My father has recently entered a nursing home. He has been for some time now obsessed with his bowel movements, mainly constipation. He suffers anxiety which has lessened since entering the facility. However he is obsessed daily with his bowel movements. If he goes first thing in a morning we all have a good day, but if not he is a nervous wreck. He is medicated for it, but sometimes asks for too much and then is the the other way. He will discuss it with everyone even if they're just delivering his cup of tea. I am not embarrassed by this but am concerned that it is off putting for others and that people will start avoiding him and not caring about him. I have asked him not to discuss it with everyone, however, he continues to. The doctor believes there is nothing wrong with him medically in this department and that he is simply obsessed. We are making arrangements for him to be seen by a mental health professional. I would be greatful for your input this is wearing me down I left the facility in tears yesterday. I'm at a bit of a loss as to how to help him.
Let the nursing home deal with it.
BTW, she has no medical reason either....shes had all the tests, blood work etc. and i make sure she gets plenty of fiber etc
Keep working with his doctors, nurses and aides to get him as many of those good mornings as possible— he will talk about it less. Maybe that will incentivize his healthcare workers.
Hospital prescribed the Miramax and prune juice daily regimen, with suppositories every day for the hemorrhoids. WE had been asking for weeks before this that she get prune juice every morning, but it did not happen. We even took prune juice up there and put cans on the dresser the prior week, but by then it was beyond just prune juice.
Then last week one day, she started complaining of the same hemorrhoid type pain. I had the aide change her in front of me and I checked her bottom....hemorrhoids again. I went out and asked whether she was still getting the suppositories for them..and the nurse said, well no, we didn't know she still needed them. Well, I wonder, do your aides not report this when they change her ? As my brother says, nursing homes are just warehouses for the elderly. There is little or no compassion.....and not just in this one. I talk with several friends who either have family or friends in a NH in this county...and all the same problems. Sorry for the rant, but I am sooooo frustrated. She does not deserve this.
By the way, we went to NH administrator about this. When we told her about the nurses and aides just standing around nurse's station while my mom screamed and screamed, the administrator brushed that off, saying they get immune to screaming because they hear so much of it. On the other hand, I still have dreams about that.
This is not going to help your relative get better, but it may help you in the future to know that you did not allow the NH to slide by and not take care of your relative in the right way.
#1. Person to person conversations or phone calls with the NH staff are not recorded. Which you know, of course. And, yes, some of the nurses and staff and even unit managers will lie to you.
#2. If possible, alter your visitation times. If you always go the same days and time, believe me, they know that. Just show up at other times; don't even tell your relative in advance. Trust me, if this particular NH is shading you, they will freak out if you just start showing up when they do not expect you. Watch and see what they do. If all of a sudden, within one hour after you get there, everyone from the nurse to the aide to housekeeping shows up in the room......hey....they are afraid of you. That's not their normal schedule. That is how you monitor them.
#3. Every time something happens that seems not right to you, and every time your relative calls and complains, just take the time to enter the time and date of the call and the complaint in your calendar; whether that's on your iPhone or Samsung, or even just get a normal notebook, whatever. Just do it. It won't prove anything as far as evidence, but it will show that you were keeping track and entering details.
#4. You need to put your concerns and complaints in writing, and send them to the NH, to everyone to the top administrator to any unit manager and unit nurse, and do not email it and do not snail mail it: you must mail it registered/certified mail so that you have proof that someone signed for it. I always go to the UPS store. Yes, it costs money. But, I always know that it was delivered, and can track it, and I have a record. And, CC everyone you want to. The "CC" scares the crap out of people below the top level. You can follow the same letter up with an email, but PLEASE do not opt for the easy, free way to lodge your complaints. If you do not do it in a way that you can prove you did it, it's the same as not doing it.
Lastly, based on what you told all of us, your relative is in a shitty NH. I hope that there is a way to transfer your relative.
Honestly, I just don't understand it. Yeah, I know....walking around all day and night with your own water bottle is something that started maybe 10-15 years' ago. So, someone who is 91 years old is not going to "get it."
But, it's just water. Why oh why can't they just understand that it's a medical issue and drink the water the same way that they take their meds, and get upset when they don't think they get their meds on time?
I asked the entire medical staff: they said they cannot do anything other than to "suggest" that she drinks more water.
It's a serious problem. I understand.
If the X Ray comes back negative then all is well. The radiologist is the one “reading” the X Ray and has the final diagnosis. Ask for the radiologist’s report. If everything is not OK, then steps will need to be taken to remove the impaction (Enema first, hopefully that does it.)
Its easy to “dismiss” older people’s idiosyncrasies but you need to make sure nothing is wrong before you write off their complaints.
After everything has been checked, things you can do to encourage your dad to keep his bowels moving are;
1. Drink more water (or non-caffeinated drinks). Elderly NEVER drink enough.
2. Eat prunes or drink 4 oz. prune juice/day.
3. Walk as much as possible-even if it’s only up and down the halls of the facility.
4. Eat fruits and vegetables every day.
5. On the advice of his doc, add Miralax to his medication regimen. (I believe it’s over the counter but you would need the doctor’s approval first.)
6. Also ask if he can start stool softeners. Do not confuse these with laxatives-they are not! Stool softeners just keep more water in the stool, making it easier to pass.
7. Check with the doc to see if any of dad’s other meds cause constipation.
Now, I’ll agree that lots of seniors are bowel obsessed. Many were told as kids that they would get sick if they didn’t “go” every day. Many poor seniors are straining to push out something that isn’t there or ready to come out. Bowels, like many other body functions don’t have a built in clock for when to work.
