Question posted July 4,1998 by Steve, New York:
My father has had an Ileostomy for about 16 years. He's also now in the moderate to advanced stages of Alzheimer's. He's currently residing in a facility designed to take care of people with this type of disease. Recently he's become a problem for the facility because he keeps removing his pouch. He may not like the feel of it and/or has forgotten what it's there for. The staff has worked with him trying to get him to keep it on, without much luck. They also tried getting him to wear Depends. He won't leave those on either. It's becoming a health issue for this facility and something needs to be done. They've had limited success lately by mildly sedating him, but this may not last. Do they make pouches, etc. with straps and bands that he couldn't remove? If anyone has had any experience with this type of situation I would greatly appreciate hearing from you.
Reply posted July 16, 1998 by Bart Tappe, Clinical Nurse Specialist, Head of Stoma Therapy Dept, Central Sheffield University Hospitals, UK:
I have treated a lot of patients with Alzheimer's and similar
problems have come up over and over again. Firstly it is important to
ensure that there is no peristomal skin irritation or soreness, as this
would cause the ostomist to be restless. One should ensure that the
appliance the ostomist wears is the right type, size and material for
the patient to feel comfortable with. If there is no reason why the
ostomist wants to remove their appliance then there are two solutions we
tend to use in this patient population. Firstly one can use an abdominal
belt (a wide belt about 12-16 inches
Reply posted July 16, 1998 by Prilly Stevens, ET Nurse, South Africa:
I have found the application of Tegaderm - over/around
adhesive of a pouch useful in these cases - as it is very difficult to
get fingers under the adhesive to remove the pouch! Another useful tip
- is to utilise Netalast over the pouch - this also would act as
a means to keep the Depends incontinence pads in place.
(Tegaderm is marketed through 3M. Use the
Reply posted July 16, 1998 by Gwen Turnbull, RN, BS, CETN, New Jersey:
Hi -- I just reviewed a clinical study from a company who manufacturers "lock ring" two piece pouching systems. One of the investigators put the pouch on so that the lock-ring mechanism was underneath the pouch in the front (upside down). This prevented one of her confused patients from unsnapping the pouch from wafer. Of course, if your father is pulling the entire system off of his abdomen, this won't work. I believe that there are two companies who manufacture this type of system, Coloplast and ConvaTec. Hope you're able to find a workable solution.
Reply posted July 16, 1998 by Helen DuBois, RNET, Virginia [also UOA President at the time]:
Although I do not have any suggestions that are new and revolutionary I have one you might try. Many years ago I had two small children who did much the same thing as your Father is now doing - taking off the pouch at the worst times. We tried many things over several weeks but, the one that worked the best was having the child wear snug underwear - so the pouch did not flap around, briefs are great and you might try about one size smaller than usual. We also then had the children wear overalls. This made it a little harder to get the hands where they were not supposed to be. Over a period of time as the children grew and learned this did not last but a few months. I know that this will not be the perfect solution, and might not be long lasting, but hopefully it will work for awhile at least.