Matilda said that she hadn’t properly answered the doctor’s questions about
Alex‘s incontinence because that would have just made things worse. She
explained that Alex had had some urinary incontinence for a year or more
but this had been mostly at night or he had just used the wrong place or
thing to urinate in. But over the past month he had been wetting himself
and was now occasionally incontinent of faeces as well.
Again Mary Jo disciplined herself from jumping in and answering the parts
of the questions she could answer. She was feeling that her grandmother
had a new level of trust in her and she wanted to live up to that trust.
Somehow it also really mattered to understand what her grandmother was
Their conversation extended beyond ‘Alex’s problems’ to Mary Jo’s learning
more about her own (and Alex’s) extended family in Europe and some
catching up about what Mary Jo was up to at work and in her rather inactive
Towards the end of the evening Mary Jo said that she felt that the
Alzheimer’s Association was the best source of information for her
grandmother and that she would be happy to go along with her and support
any steps or stages she chose along the way. When her grandma was ready
Mary Jo was also willing to approach the social worker and get the full
information about nursing home assessment and admission and what that
Prompting questions, set 3
• What influence does the type of dementia have on the onset, progression
and prognosis of the condition?
• What factors contribute to the likelihood of aggressive behaviour in people
• Identify what community resources are available in your community to
answer Matilda’s questions.
• What could account for the changes in Alex’s continence issues?
What resources and advice could be made available to Alex in his own
• How would you as a health professional support Matilda’s plans to travel to
Matilda did explore the information and community resources available to
her and Alex. She found that the carers’ support group was very welcoming
and good at sharing helpful information.
The continence nurse specialist did an assessment and Alex was found to be
constipated, with some faecal overflow, and his dietary habits and exercise
regime were adjusted under her supervision.
Mary Jo became a regular visitor and support to her grandmother. The
range of topics that they discussed together expanded and sometimes even
surprised Mary Jo.
What you need to do to meet your learning outcomes
? Explore these websites
Explore the following websites, which provide information about dementia.
Australian Government Department of Health and Ageing 2007, Dementia,
AIHW 2007, Dementia in Australia: national data analysis and development,
AIHW Cat. No. AGE 53, AIHW, Canberra,
Dementia Training Study Centres: http://www.dtsc.com.au/
Bridges-Webb, C & Wolk, J 2003, Care of patients with dementia in general
practice: guidelines, NSW Department of Health, Sydney,
Dementia Care Australia: http://www.dementiacareaustralia.com
Alzheimer’s Australia: http://www.alzheimers.org.au
Simons, LA, Simons, J, McCallum, J & Friedland, Y 2006, ‘Lifestyle factors and
risk of dementia: Dubbo study of elderly’, Medical Journal of Australia,
vol. 184, no. 2, January, pp. 68-70,
Department of Human Services, Victorian Government Health Information 2004,
A guide for assessing older people in hospitals, developed by the Centre for
Applied Gerontology, Bundoora Extended Care Centre, Northern Health,
This guide provides one of the major discussions in the field regarding the
pros and cons of assessments and other tools that are available.
Tameside Council, The single assessment process for older people, frequently
asked questions, http://www.tameside.gov.uk/sap.
This web resource about the single assessment process (SAP) was developed
by the Department of Health in the UK. It discusses different types of
assessment scales and social problems facing the older person.
Ministry of Health [NZ] and New Zealand Guidelines Group 2003, Best practice
evidence-based guideline summary, ‘Assessment of older people with complex
needs’, New Zealand Government,
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