Journal of Gerontological Nursing

CNE Article 

Behavioral Characteristics of Bowel Movement and Urination Needs in Patients With Dementia in Taiwan

Yen-Hua Shih, MS; Chi-Jane Wang, PhD; En-Ping Sue, MS; Jing-Jy Wang, PhD

Abstract

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Instructions

1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must:

Read the article, “Behavioral Characteristics of Bowel Movement and Urination Needs in Patients With Dementia in Taiwan” found on pages 22–29, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz.

Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study.

Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated.

 

This activity is valid for continuing education credit until May 31, 2018.

Contact Hours

This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated.

Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Activity Objectives

Explain common behaviors indicating excretion needs in patients with dementia.

Distinguish the unique behavioral characteristics of bowel and urination needs in patients with dementia.

Disclosure Statement

Neither the planners nor the authors have any conflicts of interest to disclose.

Patients with dementia, especially those with advanced dementia, may not be able to express their bowel movement and urination needs using lucid language, and instead do so through behaviors. The aim of the current study was to understand and compare the behavioral characteristics of bowel movement and urination needs in patients with dementia. Observations were made by caregivers of 187 patients with dementia based on the Behavior Checklist developed by the research team for bowel movement and urination. Sixteen behavioral characteristics were identified for both bowel movement and urination; among these, anxiety, taking off/putting on clothes inappropriately, restlessness, attempting to go elsewhere, scratching skin, repeated behavior, and making strange sounds were commonly reported. Facial expressions of sorrow, restlessness, and anxiety were the three most common behaviors related to bowel movement needs, whereas anxiety, taking off/putting on clothes inappropriately, and constant moaning were the most common behaviors for urination needs. The findings suggest that the common behavioral characteristics could be seen as indicators of excretion need and the others can be used to distinguish between the need for bowel movement and urination. [Journal of Gerontological Nursing, 41(6), 22–29.]

Ms. Shih is Lecturer and Doctoral Student, Department of Nursing, Tzu-Hui Institute of Technology, Pungtung County & National Cheng Kung University Institute of Allied Health Science, Tainan; Dr. C.-J. Wang is Assistant Professor, Department of Nursing, National Cheng Kung University, Tainan; Ms. Sue is Head Nurse, Chia-Man Psychiatric Hospital, Tainan; and Dr. J.-J. Wang is Professor, Department of Nursing & Institute of Allied Health Science, National Cheng Kung University, Tainan, Taiwan.

The authors have disclosed no potential conflicts of interest, financial or otherwise. The authors thank the participants of this study and are grateful for the research funding received from the National Science Council, Taiwan (research grant NSC 101-2314-B-006-022).

Address correspondence to Jing-Jy Wang, PhD, Professor, Department of Nursing & Institute of Allied Health Science, National Cheng Kung University, 1 University Road, Tainan City 701, Taiwan; e-mail: ns127@mail.ncku. edu.tw.

Received: September 26, 2014
Accepted: January 08, 2015

Posted Online: April 17, 2015

 

Do you want to Participate in the CNE activity?

Abstract

How to Obtain Contact Hours by Reading this Article
Instructions

1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must:

Read the article, “Behavioral Characteristics of Bowel Movement and Urination Needs in Patients With Dementia in Taiwan” found on pages 22–29, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz.

Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study.

Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated.

 

This activity is valid for continuing education credit until May 31, 2018.

Contact Hours

This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated.

Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Activity Objectives

Explain common behaviors indicating excretion needs in patients with dementia.

Distinguish the unique behavioral characteristics of bowel and urination needs in patients with dementia.

Disclosure Statement

Neither the planners nor the authors have any conflicts of interest to disclose.

Patients with dementia, especially those with advanced dementia, may not be able to express their bowel movement and urination needs using lucid language, and instead do so through behaviors. The aim of the current study was to understand and compare the behavioral characteristics of bowel movement and urination needs in patients with dementia. Observations were made by caregivers of 187 patients with dementia based on the Behavior Checklist developed by the research team for bowel movement and urination. Sixteen behavioral characteristics were identified for both bowel movement and urination; among these, anxiety, taking off/putting on clothes inappropriately, restlessness, attempting to go elsewhere, scratching skin, repeated behavior, and making strange sounds were commonly reported. Facial expressions of sorrow, restlessness, and anxiety were the three most common behaviors related to bowel movement needs, whereas anxiety, taking off/putting on clothes inappropriately, and constant moaning were the most common behaviors for urination needs. The findings suggest that the common behavioral characteristics could be seen as indicators of excretion need and the others can be used to distinguish between the need for bowel movement and urination. [Journal of Gerontological Nursing, 41(6), 22–29.]

