From Stillwater-Ponca City (OK) Ostomy Outlook Oct 1998:

Ostomate with Alzheimer's Disease

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 [30-40 cm] high going around the abdomen and covering the ostomy appliance) or if that is not practical a one piece undergarment (where underpants and vest are one), quite fashionable at present. In both cases the appliance is out of view and easy reach. With these people often one sees: "out of sight is out of mind." Both these methods of solving the problem mean that it does not restrict the ostomist in their movements. It does not interfere with the ostomist's quality of life or activities of daily living, as they are not restrained in any form or way. Any form of restraint will make the patient more restless, and for that reason is in my view undesirable.

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 10 cm × 12 cm size and cut in half to edge the adhesive around the pouch. Opsite is marketed through Smith and Nephew.)

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.