People who have Alzheimer's disease commonly face some form of incontinence as the disease progresses, particularly in the middle and late stages. 

Alzheimer's disease is a progressive neurological disorder that is irreversible. The disease, over time, destroys memory, thinking skills, and the ability to carry out everyday tasks. The disease shrinks the brain, which causes brain cells to die. According to the Mayo Clinic, approximately 5.8 million people over 65 are affected in the United States alone. 

The most commonly recognized signs of the disease can include being forgetful of recent conversations and events. Other early symptoms may include difficulty remembering words, vision, spatial issues, and impaired reasoning and judgment. As the disease progresses, the person affected typically has trouble driving and completing everyday actives. As memory impairment progresses, it becomes more severe; people become angry, violent, or worried.

There are a few reasons why this might occur; the person may become unable to recognize that they need to use the bathroom. Their incontinence issue could result from a medical condition, a result of medication, or environmental obstacles. While catheters can help patients in their later stages of Alzheimer's, the risk for UTIs poses an even more significant risk for these individuals, particularly when considering the risk of the individual pulling the catheter. For male patients, the QuickChange Wrap is a great non-invasive alternative to keep the individual dry. 

The Stages of Alzheimer's Disease

There are three stages of Alzheimer's disease: mild, moderate, and severe. The mild stage is an early stage of the disease in which the individual can still function independently. Those in the moderate stage show significant memory loss, difficulty recognizing family and friends, confusion, and personality changes. The severe stage, the final stage of the disease, is when the person will require help with basic activities like eating and walking.

What symptoms may look like:

• Continuously misplacing possessions
• Repeating statements and questions
• Difficulty concentrating and thinking about abstract concepts
• Forgetting conversations, event, or appointments
• Forgetting the names of family members and everyday objects
• Getting lost in familiar places
• Inability to recognize numbers
• Being unable to take part in a conversation, express thoughts, or recall the correct word for objects
• Changes in personality and behavior 

Dementia vs. Alzheimer's

A common misconception is that dementia and Alzheimer's disease are the same; however, dementia is a group of symptoms with several causes. While all Alzheimer's is dementia, not all dementia is Alzheimer's. Typical dementia symptoms include difficulty with memory, problem-solving, language, and other cognitive skills may be affected. Dementia is a result of nerve cells in the part of the brain that correlate with the cognitive function being damaged or destroyed. Some common causes can lead to dementia-like symptoms: depression, delirium, side effects of medications, certain vitamin deficiencies, thyroid problems, and excessive use of alcohol.

On the other hand, while nerve cells are also damaged and destroyed with Alzheimer's disease, there is a progression in brain changes. Alzheimer's typically begins years before the first symptoms of Alzheimer's dementia become present. Alzheimer's disease is ultimately fatal. The symptoms for people with Alzheimer's vary, but those who develop the disease experience several symptoms that change over the years. In its early stages, the disease can look like having a difficult time remembering events, recent conversations, as well as apathy and depression. Later phases will include impaired communication, disorientation, confusion, poor judgment, difficulty speaking, behavioral changes, and eventually difficulty swallowing and walking.

While someone may develop dementia, they may not always develop Alzheimer's disease. In some cases of dementia, unlike Alzheimer's, the condition may be reversed.

Causes of Alzheimer's Incontinence 

When your loved one begins to deal with incontinence, it's essential to discuss with your doctor as it may not have to do with their ability to recognize that they need to use the restroom. Possible causes include:

Medical conditions such as UTIs, constipation, and prostate problems. Incontinence can also be a result of diabetes, a stroke, or a muscular disorder.

Medication such as for sleeping or to reduce anxiety may relax the bladder muscles, which can lead to urinary incontinence. 

Managing Incontinence

When caring for an Alzheimer's patient with incontinence, there are steps that caregivers can take to aid the situation.

First, it's important to understand that accidents can be embarrassing for the person, so it's best to approach the situation in ways that preserve dignity. Be matter-of-fact, don't scold. That being said, communication is vital, both in encouraging the person to communicate with you if they need to use the bathroom and in letting them know that it's safe to talk to you. 

Make finding the bathroom easy for them by keeping the bathroom door open, so the toilet is visible. Remove any items that could be mistaken for a toilet, such as trashcans and plant pots. 

As the caregiver, pay attention to that person's bathroom routine and schedule so that you may be able to remind them to go to the restroom. Be sure to choose clothing that is easy to remove and clean, as accidents can happen at any time. 

When leaving the house, make a note of where bathrooms will be at your destination, and when there, let the patient know where the restrooms are. When going out, padded undergarments and adult briefs can be used, even if the person doesn't ordinarily use them—this can be of help when going somewhere where getting to the toilet might be difficult. In these situations, if the man is bowel and urine incontinent, a QuickChange can be used in conjunction with briefs— this way, if only the wrap is soiled, you won't need to change the briefs as well. 