Ms. Shih is Lecturer and Doctoral Student, Department of Nursing, Tzu-Hui Institute of Technology, Pungtung County & National Cheng Kung University Institute of Allied Health Science, Tainan; Dr. C.-J. Wang is Assistant Professor, Department of Nursing, National Cheng Kung University, Tainan; Ms. Sue is Head Nurse, Chia-Man Psychiatric Hospital, Tainan; and Dr. J.-J. Wang is Professor, Department of Nursing & Institute of Allied Health Science, National Cheng Kung University, Tainan, Taiwan.

The authors have disclosed no potential conflicts of interest, financial or otherwise. The authors thank the participants of this study and are grateful for the research funding received from the National Science Council, Taiwan (research grant NSC 101-2314-B-006-022).

Address correspondence to Jing-Jy Wang, PhD, Professor, Department of Nursing & Institute of Allied Health Science, National Cheng Kung University, 1 University Road, Tainan City 701, Taiwan; e-mail: ns127@mail.ncku. edu.tw.

Received: September 26, 2014
Accepted: January 08, 2015

Posted Online: April 17, 2015

 

Do you want to Participate in the CNE activity?

The number of individuals with dementia is increasing as societies age. According to the World Health Organization (WHO; 2012), one new dementia case is diagnosed every 4 seconds. In Taiwan, older adults now account for up to 11.5% of the total population based on statistics from the Ministry of the Interior (2014). At the end of 2011, more than 190,000 individuals were diagnosed with dementia in Taiwan. By estimating the population and community prevalence of dementia, this number is expected to exceed 620,000 in 2046, and 720,000 in 2056, resulting in four of 100 individuals having dementia in Taiwan (Taiwan Alzheimer Disease Association, 2012), with 21 families and care providers affected by each patient with dementia (Pai, 2009).

Behavioral and psychological symptoms of dementia (BPSD) are common in patients with advanced dementia (Colombo et al., 2007; Fernandez, Gobartt, & Balana, 2010; Savva et al., 2009). BPSD consist of a variety of symptoms and behaviors (e.g., depression, physical aggression, psychotic syndrome), which have been considered indicators of unmet needs of older adults with dementia (Algase et al., 1996). The Need-Driven Dementia-Compromised Behavior model (Algase et al., 1996) proposes that behavioral symptoms are unmet needs because patients with dementia are unable to express their needs through appropriate language. Therefore, certain behaviors of patients with dementia should not be seen as simply bothersome for caregivers, but instead a way of trying to convey needs and thus be regarded as meaningful indications of unmet needs.

Literature Review

Bowel movement and urination are basic needs, and constipation and urinary incontinence are common health problems for older adults. Constipation is one of the most common health problems in primary care (Gallegos-Orozco, Foxx-Orenstein, Sterler, & Stoa, 2012) and the general population, and of particular concern among older adults (Suares & Ford, 2011). Patients with persistent constipation have a lower quality of life, and the condition is associated with higher levels of self-reported depression among older women (Koloski et al., 2013). According to the North America Nursing Diagnosis Association (NANDA), constipation is defined as a “decrease in normal frequency in defecation accompanied by difficult or incomplete passage of stool and/or passage of excessively hard, dry stool” (Carpenito, 2013, p. 185). Major defining characteristics of constipation are hard, formed stools; defecation fewer than two times per week; and prolonged and difficult evacuation. Such defining characteristics are useful for cognitively intact individuals who are able to report their problems, yet patients with dementia might not be able to express themselves orally and so convey concerns about health problems, such as constipation, through their behaviors. A retrospective cohort study that examined the association between resident characteristics and the development of wandering behavior found that constipation was the indicator of an increased risk for developing this behavior for patients with dementia (Kiely, Morris, & Algase, 2000).

