Coprophagia And Scatolia In Demented Elderly Residents

TheCommuter, BSN, RN

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.