Teaching a person with dementia how to care for their stoma is not possible in all cases, but where it is possible, attempts should be made to encourage them. The level of independence achievable will vary. A person with dementia may benefit from extra time and repetition of the tips below. These were suggested by healthcare professionals who have been actively involved in the care of ostomates with dementia.
Bag changing and stoma care
Lessons should break tasks down into small, simple steps, with repetition and continuity being key components.
Where possible, the above should take place in quiet and familiar surroundings.
Some people with dementia benefit from written instructions. Others may be helped by the diagrams on pages 6 and 7.
If the person with dementia is elderly, it is important to remember that they may have other conditions (such as hearing loss) that can impair learning and so need to be taken into account.
People with dementia who are actively involved in changing their bags should be encouraged to wear gloves. This reduces the risk of infection, faeces under the nails and faecal spreading.
Some people with dementia who require their bag to be changed for them might resist. In these cases, distraction could help. For instance, encouraging the person to clean their teeth or brush their hair during the process might be helpful. Standing the person in front of a mirror so they can focus on the task they are performing and not the bag change can also help.
Fiddling with the bag and inappropriate bag removal can be avoided by:
Putting on net pants with normal underwear on top, following bag changes.
Tucking the person with dementia’s vest/ shirt/ blouse into their pants.
Keeping the person with dementia occupied with small tasks as a way of distracting their attention.
Noting the timings of bowel movements to ensure, where possible, timely bag changes take place. Bag fiddling is often triggered by a heavy bag.
If the person is living at home, then visits from the community nurse should be scheduled for mid–morning. This allows the person time to get into their ‘morning’ routine.
Bag choice is important. One–piece bags with a pre–cut aperture have the advantage of being uncomplicated for both the person and carer. Two–piece bags, where the flange can remain in situ for up to three days, helps protect the skin where frequent changes are necessary.
The bowel plays an important role in the absorption of medication. As stoma surgery often involves the removal of a large amount of the bowel, it is vital to consider the impact that this might have on a person taking drugs for their dementia and other conditions. It is therefore important for carers to be aware of this and ensure that the matter is discussed with the appropriate healthcare professional both pre– and post–operatively, and when any changes to medication take place.