Urinary incontinence is a silent health issue among the older adult population (Specht, 2005). The prevalence of urinary incontinence increases with age (Kyle, 2012; Suares & Ford, 2011), and women especially have a high risk of developing this condition (Sensoy, Dogan, Ozek, & Karaaslan, 2013). Studies reported that the prevalence rates of urinary incontinence (defined as “any leakage” [Offermans, Du Moulin, Hamers, Dassen, & Halfens, 2009, p. 189]) in nursing homes are high, ranging from 43% to 77% (median = 58%) (Offermans et al., 2009), and from 1.1% in a general community population to 38% in those receiving home care services (Drennan, Rait, Cole, Grant, & Iliffe, 2013). NANDA defines impaired urinary elimination as “dysfunction in urinary elimination” (Carpenito, 2013, p. 699). Major defining characteristics of impaired urinary elimination (of which one or more must be present) include urgency, dribbling, frequency, bladder distention, hesitancy, large residual urine volumes, retention, enuresis, dysuria, incontinence, and nocturia.

Urinary incontinence commonly occurs in the general older adult population and also in patients with dementia (who are unable to express their symptoms through appropriate language). Urinary incontinence often occurs in patients with advanced dementia and is particularly associated with Alzheimer’s disease (Hägglund, 2010; Offermans et al., 2009). Studies have found that patients with dementia have approximately three times the rate of diagnosis of urinary incontinence compared to those without dementia, with both groups between ages 60 and 89 and receiving primary care (Grant, Drennan, Rait, Petersen, & Iliffe, 2013); a positive correlation exists between incontinence and dementia severity (Rose, Thimme, Halfar, Nehen, & Rübben, 2013). Furthermore, urinary incontinence of different degrees presents a common health condition (83%) in nursing homes and more severe incontinence is correlated with worse nutritional status, increased depression of BPSD, and worse mobility (Rose et al., 2013). In addition, urinary incontinence increases daily life dependence and might cause earlier institutionalization (O’Donnell et al., 1992). However, few studies examine the defining behavioral characteristics of constipation and urination in patients with dementia.

Strategies used to manage the needs of bowel movement and urination in patients with dementia include (a) the regular use of pads and other absorbent aids, (b) timed and prompted voiding (Hägglund, 2010; Specht, 2005), and (c) prescription of laxatives (Volicer, Lane, Panke, & Lyman, 2004). However, the use of pads, continence products, or indwelling catheters could increase the risk of urinary infection (Rose et al., 2013) and negative effects on patients (Omli et al., 2010), and the use of rectal laxatives can cause abdominal discomfort.

Memory loss, reduced language skills, and impaired reasoning among patients with advanced dementia result in toileting difficulties (Sakakibara, Uchiyama, Yamanishi, & Kishi, 2008), problem behaviors, and unmet excretion needs (Bravo, 2004; Hägglund, 2010). Communication difficulties make it challenging for patients to express needs for bowel movements and urination, and health care professionals have difficulty determining the behavioral characteristics associated with these needs, which hinders them from providing the necessary assistance (Wang, Hsieh, & Wang, 2013). Therefore, a better understanding of the characteristics of these two problems will help professional and nonprofessional caregivers detect patients’ needs for bowel movements and urination, as well as alert them to the problems of constipation and urinary incontinence, thus helping in the provision of timely and effective intervention and treatment. As such, the purpose of the current study was to examine the behavioral characteristics of bowel movement and urination needs in patients with dementia and identify the distinguishing characteristics of these two excretion needs.

Method

Research Design

A descriptive, cross-sectional design was used for the current study.

Sample

Purposive sampling was used to recruit participants from eight long-term care (LTC) facilities and one day care center in southern Taiwan. Inclusion criteria were: (a) age 65 and older; (b) diagnosed with Alzheimer’s disease according to the Diagnostic and Statistical Manual of Mental Disorders IV (American Psychiatric Association, 1994) criteria or a Mini-Mental State Examination (MMSE; Folstein, Folstein, & McHugh, 1975) score of 18 or less (with <6 years of education) or 23 (with >6 years of education); and (c) unable to express bowel movement and urination needs in lucid language. Data were collected through observations that were mostly performed by nursing staff, as well as social workers and nurses’ aides, who had been taking care of the participants for at least 6 months. Under the care provider–patient relationship, observers became familiar with the patients and were able to recognize their behavioral characteristics of bowel movement and urination needs and provide toileting assistance. The sample was estimated to have an effect size of moderate magnitude (0.5) and power (1–beta) of 0.80.

Ethical Considerations

Ethical approval was obtained from the university hospital’s institutional review board. Written consent was obtained from each participant or his or her family surrogate (if unable to consent) before data collection. Participation was voluntary and anonymity and confidentiality were emphasized and maintained.

