Hygiene question

Hope5757

I’m sorry for the rather embarrassing nature of this question, but I don’t have anyone else to ask.

My 91 yo MIL has recently had two incidences of incontinence. We’ve been able to avoid any additional incidents by going to the bathroom every 3 hours. My questions are:

MIL regularly tells me that she doesn’t have to go and we have the same argument where I insist she goes. Once she sits on the toilet, she invariably has a decent urine void and many times will also have a bowel movement. Is dementia impacting her ability to recognize when she should void? She’s not truly incontinent. Rather, she doesn’t seem to recognize when she should pee until it gets to become an emergency.

Secondly, because she hadn’t showered for almost 6 weeks, I was very concerned over hygiene. I wasn’t sure she was wiping well and I knew she wasn’t washing her hands after a BM. So, I’d wipe her bottom and hands with wipes then use sanitizer on her hands. There would be a decent amount of fecal matter on the wipe. Nothing horrendous and if she were showering regularly or was wiping “front to back”, I wouldn’t be as concerned. But I worry a lot about UTIs.

Am I being overly rigid about hygiene? She and I both would be happier if I were not wiping her.

terei

What you are doing is not as effective as a shower, but is probably fine. IMO you are not being rigid at all

terei

Additionally, the description you used that she cannot recognize whether she has to void, is the definition of incontinence. The reason she is not having accidents is because you are managing her incontinence by toileting her every three hours.

Hope5757

@terei,

Thank you so much. I almost teared up at your confirmation. I have no idea what the right thing is.

Iris L.

Read a lot of threads. There are many threads on toileting and on bathing. Make use of adult "baby" wipes. Keep posting and asking questions. Nothing is embarrassing .

Iris

harshedbuzz

@Hope5757

I'm sorry. I recall this phase and many pointless arguments I had with my mom over whether dad was incontinent or not. She saw it as a character flaw to be discretely hidden while I saw it as symptom of further damage to his brain. If you look at dementia as a regression, your dear MIL is somewhat like the toddler who 1) isn't neurologically mature enough to recognize their bladder is full and 2) doesn't have the executive function skills to manage the multistep task of toileting including the etiquette piece of wiping, handwashing and flushing. I'd say she fits the criteria for incontinence as she is not independent in it as an ADL. This isn't a condemnation as mom thought, just a sign she needs help and you need to protect certain surfaces like her mattress.

One thing many suggest is a bidet seat if she'll sit for it. A warm water model with a remote you operate can be a godsend. One thing that helped mom get dad's hands washed, was running warm soapy water in the sink for him to plunge his hands in. He typically allowed that. YMMV.

The bathing issue is more of a stage 6 behavior. When you say she refuses to shower what of the many versions of this are you seeing? Are you expecting her to shower independently or is she refusing to cooperate? Does she think she already did? Have you tried having a HHA assist with showering? Sometimes PWD find it easier to allow a professional to assist. This was one area where the MCF was better able to care for dad than mom was— he'd allow them to help. Same with my friend's mom as long as she recognized her daughter. There are some great videos on Teepa Snow's YouTube channel about showering. That said, wipes do get the job done along with rinse-less shampoos.

HB

mommyandme (m&m)

Are you using an incontinence pad in her underwear? That’s what my mom started with. I wonder if your MIL will wear adult “pull ups”. I know how the toileting and disagreeing about it can get frustrating. Maybe a pad or pull-up will alleviate some of your worries. I think wiping by others/you will eventually become a regular thing. Having flushable wet wipes help with cleaning and so does lots of vinyl gloves. Oh, the double gloved moments, ugh.

Your MIL is incontinent in my opinion. Have you thought of having a hospice evaluation? The weekly CNA could really help with hygiene.

Hope5757

@Iris L. - Thank you Iris. I appreciate the encouragement. I’ll keep reading!

@harshedbuzz - I have a strong tendency for taking things too literally. So, I thought incontinence was literally accidents without even realizing an accident had occurred.

@mommyandme (m&m) - Thank you! She’s wearing washable padded underwear and I have waterproof pads on her bed and recliner. Her PCP had recommended palliative care but she wants aggressive treatment for now.

M1

Hope do you hold her medical poa? In that case you get to make the decision about treatment. She is not capable of making any decisions about what treatment is appropriate or not.