The Later Stages of Alzheimer's

As Alzheimer's disease reaches the last stages, the brain changes affect physical functions. Someone impacted by the disease may have difficulty swallowing, balancing, and bowel and bladder control. These symptoms can, in turn, increase the patient's vulnerability to:

• Falls
• Bedsores
• Dental problems
• Malnutrition and dehydration
• Fractures
• Infection

Treatment 

While medication can for a time improve or slow the progression of symptoms, however, no treatment cures Alzheimer's disease. Your doctor may prescribe drugs to slow down the progression of the disease. However, it's important to understand available options to treat some symptoms to improve quality of life. 

People affected by this disease often have a difficult time sleeping. While medication may be prescribed, there are also non-drug approaches that doctors recommend trying first. Sleep problems can be made worse by depression, restless leg syndrome, and sleep apnea. 

To help promote rest:

• Avoid alcohol, caffeine, and nicotine
• Treat pain 
• Maintain regular meal and bedtimes, as well wakeup time
• Regular exposure to the sun
• Nightlights and security objects

Changes in behavior begin to happen as the brain cells deteriorate. This can often look like irritability, aggression, emotional distress, anxiety, delusions, hallucinations, and depression. Change can be stressful for anyone, but it can be particularly difficult for someone affected by Alzheimer's disease. 

Situations that may trigger distress:

• Moving locations
• Changes in familiar environment or caregivers
• Hospital admission

For the caregiver, it is essential to identify what may trigger the person's response. It's also vital for the caregiver to recognize that the person isn't intentionally mean but that it is a symptom of the disease. 

Some ways to manage these symptoms include:

• Avoid being confrontational 
• Respond to emotion and not behavior
• Check for pain, hunger, thirst, constipation, full bladder, fatigue, infections, and skin irritation
• Create a calm environment
• Plan for periods of rest between stimulating events
• Acknowledge their requests and questions

 When non-drug approaches fail, medication will be needed to help with sleep and behavior.

Caregiving

There can be many challenges when caring for someone with Alzheimer's disease, and the care tends to be long-term. According to the CDC, 32% of caregivers working with a patient with dementia end up providing care for five or more years.

Planning activities is an excellent way for caregivers to keep their loved ones or patient engaged. Activities are best planned at the time of the day when the person with Alzheimer's is at their best. Some great activities to plan for:

• Going for walks and light stretching
• Listening to music
• Cooking and baking
• Household chores
• Visiting friends and family
• Seeing a movie 

When going out, some caregivers will carry cards that they'll hand out that say things like, "My partner has Alzheimer's disease and may say or do unexpected things. Thank you for understanding." 

A nutritious diet is important for everyone, but particularly when someone has this disease. People with Alzheimer's may forget when they last ate, eat the same foods every day, or forget how to cook. As a caregiver, you can ensure that the person is getting enough nutritious food by giving them finger foods that are easy to pick up and eat, easy to chew, and serving meals at the same time every day.

Anxiety can become high for a person with Alzheimer's, so helping boost their self-esteem can be helpful. It's essential to ensure that everyday hygienic tasks are done, like brushing teeth, showering, and trimming nails. Other important routines include getting them dressed by helping choose and layout outfits, also opting for clothing with velcro or zippers.

Some of the products that can help when caring for someone with Alzheimer's disease:

• Timed pillboxes
• Picture phones
• Medical alert bracelets
• Nightlights
• Object locators
• Weighted blanket
• QuickChange Wrap (for men with urine incontinence)

Care for the caregiver

The challenges of this disease also make self-care particularly important for the caregiver. Caring for a family member with Alzheimer's disease can affect the caregiver's physical and mental well-being. You can't pour from an empty cup, which is why self-care is so important. So, what can you do?

Someways to take care of yourself as a caregiver include:

• Talking about your loved one's condition with close friends and family. You also have the option of speaking with a counselor or support group. Speaking about what you're dealing with help to relieve emotional tension 
• Sleep 7-9 hours every night 
• Daily exercise can relieve stress and increase energy levels
• Eat healthy foods
• Take breaks every day
• Make time to see friends

Don't be afraid to ask for help. Caring for someone with Alzheimer's isn't easy, and you don't have to do everything yourself. You can ask for help by asking people that you're close with to make meals, visit, or take care of the person for a short time. There are also home healthcare services that you can reach out to, and there are national resources that help pay for some of this help.

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Sources

-Mayo Clinic

https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/symptoms-causes/syc-20350447 

-National Institute of Aging

https://www.nia.nih.gov/health/what-alzheimers-disease 

-Alzheimer's Association

https://www.alz.org/alzheimers-dementia/treatments/for-sleep-changes

-Medical News Today

https://www.medicalnewstoday.com/articles/326374#communication 

-Alzheimer's Association: 2018 Alzheimer's Disease Facts and Figures