Instrument

The Behavior Checklist for bowel movement and urination, constituting two sub-checklists developed by the study team, was used for data collection. The checklist was based on the literature and individual interviews with 10 nurses with experience working with patients with dementia. The behavioral characteristics of interest included symptoms and signs of bowel movement and urination expressed by patients, as these could be indicators of bowel movement and urination health problems. The bowel movement sub-checklist consisted of 25 items, whereas the urination sub-checklist contained only 20 items. A yes/no response format, which is user-friendly for care providers, was adopted. Observations were based on the events of the previous 2 weeks. An expert content validity index of 0.96 was obtained. Cronbach’s alpha for internal consistency reliability (KR-20) was found to be 0.713 and 0.554 for the bowel movement and urination subscales, respectively. The inter-rater reliability for each item of the two subscales indicated Kappa values between 0.167 and 1, with most items achieving a satisfactory level of reliability.

Data Collection

After obtaining human subject protection approval from the university hospital review board, all care managers of the selected LTC facilities and day care centers were contacted, and care providers from each study site who met the related criteria were referred to the study. Researchers made appointments with the observers to obtain written consent and verbally explain the behavior definitions and study tool. Residents from all study sites who met the study criteria were recruited and their consent was obtained. Observers completed the bowel movement and urination checklists based on a 2-week observation period. Demographic information and MMSE scores were collected through chart review. Researchers collected completed behavior checklists.

Data Analysis

SPSS version 18 was used for data entry and analysis. Means and standard deviations were obtained for continuous variables. Frequencies and percentages were calculated for discrete variables.

Results

Participant Demographic Details

Of 210 patients with dementia observed, only data for 187 were analyzed because 23 did not have complete data for both health problems. Among patients whose data were analyzed, most were observed by professional nursing staff (n = 168, 89.8%). Others were observed by social workers (n = 5, 2.7%) and experienced nurse aides (n = 14, 7.5%). Patients’ ages ranged from 70 to 90 (mean = 80.1 [SD = 9.6]) and 59% were female (n = 111). Approximately one half of patients were illiterate (n = 83, 44.4%) and one third received little education (n = 57, 30.5%). Most patients were widowed (55.6%) and had children (87.2%). The mean age at which dementia was diagnosed in this population was 75.2 (SD = 11 years). MMSE scores for patients with lower levels of education ranged from 0 to 18 (mean = 6.3 [SD = 6.2]), whereas scores for those with higher levels of education ranged from 0 to 23 (mean = 10.2 [SD = 7.7]). Regarding the type of dementia, 72 patients had Alzheimer’s dementia (38.5%), 35 (18.7%) had vascular dementia, and 19 had other types of dementia (10.2%); dementia type was unspecified for 61 patients (32.6%). The demographic characteristics of participants and subgroups are presented in Table 1.

Demographic Data of Participants (N = 187)Demographic Data of Participants (N = 187)

Table 1:

Demographic Data of Participants (N = 187)

Common and Unique Behavioral Characteristics of Constipation and Urination

Among the 25 behavioral characteristics for bowel movement needs, facial expressions of sorrow, restlessness, anxiety, scratching skin, and taking off/putting on clothes inappropriately were the most commonly observed (>30% of patients observed). Among the 20 behavioral characteristics for urination needs, anxiety, taking off/putting on clothes inappropriately, constant moaning, and restlessness were the most commonly observed (>30% of patients observed). Among these common behaviors, anxiety, restlessness, and taking off/putting on clothes inappropriately occurred in more than 30% of patients with dementia when they experienced either bowel movement or urination needs. However, facial expressions of sorrow and constantly asking for the toilet were unique to bowel movement needs. In contrast, constant moaning was unique to urination needs.

The least frequent behavioral characteristics for bowel movement needs in patients with dementia were eating or drinking inappropriately, throwing objects, sexual assault or exposing genitalia, harming themselves or others, screaming, and rude actions or agitated behavior. The least frequent behavioral characteristics for urination needs in patients with dementia were sexual assault or exposing genitalia and harming themselves or others. These infrequent behaviors occurred in less than 5% of patients when they experienced needs for bowel movement or urination (Table 2).

