Hi everyone. I'm new to this forum and am so grateful these message boards are available! Not only have I received good information on caring for my mom but also important emotional support. After reading some postings on UTI's I'm wondering if my mom has one. After a painful bout with constipation about 2 weeks ago she has had a significant mental decline - completely incontinent now, decreased appetite, unable to feed herself now, and the hardest to see is a loss of her vocabulary. She struggles to communicate and I can see how hard she is trying to get the words out. She can still walk around but cannot get up from a lying position by herself now. I would say she is in stage 6 and with this decline - entering stage 7(??) Not sure if this is a natural progression of the disease or a UTI or a result of getting a flu shot or the result of discontinuing Zyprexa from 10 mg. to zero. How is a UTI diagnosed? Is a urine sample necessary? If so, this will not be an easy task since she is now incontinent and unable to tell me when she needs to go. Would a UTI clear up without antibiotics? She has her next doctor's appt in 2 weeks. Not sure if I should take her sooner. It's always a big challenge getting her to take a drive in the car, especially to go to the doctor's. Thanks in advance for feedback anyone can offer.

I have had some of the same questions about UTI that you are having. my LO seems to keep an UTI. I am lucky to have a home health care nurse coming in twice a week to make sure she is physically fit. My LO for the most part can not tell me when she needs to go eihter. I have learned that when she starts showing signs of decline (she is in late stage 6), such as excesive confusion, unable to verbalize enough to put a sentence together. My first thought (now) is to have her checked. It has happened so often in the past year that now her doctor just calls the order in to the home health care nurse. She does and in and out cath. on her to get the sample that is needed. I have also discovered by trial and error and asking a ton of questions from health care workers (Luckily my SIL is a home health nurse in another state but a good source of information) to make sure that when they run the test to determine an UTI to have them do a culture as well. Some antibiotics (even broad spectrum) does not work. The culture will let them know what will work and what wont work. Our last bout with an UTI (a couple of weeks ago) the only antibiotic that would work was an injection. Given 2 times a day for 7 days. While it wasn't feesible to have the home health nurse coming out that often, I learned how to give the injections myself (less stressful for my LO also). I am not a nurse by any means so I just added another hat to my many jobs that I have learned while taking care of my LO. I have learned that any medication change even a minor one will always send my LO into what seems like a decline until her brain can adjust to the changes. I am not sure how your LO doctor does thing but he (or she) should be able to get a sample to check. Before I had the home health nurse coming in, I have even had to take my LO over to the emergency room to have her checked.
One thing to keep in mind that if it is an UTI it can be very painful for you Loved One, even if they can't verbalize it. I understand how hard it is to get her in a car, because I have the same problems (especially to go to the doctor). I have to get into Mom mode and have plenty of lollipops in my purse. I started the reward system for her getting in and out of the car without a struggle by including a trip to McDonalds for a happy meal either before or after the trip. It's better to have a struggle getting her to the doctor and finding out whether or not she does have an UTI and starting treatment than to wait and her be in pain and not be able to tell you what is going on. My heart really goes out to you, because I have been in your shoes several times. Now when there is an abrupt change UTI is the first thing I have checked. I don't know if any of this will help you, but maybe you will be able to get some helpful information.

Any infection in the elderly can result in confusion, decreased cognitive function....so in AD patients, sometimes an infection can be overlooked.

I would call the doctor's office, and inquire about the possibility of a urinary tract infection, and explain that due to incontinence you probably can't collect a sample.

With my mom, she could always go in the AM when I took her to the bathroom, so I could collect samples. They may have to insert a catheter to collect a sample.

It will probably not clear up without antibiotics. You can try having her take more fluids, and cranberry juice, but that won't clear up an established infection.

There is really no way to know if it's a UTI or natural progression of AD. All you can do is eliminate the UTI as a factor.

Serenity... (saying this as gently as possible)have you considered Hospice? They would be a blessing to you, they can come to your home and help with your Mom. She may have to be catheterized to get a urine sample.... I was so relieved when I did not have to transport my mother anymore....

I appreciate this feedback so much. Re: hospice - I am very open to this help. I have read only positive things about hospice on these boards and could certainly use the extra help - both physically and emotionally. I didn't want to inquire prematuraly though. Does it seem like it is time to ask for a hospice assessment? What was going on with others when they took this step?

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Originally posted by Serenity:
I appreciate this feedback so much. Re: hospice - I am very open to this help. I have read only positive things about hospice on these boards and could certainly use the extra help - both physically and emotionally. I didn't want to inquire prematuraly though. Does it seem like it is time to ask for a hospice assessment? What was going on with others when they took this step?

