1. Expert Q&A: Benefits - Weds 23 October, 3-4pm

    Our next expert Q&A will be on the topic of benefits. It will be hosted by Lauren from our Knowledge Services team. She'll be answering your questions on Wednesday 23 October between 3-4pm.

    You can either post your question >here< or email them to us at talkingpoint@alzheimers.org.uk and we'll be happy to ask them on your behalf.

Mum took catheter out herself, now doctor is questioning her capacity......

Discussion in 'I care for a person with dementia' started by LizzyA, Jun 16, 2015.

  1. LizzyA

    LizzyA Registered User

    Feb 21, 2013
    72
    Near Reading
    Hi. I posted a few days ago to say that my mum was being discharged from hospital with a catheter and that i was worried about her taking it out due to her vascular dementia.
    She was discharged yday (with carers calling 4 x a day) and I had a call this pm from her GP as a district nurse had called and found mum had removed the catheter. The GP now feels that mum needs to go into a care home as she will go back into urinary retention without a catheter.
    I've spoken to mum twice tonight and she'd told me she'll kill herself if she has to leave her home and go into care. She has no recollection of removing the catheter or why it is needed.....
    A care home seems extreme. Mum's vascular dementia seems to have worsened quickly but apart from the really bad short term memory she is reasonably independent and happy at home. A care home seems extreme and I am now worried that the doctor will try and insist on this as a solution to the catheter issue. I'm not convinced that she'd keep it in in a care home either!!
    So a bit of a nightmare here. Some sort of respite care has been sorted for her from tomorrow but that's in lieu of a more permanent solution :-(
     
  2. Soobee

    Soobee Registered User

    Aug 22, 2009
    2,734
    South
    #2 Soobee, Jun 16, 2015
    Last edited: Jun 16, 2015
    I don't know what the solution is but I think you're right that being in a care home won't stop her from pulling a catheter out all the time. Maybe the gp or hospital could explain how a care home could possibly help with the urine retention issue?

    Care homes aren't as bad as many think they are but I can understand your mum's reticence to leave her home.
     
  3. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,439
    Oh gosh, I'm sorry you are dealing with this. The truth is, no specific location will stop this happening - care home/nursing home/hospital/ or home: she has dementia and I can't see how anyone could stop this happening, barring tying her hands behind her back frankly and obviously that's not an option.

    Is this is regular (through the urethra) type catheter, or a suprapubic catheter? And is this going to be a long term thing?
     
  4. Spamar

    Spamar Registered User

    Oct 5, 2013
    6,976
    Suffolk
    I feel that in a care home there would be 24hour care so catheter could be replaced. If your mum has such a poor memory, of course she will pull it out. OH was the same, though he didn't pull catheter out, just everything else, cannula, 3 drains, even epidural.
    However, if mum gets urinary retention, that can lead to all sorts of problems. So, devil or deep blue sea? I'd go for the care home.
     
  5. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,439
    I very much doubt that anyone in a care home would be qualified to replace a catheter. In fact, even a nursing home might be stretched to do that, at least immediately. Of course, in either place one would hope they would notice fairly quickly what had happened, so there's that.
     
  6. Chaucer 1931

    Chaucer 1931 Registered User

    Mar 30, 2014
    226
    I agree with Jennifer PA, no matter where your mum is,either in a care home or in her own home,she is going to do it anyway..
    I have had this theoretical debate with myself,over deciding whether I should put my mum into care or to carry on caring for her here.
    Now I know your mum is independent in her own home,and aside from the removal of the catheter,I think it is an extreme reaction from her GP as there are a couple of ways to try and manage her without a catheter,but at the cost of the district nurses time if they were willing to-intermittent catheterisation,where your mum would have one or a couple of visits to be 'drained' by the nurses.
    It depends on a few factors,(but it's worth discussing with the GP)it's not the most comfortable procedures ever-but it would take away the risk of your mum damaging herself by removing the catheter.
    My mum tried this for a few months but after her last spell in hospital,she was sent back out with catheter in and the nurses have said if she pulls it our herself again,then they would return to intermittent catheterisation.