Frequency of Behavioral Characteristics of Bowel Movement and Urination Needs (N = 187)

Table 2:

Frequency of Behavioral Characteristics of Bowel Movement and Urination Needs (N = 187)

Discussion

Patients with dementia, especially those in an advanced stage, are not able to express themselves clearly verbally even when they have excretion needs. Restlessness and anxiety were found to be the most frequently occurring and shared characteristics when patients had a need for either bowel movement or urination. When patients with dementia feel bowel and bladder pressure and have a need to defecate or urinate, irritability can occur, leading to restlessness and anxiety because they are unable to clearly communicate their needs (Potter & Wagg, 2005). Similarly, another behavior that occurred for both needs was taking off/putting on clothes inappropriately. This can be explained by the fact that when individuals need to go to the bathroom, they must first pull down their pants, skirt, underwear, and so on, but patients with dementia are unable to perform such actions appropriately (Potter & Cottenden, 2002) and instead may do so at the wrong time and place. Although anxiety and restlessness seem to be similar behavioral characteristics, the former is related to the psychological domain and the latter to the physical domain.

The current study found that facial expressions of sorrow was the most common behavior when patients experienced a need for bowel movement, which is understandable because facial expression is one of the most natural, human, nonverbal reactions. Similarly, Hemsley, Balandin, and Worrall (2011) found that health care providers usually recognize patients’ needs for toileting through their facial expressions.

Scratching only occurred when patients needed a bowel movement. Goosebumps tend to appear when individuals have an urgent need to defecate, which can then cause an itching sensation, leading the patient to scratch their skin. In addition, abdominal fullness and rectal tenesmus can be caused by constipation, and these uncomfortable symptoms can be expressed not only by showing facial expressions of sorrow, but also by rubbing the belly and constantly asking for the toilet.

Constant moaning was a unique behavior to convey the need for urination. The sensation of urinary incontinence is usually a more urgent feeling, and patients with dementia are prone to behave persistently, such as constantly moaning or ringing a bell to request a change of pads or express their need for urination. Tearing materials or damaging property were also common behaviors used to convey an unmet need for urination, as well as to express an urgent need to go to the toilet or show that their pants or pads were already wet and uncomfortable.

Facial expressions of sorrow and constantly asking for the toilet were unique behaviors related to bowel movement needs, whereas constant moaning was unique to urination needs. As such, these characteristics can be used to distinguish the needs to defecate or urinate and help care providers appropriately assist when needed.

According to Kovach, Noonan, Griffie, Muchka, and Weissman (2001), problematic vocalizations and resisting care are two behaviors associated with unmet needs. Problematic vocalizations include non-aggressive (e.g., continuous talking, complaining) and aggressive (e.g., screaming, abusive language) behaviors. These are the most frequent, persistent, and annoying disruptive behaviors seen among residents with dementia at nursing homes (Cubit, Farrell, Robinson, & Myhill, 2007; Nelson, 1995). In the current study, making strange sounds, constant complaining, cursing or verbal assault, persistent or unreasonable demands, screaming, harming themselves, tearing materials or property damage, rude action or agitated behavior, and throwing objects or others are all similar to problematic vocalizations.

Aimless wandering was a behavioral characteristic related to bowel movement and urination needs. An earlier study noted that patients with dementia with a high hourly wandering rate and duration had more health issues, such as heart and lower gastrointestinal tract problems, as well as poor nutritional statuses (Algase, Antonakos, Beattie, Beel-Bates, & Yao, 2009). Walking may help relieve abdominal discomfort and may also indicate that patients with dementia are trying to find the toilet.

Study Limitations

One behavioral characteristic can indicate a number of needs and one unmet need may trigger numerous behavioral characteristics. Therefore, the authors cannot fully confirm that the behavioral characteristics identified in the current study are unique to constipation or urinary incontinence, as they may be caused by other physical and mental health conditions (e.g., side effects of medication). In addition, certain behaviors may be attributed to other causes, such as living in an institution or community, or other health conditions (e.g., delirium, sundown syndrome). In the current study, the majority of data were collected in LTC facilities, but future studies should include patients from day care and geriatric wards. All data were collected among the Taiwanese population. Cultural differences in the expression of behavior characteristics need to be taken into account so that the study can be replicated in other cultures.

Implications for Clinical Practice

The defining characteristics for constipation and urinary incontinence among the general population (developed by NANDA) focus on subjective and objective characteristics. However, patients with dementia are unable to provide subjective information to convey their needs. Therefore, the behavioral characteristics of bowel movement and urination needs identified in patients with dementia in the current study could be useful references for care providers when assessing excretion needs for such patients. The current findings can be used as a basis to develop details of the defining characteristics of constipation and urinary incontinence for patients with advanced dementia. The behavioral characteristics observed and recognized are also useful for staff education at LTC facilities to provide appropriate care and toileting assistance for patients with dementia.

