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Coprophagia And Scatolia In Demented Elderly Residents

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 15 years experience.

The healthcare workers, visitors, and concerned family members who regularly come into contact with the demented elderly population in institutionalized settings have, in all likelihood, witnessed acts of coprophagia and scatolia on more than one occasion. The purpose of this article is to discuss coprophagia and scatolia.

Coprophagia And Scatolia In Demented Elderly Residents

Professionals who work with residents of nursing homes, memory care units, assisted living facilities, geriatric psychiatric centers, and other types of long term care settings experience a mixture of triumphs and stressors on a daily basis. The healthcare workers, visitors, and concerned family members who regularly come into contact with the demented elderly population in institutionalized settings have, in all likelihood, witnessed acts of coprophagia and scatolia on more than one occasion.

Coprophagia, better known as the oral intake of one's own feces, is often observed in elderly people afflicted with Alzheimer's disease and other forms of dementia. Scatolia, better known as the smearing of one's own feces, and sometimes referred to by nursing staff members as the 'finger painting' of fecal matter, is another behavior that has been commonly noted in this particular patient population.

Both behaviors are upsetting, disturbing, and sometimes produce emotional responses from the people who genuinely care about the welfare and safety of demented elderly residents.

The practices of coprophagia and scatolia are also associated with a multitude of serious health problems that place the demented elder at grave risk, including the hepatitis A virus, chronic oral and gingival infections, skin abscesses, intestinal parasites, airway obstruction, aspiration, sialadenitis (inflammation of the salivary gland), and constant urinary tract infections.

In addition, some residents who have engaged in coprophagia have died due to cafe coronary, which is a fatal choking condition that takes place when the fecal matter lodges in the elderly person's throat while he or she is consuming it.

The exact cause of coprophagia and scatolia in elderly residents with cognitive impairment remains unknown at this time, although some theorists believe that several forms of dementia lead to behavioral disinhibition that make the confused elder far more prone to these practices than other populations. Furthermore, the exact incidence and prevalence of coprophagia and scatolia are not yet known due to the lack of formal research on these two behaviors.

Several pharmacologic and nonpharmacologic treatment modalities exist to address the practices of coprophagia and scatolia in the demented elderly population. According to Sharma (2012), treatment of coexisting psychiatric illness, relief from constipation and pruritis ani, and ensuring the maintenance of good oral hygiene have all been reported to be effective.

Drugs such as selective serotonin reuptake inhibitors (SSRIs), antipsychotics, tricyclic antidepressants, and Aricept have resulted in improvement in some cases. Correcting any nutritional deficiencies is highly recommended by certain practitioners. Behavioral interventions are considered to be part of first-line management, especially in geriatric patients with limited cognitive abilities (Sharma, 2012).

Although coprophagia and scatolia are problematic behaviors often practiced by elders with dementia, the safety, health, and quality of life of these individuals can be maintained or greatly improved with some patience, understanding, knowledge, and effective treatment.

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TheCommuter, BSN, RN, CRRN is a longtime physical rehabilitation nurse who has varied experiences upon which to draw for her articles. She was an LPN/LVN for more than four years prior to becoming a Registered Nurse.

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17 Comment(s)

VickyRN, MSN, DNP, RN

Specializes in Gerontological, cardiac, med-surg, peds. Has 16 years experience.

I have unfortunately witnessed this type behavior. One elderly demented patient (who used to be a demure Southern Belle school teacher in her earlier life) was scooping feces out of her pamper, eating kernels of corn she found in the feces, and painting the wall above her bed with the rest.

I have worked as a CNA for three years in a nursing home with dementia patients and I have neither heard these medical terms not witnessed this behavior. I have heard of scatolia as fecal smearing, a behavior most often performed by mentally ill or autistic persons. As some one who has gotten used to poop, the though of encountering someone eating or who had eaten feces, makes me want to gag. I am not sure how I would handle it, if I ever do encounter it.

TurtleCat

Specializes in Geriatrics.

I have heard of this before, but have yet to witness it (considering I'm not even a CNA yet -- supposed to be starting CNA classes in 2 months :D) To me, this is pretty sad and depressing to think about. Can you even imagine being so confused and having your mind deteriorated to such a point that you'd eat your own feces, and not even know what you were doing?? I have the utmost compassion for the dementia and Alzheimer's population, as having a disease like that would be one of my worst nightmares.

