My father is 86 years old and vital in many ways; his primary problem is some urinary incontinence, wearing the same clothes over and over and not showering. He was here recently for 2 weeks and so faras I know, he took one shower, although he said several times that he was going to. He leaks urine pretty bad and does wear a pad, the question is, how often does he change it. I know that he does not not wear it at night when sleeping, nor does he wear underwear (he comes out in the a.m. 1/2 naked to go to the bathroom, He urinate on the bed, in the floor in the bathroom, on the furniture and on himself. He can't smell, so he is not aware that he smells unless someone (me) tells him. It is VERY difficult to talk with my dad about this over and over and over. He knows he has a problem. Just recently he emptied a pee bucket that he keeps in his room and he not only missed the toilet, it felt as though he dumped the whole thing on the floor.This could have been a mistake, but he doesn't clean it up and he does not tell us. He has had fecal problems too, where feces was all over the toilet seat (on the top), which he had to see, but did not clean up, nor did he tell us about it. I love my dad dearly and I know this has to be so hard on him; I am tryinig to be sympathetic, but something has to change.He has been told numerous times to change his clothes, to change his bedding (for when he is at his house, I change it when he is here), and to shower. I say these things as gently as possible to him.. he will do it one time, but then goes back to his old ways. I have read that this type of conversation comes better from an old friend, or from a Dr. than it does from children. I am considering calling his Dr. to see if he will talk with dad. Does anyone have an suggestions on what to do, or how to better handle this? Any suggestions would be appreciated., Thanks so much.
I had to have the shower talk with my dad. It was uncomfortable and embarrassing. The fact that he did not have dementia made it worse. I approached him as gently as I could and instead of asking him what his hygiene habits were (I didn't want to quiz him and make him feel bad) I suggested some hygiene habits. I figured that whatever I suggested he'd do less so I suggested he shower 4 times a week hoping that he'd shower at least 3 times a week. After time went by and this approach proved to be ineffective I hired a bath aide 3 times a week. My dad REALLY didn't like this but he put up with it but then soon decided that he'd rather shower himself than have someone else come to the house to do it. So he got himself into the shower 3 times a week.
I think the older my dad got the harder it became to keep up with hygiene. He was embarrassed about it and didn't want to discuss it with me and I understand that. But we needed to discuss it. Like someone before me posted, skin care, peri care, and overall hygiene habits are vital to someone's health plus I think it makes our parents feel better after having gotten it done. It's an accomplishment.
I would compromise when it came to many areas but I would not compromise when it came to hygiene and basic self-care. I think it made my dad uncomfortable as well, especially when he began needing Depends, but I approached it very matter-of-factly and as kindly as possible. I admitted I was embarrassed at having to have these conversations but we were both adults, we shared the same house, and some things needed discussing. Once I put it out there that way it cleared the air somewhat and allowed us to discuss the issues.
You'll find what works for you. It's an uncomfortable situation for everyone but once you take the bull by the horns and begin to tackle it it will get easier. Good luck!
My 89-year-old mother died quickly from UTI complications. During a visit, I had tried talking with her about her "odor" and she was so overly-proud she glared hatefully at me and told me to mind my own business. She appeared very much in command of herself and ADLs. Assuming she was rational, I did nothing but left. The result? Three days later she was rushed to emergency after spending two days in vomit and green fecal matter on the floor after falling, delirious. My sister and I (who live hundreds of miles away) rushed to the hospital to learn her UTI turned into a blood infection, and the "Failure To Thrive" syndrome set in and killed her. Adult Protective Services and local detectives investigated my Dad for abuse. The entire family was interviewed. They saw that there was no abuse, and Mom in a lucid moment concurred "My family is wonderful and leave us alone." We brought her home with Hospice oversight, and she died a week later. Dad was nearly oblivious. We knew if Dad couldn't call an ambulance for Mom (Mom had to tell him to after a lucid moment throwing up) -- that Dad needed firm care. My sister and I do prompt Dad to shower and change when we visit, and he does. But we could not wipe our father after bowel movements. Some kind of taboo for us there. Watching someone die from a UTI is horrible. Which leads me to say this. The person you are afraid of confronting is not the same person for whom you used to have immense respect and sensitivity toward. They are the same body, but they have gone to another place to live, not consciously. So it seems to protect the vestige of that person you honor, you have to watch out for them like a parent. But a parent who has a very different child that cannot learn nor mirror nor thrive. Letting go of a beloved parent-of-yore does not come easy. All we can do is try to let go with love. Our parents decline and fade, if we want to do best for them, we have to wrestle with our own limits. I have found docs don't deal with this issue beyond "Do you bathe?" Elder's answers in my experience: "Yes." Doc to me privately afterward: "You'll have to deal with it." It is up to you to set your limits, and hopefully reach out to any and all objective help you can find, like Area Agency on Aging, enlisting caregiver help, etc. I feel for you and cry for you, but you are not alone.