Conclusion

The common behavioral characteristics found in the current study can be seen as indicators of excretion needs and the unique behavioral characteristics associated with bowel movement and urination needs could provide useful indicators to distinguish between them.

References

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Demographic Data of Participants (N = 187)

Variable n (%)
Age (years) (mean [SD]) 80.1 (9.6)
Gender
  Female 111 (59)
  Male 76 (41)
Education
  Illiterate 83 (44.4)
  Elementary school 57 (30.5)
  Junior high school 16 (8.6)
  Senior high school 17 (9.1)
  Junior college 7 (3.7)
  University 6 (3.2)
  Master’s degree and above 1 (0.5)
Marital status
  Widowed 104 (55.6)
  Married 55 (29.4)
  Single 20 (10.7)
  Divorced 7 (3.7)
  Other 1 (0.5)
Have children
  Yes 163 (87.2)
  No 24 (12.8)
Onset age (years) (mean [SD]) 75.2 (11)
Type of dementia
  Alzheimer’s 72 (38.5)
  Unspecified 61 (32.6)
  Vascular 35 (18.7)
  Other 19 (10.2)
MMSE (mean [SD])
  Lower education 6.3 (6.1)
  Higher level of education 10.2 (7.7)
Institution
  Long-term care 181 (96.8)
  Day care 6 (3.2)
Past career
  Unemployed 67 (35.8)
  Agriculture 41 (21.9)
  Military and government 24 (12.8)
  Laborer 20 (10.7)
  Business 12 (6.4)
  Fisheries 2 (1.1)
  Other 21 (11.2)

Frequency of Behavioral Characteristics of Bowel Movement and Urination Needs (N = 187)

Bowel Movement Urination
Items n (%) Items n (%)
Facial expressions of sorrow 120 (64.2) Anxiety 89 (47.6)
Restlessness 88 (47.1) Taking off/putting on clothes inappropriately 80 (42.8)
Anxiety 78 (41.7) Constant moaning 71 (38.0)
Scratching skin 75 (40.1) Restlessness 57 (30.5)
Taking off/putting on clothes inappropriately 67 (35.8) Attempting to go to another place 50 (26.7)
Asking for toilet constantly 57 (30.5) Repeated behavior 49 (26.2)
Attempting to go to another place 46 (24.6) Scratching skin 46 (24.6)
Belly rubbing 41 (21.9) Tearing materials or damaging property 45 (24.1)
Repeated behavior 39 (20.9) Making strange sounds 40 (21.4)
Making strange sounds 39 (20.9) Constant bell ringing to request change of pads 38 (20.3)
Sitting on the toilet a long time 37 (19.8) Aimlessly wandering 37 (19.8)
Constant complaining 36 (19.3) Changed interests 37 (19.8)
Aimlessly wandering 32 (17.1) Rapid walking 28 (15.0)
Changed interests 31 (16.6) Persistent or unreasonable demands 26 (13.9)
Cursing or verbal assault 26 (13.9) Rude action or agitated behavior 23 (12.3)
Repeating words 23 (12.3) Urinating outside the restroom 22 (11.8)
Persistent or unreasonable demands 17 (9.1) Cursing or verbal assault 21 (11.2)
Defecating outside the restroom 17 (9.1) Belly rubbing 13 (7.0)
Tearing materials or damaging property 11 (5.9) Harming themselves or others 7 (3.7)
Rude action or agitated behavior 9 (4.8) Sexual assault or exposing genitalia 5 (2.7)
Screaming 8 (4.3)
Harming themselves or others 8 (4.3)
Sexual assault or exposing genitalia 3 (1.6)
Throwing objects 3 (1.6)
Eating or drinking inappropriately 2 (1.1)

Keypoints

Shih, Y.-H., Wang, C.-J., Sue, E.-P. & Wang, J.-J. (2015). Behavioral Characteristics of Bowel Movement and Urination Needs in Patients With Dementia In Taiwan. Journal of Gerontological Nursing, 41(6), 22–29.

  1. Anxiety, restlessness, and taking off/putting on clothes inappropriately occurred when patients with dementia experienced either bowel movement or urination needs.

  2. Facial expressions of sorrow and constantly asking for the toilet were unique behaviors related to bowel movement needs, whereas constant moaning was unique to urination needs.

  3. The unique characteristics can be used to distinguish the needs to defecate or urinate and help care providers assist appropriately when needed.

10.3928/00989134-20150414-01

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