Hope5757

Hi @M1- Prior to designating a medical POA 20 years ago, she elicited a commitment that the POA would honor her wishes. She’s always wanted every possible medical intervention.

harshedbuzz

@Hope5757 said: Her PCP had recommended palliative care but she wants aggressive treatment for now.

Are you her health care proxy/agent?

I am a little confused with the notion of "aggressive treatment". Does she have some condition other than dementia that has a potential for cure for which she would be deciding between "aggressive treatment" and managing symptoms?

HB

Iris L.

91 year old DMIL with dementia has anosognosia. She is not aware of the nature of her condition. What aggressive treatment is she thinking of?

Iris

Hope5757

@harshedbuzz and @Iris L. -

MIL has had lung cancer for over a decade and kidney disease for about 5 years. As recently as four months ago, she asked her oncologist to send her to a specialist for trials. He declined but she continues to ask. For many different reasons, multiple oncologists have determined additional treatments were not advisable.

But when I mentioned aggressive treatment, I was thinking about the chest compression and ventilator questions at the ER. MIL was not just a “yes”. It was “YES!”

Her son (my spouse) holds a springing medical power of attorney.

mommyandme (m&m)

Sounds like you’re on top of things! Does your MIL also wish for a feeding tube? That was something my mom made clear she did not want.

Hope5757

@mommyandme (m&m) -

I don’t know if she would understand the feeding tube question. I hope we never have to find out.

mommyandme (m&m)

I should have mentioned that my mom stated her EOL wishes well before her diagnosis, in her living will. Fortunately, because she cared for her own mother (not dementia) she saw the importance of getting her wishes medically and financially legalized. Such a loving gift she provided my brother and I.

Iris L.

There have been many discussions about aggressive treatments late in life. One book to read is Hard Choices for Loving People. Many members have found it helpful.

Iris

harshedbuzz

It sounds like she doesn't comprehend what she's asking for which is all the more reason not to discuss it with her.

In addition to the book Iris recommended, I like Being Mortal.

My mom who doesn't have dementia had no idea what Hail Mary end-of-life care looked like until she read that. That said, mom has a lot of misinformation of this sort of thing. Mom's a bright college-educated woman who said she'd never want hospice "because they won't feed you".

HB

Hope5757

Thank you @Iris L. and @harshedbuzz -

MIL just got back from her 2nd hospitalization in less than a month. Both were due to significant difficulties with breathing. The first visit, they discovered a clot in her lung. This time, the doctors think it’s a combination of many different medical issues. She barely qualified for home oxygen according to the readings, yet she seems so distressed. I wonder how much of the breathing issues are related to her dementia confusion.

Unfortunately, she kept pulling off the nasal cannula. She’s sundowning so I’m hoping it’ll be easier tomorrow. The last hospitalization impacted her badly. I’m hoping this one won’t be as bad.

As to the end of life decisions, it’s all up to DH as the POA. But, whatever happens, I’m praying that she won’t suffer unnecessarily and DH will be able to reach decisions with peace.

Little1211

Hello, I care for my 92 y.o. Dad who also has some issues due to voiding & BM. We tried pads for men but ultimately discarded all of his regular underwear and shifted instead to Depends underwear. We still need to remind him to change them and ensure there is a disposable pad on his bed before he sits down while changing them. This prevents BM on beadspread. I also tend to give him wipes to take care of cleaning his front and insist that I clean his backside. He often doesn't realize when the disposable underwear is wet or has BM. It is tough but it is the way we have learned to manage the situation. He has been living with me for the past 1.5 years. I also insist that he allow me to clean under his fingernails for obvious reasons. He doesn't seem to have a problem with it. We also have arranged for carers from 7 AM to 6 PM so that I can go to work. The AM carer gives him a shower using a shower chair every-other-day. Best of luck.

Little1211

I also purchased a diaper disposal system "Dekor Classic Hands Free Diaper Pail" on Amazon about $34 it has refills that are not bulky just continuous baag. It is a must, in my opinion, no smell in the room, easy to work with, etc. I bought 1 for the bathroom and and 1 for his bedroom for disposal of used disposable underwear and wipes. I also use disposable gloves and mask. It makes the cleanup easier.

Iris L.

Hope5757, having a low blood oxygen level will keep your mom confused. Low oxygen also causes anxiety and distress. Given her dementia and anosognosia, it will be difficult to keep her oxygenated. Don't hesitate to ask the respiratory technician for suggestions. And search Google and YouTube for tips.

Iris