with other losses in toileting skills. I would be very wary of allowing a PWD to have unsupervised access to wipes for fear of a clog. I know the manufacturers label them as "flushable" but really there is no such animal.

Some people with recurrent UTIs have success with adding a supplement to their meds. Cranberry extract and D-Mannose are most often used. Sometimes doctors will prescribe a lower prophylaxis dose if things are really bad.

I would reconsider medication. In the context of you mom having symptoms of late-stage dementia-- which is a terminal illness-- you might want to take a second look at all the medications she takes with her PCP. By the time my dad was at this point, we took a more palliative approach and jettisoned some meds. His BP was low to high-normal at its highest, so we ditched the BP meds to avoid dizziness. We got rid of the statin which could potentially cause muscle pain. His doctor also suggested removing the metformin as it upset his stomach sometimes. We kept meds to keep his breathing as good as we could. And we kept his psychoactive medications-- behavior is communication. We found dad could really hold onto negative emotion long after he'd forgotten the trigger which impacted our ability to prove a good level of care. Relieving him of his upset was a positive thing for us.

HB