    With the best will in the world,your mum would not be any better off in a care home for the sake of prevention-she cannot be watched 24hrs a day-most times the catheters are pulled out when they are in bed and I have found this to be the case with my mum.she did get up and go wandering with her night bag attached and got the tube stuck under the door,as she didn't know what she was doing! But this could also happen if she was in a care home-nobody is going to sit and watch over her all night to make sure she doesn't do anything she shouldn't .

    The issue with urine retention can damage the kidneys,the bladder is stretchable to an extent-500mls is what my mum was holding on a daily basis-on a ultrasound scan she has a few times!

    I would ask the G.P what he infers by saying your mum needing 24hr care.



    Sent from my iPhone using Talking Point
     
  7. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,439
    I don't know much (or anything) about this really, but I wondering if she had a suprapubic catheter port, whether it would be possible to incorporate Chaucer's suggestion where a nurse would come, say, twice a day to drain the bladder. In fact, would a nurse be needed? Anyway, my point is, perhaps the intermittent draining could be accomplished via a port instead of a catheter being inserted via the urethra. I don't know if this is possible: the only experience I have with ports is venous ones for chemo, but they most certainly aren't attached to anything all the time. Of course, thinking about it they are going the other way (stuff being put in rather than stuff being taken out).
     
  8. Chaucer 1931

    Chaucer 1931 Registered User

    Mar 30, 2014
    226
    There is something along the lines you are thinking of Jennifer,but it is still attached to the catheter tube,it's called a Flip-Flow(Flo?) valve.
    Basically,just the tap part of the catheter bag.. It could be worth trying your mum with those-the District Nurse/Urology nurse will have heard of these.
    Not saying your mum won't still try to remove those,but it is much less risk and much less noticeable than the entire bag..
    Perhaps this could work with your mum,she may need a reminder from the carers to empty it,but then there is the risk of her forgetting to close the valve...which is what happened with my mum..
    It's worth exploring all these options before considering her going into care,I feel it's early days for your mum yet,but maybe coupled with any other ailment/condition she has your doctor is thinking of her managing them all without her struggling..



    Sent from my iPhone using Talking Point
     
  9. LizzyA

    LizzyA Registered User

    Feb 21, 2013
    72
    Near Reading
    Hi Jennifer and thanks for replying. I completely agree (and luckily so does the social worker). It is/was (!) a regular catheter. Our lovely social worker is pressing the medics for a solution for us x
     
  10. LizzyA

    LizzyA Registered User

    Feb 21, 2013
    72
    Near Reading
    Thank you so much for all replies x

    I know that social workers are not generally popular on this site, but mums is great, very calm and measured and is now liaising with the doctors to press for a solution to the catheter issue. She agrees that mum will take it out wherever she is and is clear that a care home isn't a solution. The catheter is needed due to a rectal prolapse (which they won't treat) with the knock on impact being that the bladder doesn't empty properly.

    She goes back in to hospital today. Her memory seems really awful suddenly. The social worker feels that she doesn't have capacity and I guess that the POA will soon kick in and I'll be making decisions for her.
     
  11. Chaucer 1931

    Chaucer 1931 Registered User

    Mar 30, 2014
    226
    Hi Lizzy,

    Hope you are feeling a little less worried,it is good news that your mums social worker agrees that something could be discussed with the medics to enable your mum to continue in her own home with support,I'm sorry your mum is back in hospital but at least she can be monitored whilst the doctors and you can find a plan that is worth trying.xx


    Sent from my iPhone using Talking Point
     
  12. jenniferpa

    jenniferpa Volunteer Moderator

    Jun 27, 2006
    39,439
    I'd want a very good reason why they won't treat the underlying cause to be honest. Yes, I realise this would require surgery and that's never good when you are older, let alone with dementia, but I can't help feeling that this is one of those situations where failure to treat is actively causing harm.
     

Share This Page

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.