BrandonLPN, LPN

Has 5 years experience.

I've worked with alzheimers residents for a few years but haven't seen this yet. Frankly, it makes a good case for keeping these patients well medicated. I'd much rather be snowed than eating my own feces.

VivaLasViejas, ASN, RN

Specializes in LTC, assisted living, med-surg, psych. Has 20 years experience.

Working in geriatrics for as long as I have, I don't think there's much I haven't seen as far as demented patients' behaviors are concerned. I've seen them fingerpaint with poop (got to love that fancy term for it!), throw it at people, roll it into balls and line 'em up on their nightstand....and yes, consume it.:barf02:

Whenever I've witnessed such a thing---besides the "ick" factor---I feel terribly sad for them, because inside every severely demented individual burns a tiny pilot light, which represents the person they were. And that person would be mortified if he or she knew what was happening. These people were all young and vital once, and NOBODY ever dreams that they'll spend the final season of their life playing in their own excrement.:crying2:

CherylRNBSN

Specializes in critical care, Med-Surg. Has 14 years experience.

Eeeeew.

I had a 13 yr old Scottish Terrier that began to poop on my courtyard (slate) instead of grass. ANd I would look out my window EVERY DAY and see her eating her feces.

I could not stand it. I had loved her and provided her with a great, long life, but I had her put to sleep. Now I wonder if she was demented!

Talk about losing your dignity. I agree with OP; I'd rather be medicated than eating my own poop. Eeeew.

eleectrosaurus

Specializes in Cardiac/Neuro Stepdown. Has 1 years experience.

Crocophagia, its sad when it happens.. :sniff:

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TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 15 years experience.

LOL! Thanks for the much-needed humor! :D

Crocophagia, its sad when it happens.. :sniff:

images?q=tbn:ANd9GcQ66tR5MoENfcqNunWJnCYSfiVzp47U8JwVq86oiFbXi1GmWtqr

tyvin, BSN, RN

Specializes in Hospice / Psych / RNAC.

I've heard that there were terms for both behaviors but have never witnessed either one. I don't believe that I've ever known any patient that I've worked with to do either one. Had a psych patient who use to take a dump when outside smoking but we clipped that behavior in the bud by withholding his ciggys. Amazing how fast he stopped that.

I'm a CNA and witnessed both of these when I worked at the nursing home. I now work as a CNA in a non geriatric psych facility and still see these things but not often.

SuzieeQ

Specializes in Geriatrics, retirement, home care.. Has 3 years experience.

I have seen both behaviours, although, did not know the medical terms for them.

I've heard of people eating their own buggers ( wonder what the medical term is) but not poop...

BostonTerrierLover, BSN, RN

Specializes in Adult/Ped Emergency and Trauma. Has 16 years experience.

Nasal Crustaceans!!

So,... I'm guessing "Nasal Crustaphagia"

:) yummmm!!

(gonna go boil my mouth out now!)

@ [COLOR=#003366]CherylRNBSN, quite frankly, a pathetic reason for putting your pet down. In animals, it can mean a nutritional deficiency (at least according to my vet). Also, never met that a dog that doesn't sometimes do it. ITA with the rest of your statement that it would be better to be medicated than eating or smearing feces.

Edited by EsthyLady
missing info

The behavior seems to signal some type of distress or change in their routine. One patient who was not fed for 24 hours to evaluate whether or not they were at risk for choking subsequently developed coprophagia. It should be noted that many times we are unable to trace back the behavior to a potential root cause; in this case the daughter who cared for her at home had voiced her concern when she saw her mother attempting to mouth/eat the O2 canula the evening before the evaluation. After the evaluation the patient was released from the hospital to the care of her daughter. The behavior will either result in additional evaluations and tests or more likely added stress to the sole caregiver, unless it forces placement into assisted living due to the behavior. Does anyone else have insight into whether there are other known instances of coprophagia and / scatiolia triggered by witholding food?

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 15 years experience.

The behavior will either result in additional evaluations and tests or more likely added stress to the sole caregiver, unless it forces placement into assisted living due to the behavior.
Oh, dear. I would conjecture that anyone who is engaging in coprophagia and scatolia is most likely very inappropriate for placement in assisted living. Nursing home placement seems more becoming of someone who has reached the point of eating and smearing one's own fecal matter.