OLD AGE AND DEMENTIA

Apr 07,2017

Part of a larger problem

Doctors and others often rejoice in the fact that many people are now living into their late 80s and even 90s, and there are more centenarians today than a couple of generations ago. This is much more frequent in the industrialized west, but would soon be a reality in our country as well.

It is no doubt a laudable achievement for medical science as a whole, but a growing population of such an advanced age poses its own challenges. For only a small minority of people in this age group are truly disease-free. The need for medical attention is greater; the ability to take care of oneself diminishes with the passage of years, thus placing a heavier load on family members and other caregivers.

Urinary incontinence is, therefore, a part of a larger medical condition, or perhaps even the consequence of a completely unrelated ailment, such as senile dementia or Alzheimer’s Disease.

Dementia group of disorders

Though the causes of Parkinsonism, Alzheimer’s, Senile Dementia, and other similar disorders are very different from each other, we have grouped them together because their impact on the ability to control urine is somewhat similar.

Primarily, we are concerned here with the loss of memory and a deterioration of general awareness of one’s location, the time of the day, and so on. Thus the affected person could actually not remember the location of the toilet at home, or be unable to locate the toilet in a public place such as a railway station or airport. In fact, such a person might stray away from home, without quite realizing it and then roam around apparently aimlessly till someone on the road recognizes them and escorts them home!

Besides, in advanced cases, the afflicted person might even fall asleep during the day and pass urine in their sleep as well.

The type of incontinence we see here is a modified form of urge incontinence, where the person is unable to hold their urine beyond a point. This also means that voiding of urine is ample and copious, unlike a few drops that may have leaked onto the clothes.

Apart from the embarrassment that this is likely to cause (perhaps more to family members than to the person himself), frequent incidents of this nature could result in urinary tract infection or fungal infections (on account of the clothes being damp for long periods).

In all these cases, the response of the family members or caregivers should always be supportive rather than remonstrative. Possibilities include:

  • Marking the toilet with a large, prominent sign
  • Leaving the toilet light on at night
  • Helping the afflicted person to go to sleep easily with a help of a fixed routine, perhaps a warm beverage after dinner
  • Establish a bedtime routine that encourages him to go to the toilet just before being tucked in

Other medical conditions

While the Dementia group of disorders has received a lot of attention in recent years, a number of other medical conditions could also affect one’s toilet training and habits. One extremely common issue is chronic arthritis affecting the knees or hips, which simply means that the person moves too slowly to reach the bathroom in time!

Similarly, if someone’s vision is getting weaker, because of cataract, or retinal disease or some other common medical problem, they may not be able to read the signs and find the toilet in time. This is less likely to happen at home but very likely in a public place such as an airport or supermarket. If there is an accompanying person, the responsibility rests on the escort, but that may not always be the case. When traveling alone by air, it is surely advisable to seek the help of the airline staff, rather than stumble along on one’s own!

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