Serenity,

My MIL is in latter stages of AD. She has been incontinent off and on for about the past 5 years. About 3 years ago, we took away her panties as she was making a huge mess without diapers. She resented the depends, but she used them. Most of the time, she just had little trickles...then it got to be all -out floods. When she began being totally incontinent in bladder, she began to get kidney infections. Being diabetic, her kidney function is marginal at best anyway, and these infections were easily triggered...especially when she'd sit in soiled pants overnight.

In the past year, she has progressed rapidly into stage 7. She is now totally bed/chair bound. She has no desire to pick up her food without being prompted. She needs to be reminded to chew. Etc. We knew she had a major kidney infection because the odor of her soiled bed linens was nauseating, and the color of the wet depends LOOKED like coffee stains. Her doctor, however, is a clueless twit. Knowing she is in advanced alzheimers and totally incontinent, she insisted on having MIL come to the office to give a urine sample. That was NOT very useful, as she cannot pee on command. So she would reluctantly prescribe a low-dose of antibiotic. One round. Period. Any further treatment necessitated a visit to the office. Needless to say, it was an excercise in futility. I tried to get a referral to Hospice from her...but again, it was only after I agreed to an office visit. Not easy to do when someone is bed/chair bound, and I am the only one who can lift her and I work full time.

I finally went AROUND the doc and requested an evaluation w/ Hospice. Due to MIL's declining mental state, inability to feed, "failure to thrive", chronic diabetes, etc, she qualified. They immediately did what I had requested of the doctor and been repeatedly declined---they installed a catheter. OMG! The crap that poured out was disgusting! Her first 3 bags looked like egg-drop soup! (Sorry to be graphic) but to make a point...the doctor did not realize that one round of meds was not going to do the trick, and refused to realize that perhaps a catheter would be useful.

It has proven to be essential to our household. MIL is still at home. Prior to hospice, we had to do at least 3 changes of linens for her bed per day. Sheets, blankets, pads, nightgowns, etc. Talk about a chore! And mom had bed sores from sitting in wet pants.

Now, there is no bedsores. The laundry gets changed 2x week, not 3x per day, so our water and gas bill has been drastically decreased. MIL doesn't realize she has a catheter, so she doesn't notice the cord, or show any discomfort---except when it has to be changed.

It has given us a clue when she is getting sick...or dehydrated...or some other problem. Recently, there was blood in the urine. Possible bowel/intestinal polyps growing or turning cancerous. It gives us a "window" into her body without guessing.

And the hogwash the doctor said about having the catheter INTRODUCE bacteria, thus causing more UTI's isn't the case. In a home environment, she's used to the bugs she's lived with for 49+ years, and there is less chance of her getting another infection introduced than there is living with the one festering inside.

Hospice has also been able to treat her without having to schlep her to the doctor. The meds are cheaper. The bath aids come 3x per week. The nurse comes 2x. She has better care than we could give her alone, and the load has been greatly lifted off our shoulders.

No, hospice is not like giving up. It is calling in reinforcements when you need them.

Definatley have her checked for a UTI,,and I sure dont' understand why her Dr would have stopped Zyprexa all of a sudden,,that in itself can cause major problems. You are going to have to learn to question any and all Dr.'s in regards to what they are prescribing,,what they are taking away,,and why,,and always talk with the pharmacist too,,they know more about the chemicals that our LO's have to ingest for their ailments. You need to call the Dr and find out what is wrong and get her in there.....if you still dont' get any satisfaction,,find a new Dr..Good luck.

UTI's can definately cause our loved ones to worsen.

A home health nurse could possibly insert catheter to get a proper urine sample.

Also, for some reason, I have been able to control these infections by giving my mom cranberry tablets which are suppose to help uti's! They have definately helped my mom!

For constipation, I have been giving my mom a herbal tea called "smooth move"! That also is doing it's job!

I would call immediately and request that they get a urine sample on your mom to illiminate the possibility of any infections. Then, if she doesn't have one.....it is easier to accept the natural progression of the disease

Thank you all for your feedback. I contacted a new doctor that makes housecalls (how wonderful!) and she prescribed an antibiotic to take care of a possible UTI. We weren't able to get a urine sample and mom was not cooperative to get a sample any other way so we will try it this way. The doctor also will make the referral to hospice. Her feelings about hospice were as positive as I've read on these boards and she said it would be a great support. Thanks again for the feedback - it helps so much!