Suddenly, my mother’s behavior changed from serene and happy to confused and agitated. Did her behavior worsen suddenly due to her dementia, or could it be an infection, or something else?

I checked my mother’s temperature. She had a low-grade fever.

And then, behind the closed door of the bathroom, I heard her say, “That hurts!” Off to the doctor, we went.

She was diagnosed with a UTI.

As caregivers, we are the ones that must pick up on the symptoms that our loved ones display, and this commonly shows up as a change in behavior.

Behavior serves a higher purpose in people with dementia. It communicates to us that something is wrong, and frequently the symptoms and causes are common to more than one ailment and condition.

Five Ailments and Conditions with Symptoms Common to Dementia

If you transcribed the discussions from a group of caretakers surrounding the ailments of people with dementia, you would find many similarities, but mostly in common causes.

We have demonstrated this between five of the most common ailments and conditions that occur with dementia. We have also included some brief tips for the caregiving of each:

Incontinence

Whether it be bowel or urinary incontinence, there are no marked behavioral symptoms other than confusion, but there are many common causes and various ways to manage the physical needs.

Common causes:

• Infection (UTI)
• Constipation
• Prostrate problem
• Loss of mobility (loss of gait, balance, or inability to get to the restroom in time)
• Medications (such as diuretics and sleeping aids)
• Worsening dementia (inability to recognize the need to use the restroom, not reacting in time, or not able to tell someone that they need to go)
• Fluids (drinking too many fluids, caffeinated fluids)

As a caregiver, our first focus in caring for a person with incontinence is to help them retain a sense of dignity.

Respect their need for privacy. Don’t scold. Use soothing language, such as, “Anyone can have an accident.”

Rule out any medical conditions. Determine ways to make the bathroom more accessible, and include mobility aids (canes, walkers, etc.) to help them get there in time.

Choose clothing that is easy to remove. Monitor fluid intake. Limit caffeine.

UTI (Urinary Tract Infection)

Unlike incontinence, which is not associated with symptoms that include certain behaviors, UTIs often appear with increased dementia-like symptoms.

These symptoms come on quickly, within one to two days, and often include restlessness, agitation, social withdrawal, confusion, hallucinations, fatigue, loss of balance, urinary incontinence, and a change in urine (strong odor, pink or brown in color).

UTI’s are caused by bacteria or fungi that have entered the urinary tract.

A UTI must be diagnosed and treated as quickly as possible, as the ailment can lead to other complications, such as sepsis or kidney damage.

Proper hydration is a must when battling (and preventing) urinary tract infections.

Balance Difficulties (Falls)

With balance-related difficulties, we see physical symptoms such as walking unsteadily, shuffling, bumping into things, stooped posture, or increased falls.

We may also see changes in behavior that are common to other ailments, such as restlessness and agitation.
People with dementia are prone to balance difficulties, but when these symptoms come on suddenly, it can be indicative of other causes, such as:

• Infection (UTI and other hidden infections)
• Medications (side effects, drug or food interactions)
• Vision changes (changes in spatial awareness)
• Hearing changes (as well as problems with hearing aids)
• Pain or discomfort (pain in the body, discomfort with clothing or footwear)

The first step is to rule out any medical difficulties, such as infection, medication interactions, or side effects, as well as vision or hearing changes.

Our loved one’s living area should be made safe and easy to navigate.

Exercise is important (if possible) to improve a level of balance. Also consider mobility aids that can help improve steadiness, such as canes or walkers.

Skin Conditions (Picking, Scratching, Rubbing)

As dementia progresses, our loved ones often focus less on their surroundings and more on what is physically within reach, and that can lead to skin picking.

Repetitive skin picking may be diagnosed as a disorder called dermatillomania. Patients diagnosed with this disorder will also pick at other things within reach, such as their hair or clothing.

Repetitive skin picking, scratching, or rubbing may also occur due to other common causes:

• Infection (skin or fungal infections such as candidiasis, or hidden internal infections such as UTI)
• Dry skin (caused by dehydration)
• Medications (drug or food interactions, allergic reactions, side effects)
• Allergies (medications, foods, environment)
• Parasites (scabies, lice)
• Insect bites (ants, mosquitos, bed bugs)
• Pain or discomfort (pain in the body, discomfort in clothing or footwear)

Rule out any health-related causes that could lead to skin picking, scratching, or rubbing, including medications, infection, parasites, as well as dehydration, and allergic reactions.

Check your loved one’s environment for insect infestation, or insect bites, especially if they have been outdoors.

Swallowing Difficulties

Your loved one has recently been coughing while they are eating. It may appear as if they are having difficulty swallowing. What is the cause?

Eating is a complex process that involves chewing, swallowing, and physical abilities that can become difficult for a person with dementia, and especially as their condition progresses.

Swallowing difficulties (including the inability to chew, as well as coughing and choking) can be caused by:

• Mouth discomfort (infection or ulcers in the mouth or gums)
• Toothache
• Dentures (improper fit)
• Medication (side effects such as dry mouth or dehydration, drug or food interactions, allergic reaction)
• Infection (chest, throat, UTI, or other hidden infections)
• Stomach ailments (or other ailments that lead to loss of appetite)

Rule out anything in the mouth that may inhibit your loved one from wanting to eat, chew, or swallow food.

Rule out any adverse medication factors, and ensure there are no hidden medical causes, such as infection.

Especially as dementia progresses, feeding softer foods that require less chewing and are easier to swallow can help to prevent choking.

Patience is key in this process, as mealtime will take longer, and may require extra creativity in food preparation to help our loved ones eat.

Shared Symptoms and Causes

Compare the symptoms and causes of the five ailments, and you’ll notice several that are common.

These are the universal starting points in our approach when we notice behavioral changes. Observation is everything!

Sitting at the top of the common cause list is infection (UTI as well as other hidden infections), followed by medications (side effects, drug or food interactions), allergies, and pain or discomfort in the body.

Confusion is the most common amongst the symptoms.

We Are Here to Help

We know that it can feel disheartening and frightening for those of us that caretake our senior loved ones with dementia. We do not want you to feel alone in this journey.

We know that you want the best care for your loved one, and here at Sundara caring is what matters. Memory care is all we do…and we are really good at it.

If you have questions, we can help! Contact us online or schedule a virtual tour online or by calling us at 512-399-5080.

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