Approaches that help him keep his dignity and allow him to believe it's his idea can go a long way in assisting him in getting the self-care happening: May I help you get in the shower? It's laundry day, so let's get your clothes cleaned. Dad, I noticed a stain (or mess), let's get this cleaned up together . . .
You probably can expect much resistance at first because he will probably be embarrassed and not want help. I often took a hard-line approach and insisted. It wasn't pleasant much of the time but sometimes I could turn it into something funny.
Five years later, I'm still learning various ways to approach my dad about things. Plus we get tired of saying what seems obvious to us, so it's easy to weary of finding approaches that work! Just recently I consulted with a nurse practitioner who has expertise in elderly care and she stressed the importance of open communication; that we must address the situation. That means talking with Dad about what is happening and why he needs assistance with toiletry and why he needs to get up from the chair and that no, he is not dressed--one must wear pants around the house, etc.
As for seeking someone else to get the ball rolling, I absolutely agree. Dad can blow me off to some degree because I'm his daughter and he still "knows best" (and maybe he doesn't respect a woman as much as a man). I have found that a doctor's words give authority. Perhaps your husband, a brother, or other relative or friend might mention to your dad that he is fortunate to have you to help him as things get harder for him to do (or something like that).
And remember, you probably will have to keep working at setting the pattern of getting assistance; a few times of talking with and helping him will not have him clean up himself or seek your help. You may find that sometimes he takes care of himself okay and the next time is a disaster. Nevertheless, gentle direction on what to do next and offering assistance in a proactive way help. (And believe me, I am still learning! Being patient is not my best characteristic!)
Hope this helps.
Make sure the doctor will get your letter on his desk before the appointment. That way, the doctor can examine your dad straight away and you and the doctor won't have to have as much of a difficult conversation in front of your father. Sometimes a doctor familiar with a patient can pretty easily diagnose memory loss or dementia, but not the type. If there is a question about whether or not there is memory loss or dementia, you should ask to see a neuro-psychologist, whereas a neurologist would order and study scans and determine the type of dementia. Depending on the size of the community where your dad lives, you may be able to locate a board certified neuro-psychiatrist who could accomplish both tasks.
My aunt was evaluated and diagnosed at a large neuro-psychiatric center at a hospital in Castro Valley CA, part of the San Francisco Bay Area. She & l we're fortunate to have gone there as it saves a lot of time. By contrast, my dad was diagnosed by his cardiologist, confirmed with a brain scan by a non board certified "neurologist" (and I use the term reluctantly in her case), followed by his psychoactive medications being prescribed by a board-certified psychiatrist. We live in a hi desert community with fewer doctors and services of a good hospital are over an hour away. So it was a matter of driving my dad a very long distance 2 or 3 times (which he really couldn't handle) versus having to go in 7 or 8 times for him to get assistance. All doctors appointments confused and upset him, so it was a constant struggle to keep him calm.
BTW, my mom put him in diapers. This was BEFORE pull ups although I'm not sure it would have made a difference. Before his loss, he wore jockey shorts. After, the bathroom toilet scared him, so he used to go into his bedroom to a certain corner, pull away his diaper as if he had opened the pouch of his jockey shorts, and pee on the carpet. When my mother discovered he was doing this, she started following him to the bathroom, kept the lid of the toilet closed, and let him pee into the shower which she then rinsed out each time. No matter how it works out for each individual, the caretaking is usually going to be a lot of work.
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