He’s NOT going to stop talking about it, so, after he’s been thoroughly checked and cleared, you will need to acknowledge his concern then turn off your listening. Do NOT continue to engage him on the subject-redirect the conversation. If necessary, get up to go get a drink of water (and get him one too) or go to the bathroom. If it won’t stop, you’ll need to politely excuse yourself and leave. You must take care of your sanity too.
Good luck. 😌
Excellent response. I have learned that obsession with BMs is very common among elderly. Also, that someone can be impacted even if they are having some BMs.
It won't stop, if it's an obsession. You do have to just lay down the law and say that it's a topic that you will not discuss. And, then just ask the head Nurse if there's an issue. My mother now 91 has been obsessed with BMs for years. When she lived at home, she started every day with a suppository --- for years. When she had 24/7 caregivers, we hid the suppositories and found ways to bribe her to drink more water and also had a rule that she had to drink some prune juice at breakfast. And, give Mirolax or Dulcolax. At the times the doctor told us to.
Now she is in a nursing home. They have a fixed protocol (which can be adjusted, of course), consisting of a schedule every day for stool softeners and light laxatives, it probably consists of 4 things a day --- but no suppositories. And, prune juice at breakfast.
And, yes, it's true. If the parent doesn't eat well for only one day, but gets all the meds for constipation, then, yes, her bowels will try to expel everything. And you will hear complaints about diarrhea. Two days ago, my mother ate none of her lunch, but she is in a Jewish-based facility, and it's still Passover, so when they took way her "uneaten lunch" I had them leave the matzoh.....which is very binding.....but only because she was complaining about diarrhea all morning and I could smell in her bathroom that a lot had been going on in there. Like way too much going on.
They try to get her to NOT flush the toilet, so the aides can record when she has a BM, but of course she won't go along with that; probably just cannot remember. But, seriously....the smell alone should let them know that she had a BM. I definitely smell it, when I visit and she goes to the bathroom. And, that's even with gel air freshener.
There's really no way to get rid of the obsession. But, there is a way to have the doctor institute a medication protocol. Not a PRN....but a definitive schedule.
I guess "science" has begun to prove that fecal matter was poisonous to the body and you needed to get that out ASAP. The thinking was that you'd sit the child on the potty first thing, everyday and they could not get up until they had had a BM.
It went beyond obsession, really. That's how my dad was raised and I know he stuck by this principle of 'health' all his life.
He was also administered a 'glob' of Vicks VapoRub when he had a cold (put in the mouth and let it slowly melt) and when he had a sore throat grandma swabbed his throat with Mercurochrome, which I believe had mercury in it.
In his later years he was pretty much immobile and on large doses of Percocet. He HAD to take laxatives and MiraLax both, everyday, to ensure having a BM. Opiates will slow you down very quickly. Aging doesn't help, and yes, many elders are chronically dehydrated. My mom withholds fluids as much as she can, but I don't think she drinks more than 24 oz in a day.
We struggled with this with my FIL too. He'd be backed up one day and we'd hear about it all day, then he'd have these blowouts and --oh well--he wore thong underwear. I. Just. Can't. It was the grossest thing in the world. He WOULD NOT wear briefs, not for anything. When I threw out the thongs--he went commando. Oh well, one less thing to wash.
So I guess that generation came by the regularity issues naturally--obsessed mama's wanting to be the best, most 'scientific' mamas they could be.
We never did get dad to a state of 'normal' for him. He would have a BM and begin worrying about the next one almost immediately. He wasn't bad with anyone but mom. He spared us kids such intimate stuff, until the very end.
Some good suggestions here about making sure he isn't in fact constipated or even impacted/becoming impacted and beyond that making sure he is drinking plenty of water, get's a pro-biotic and/or pro-biotic foods each day, takes fiber (my mom now takes "triple" fiber capsules which are primarily psyllium husk I believe) daily and gets as much exercise as possible. Mom had a bout with constipation and was impacted just not fully and we added Metamucil (turned into the capsules because just about the time I got a mega size she stopped enjoying drinking it, lol) and have been really on top of her water intake and it's helped straighten things out. But I would suggest that you have a doctor, a professional other than you, who is looking into any possible problems and cares so not sure if the one you mention is the right one or not, let him know that they have checked everything out and found the issue is that his system has slowed down, not eating as much, not as much exercise and that's normal, he might not have a BM every day and that's normal now but it is important he let someone know if it's been (whatever time determined...3 days?) and that he drink X amount of water a day, get X amount of fiber...the things suggested for helping his intestinal system straight (fermented foods especially if he likes any) so he has an investment and responsibility for keeping himself regular it's just adjusted a bit from what he's used to. I'm hoping the ability to focus on the things that will positively affect his plumbing along with a new baseline might help shift his obsession or anxiety.
Maybe even once this discussion has taken place and you can then be on the same page as the doctor when reminding him it will give you an acceptable (to both of you) way to divert the conversation if he starts in on the BM topic. So when he starts bringing it up you can ask, When was your last BM, yesterday oh remember doc said...how much water have you had today, you took your fiber, what have you eaten today, yesterday? Maybe we should go for a walk...that sort of thing. There is of course a good chance it is an obsession you just wont be able to break with reason and distraction or his system feeling better in which case a geriatric psychiatrist or specialist of some sort might be able to prescribe something that can help calm the obsessive thinking and it's not uncommon for an elder to just use the medication through the particular obsessive behavior and once it's broken they can come off it, not all the time but a fair amount of time. The trick of course is the be vigilant with making sure they try to take them off rather than just take the path of least resistance and leave them on a med that may no longer be necessary.
Good luck!
DL
And here's the thing, I wrote colace and had to fix.
"With a life like mine, Doctor, who needs dreams?" - from Portnoy's Complaint, Philip Roth.