Expert: Mary Gordon - 6/16/2009

Question
hi Mary,  my mother is 90yrs old and went into a rest home 2 years ago.  mum was on anti depressants for 10years but her psychiatrist decided to take her off them.  they took the dose down in four weeks from75mg doxapin to 25mg.  this had a terrible effect on her and after a talk with the pharmacist was told long term for this tablet should take six months to withdraw.  my mother started talking not able to make a sentence any more and dead eyes she then began to pull the poo from her bottom and has now changed to entering her vagina and pulling until she bleeds.i have managed to get the tablets reinstated and there has been a visible improvement in personality but she is still pulling at herself and denies she is doing anything.  have you come across this before. please help thank you Linda.

Answer
Hi Linda, it sounds very much like your mother has some sort of cognitive impairment. This is not just depression. Has she been assessed for some sort of dementia? If not, you should ask about having that done. There are some medications that can slow down the progress of many causes of dementia, and sometimes they can perk the person up quite a bit.

You should know that there are many causes of mental impairment. The brain is a very delicate thing, and many elderly people have all kinds of health problems that can affect their minds. Small strokes, nutritional deficiencies, normal pressure hydrocephalus, thyroid problems, lung problems, tumors, kidney problems - all these can cause symptoms of confusion. Besides these, there are many more, including the progressive neurological causes like Alzheimer's, Parkinson's, Lewy Body, Pick's Disease and others.

If her mind is impaired, she may have lost her inhibitions and her understanding of hygiene and social behavior. A lot of people with dementia will handle their feces - they just don't seem to know it's not clean, or that people think it's disgusting.

If she is becoming incontinent, she may not even understand the sensations of having a bowel movement or urinating and be confused by finding feces or wet in her underwear. She may be itchy from not cleaning herself - the skin may be irritated and she's pulling at it. Might she have an allergy, a yeast infection? Has the home tried any kind of barrier cream? Is she being kept clean and dry? Could she have a vaginal infection? Has she been tested for UTIs? In the elderly, a UTI may not cause may obvious symptoms. ? And lastly -  I hate to even ask - but is there any chance of any kind of abuse?

Keep in mind that skin in the elderly is very fragile and thin - and even more so in the genital area. If she is scratching at herself for any reason and has any fingernails at all, she can do a lot of damage, which leads to more and more irritation, bleeding - and scratching and picking.  

First stop is to have a talk with her doctor and ask him first about the possibility of dementia, and secondly, about what is causing her discomfort?

If this is strictly behavioral (i.e. a form of fidgeting), or even if you want her to stop and let things heal up, you may want to consider trying some special garments for a while to prevent her from damaging her genitals.
Here are a couple of examples that make it impossible for the person to get their hand into their pants.
http://silverts.com/Products/index.cfm?fuseaction=productdetail&productno=23310
http://www.taketorausa.com/lounge.asp
http://www.spec-l.com/Back_Snap_Knit_Jumpsuit-p5714.html  

Hope this helps.

I know how distressing these kind of behaviors can be - it's mortifying to think your own mom would come to this point. See what the doctor has to say, and if there is anything he suggests to help.

Mary G.