Coprophagia And Scatolia In Demented Elderly Residents

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by TheCommuter TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 16 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. 105 Articles; 5,349 Posts

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.

reagansm

reagansm

39 Posts

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

TurtleCat

Specializes in Geriatrics. 150 Posts

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. 3,358 Posts

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. 142 Articles; 9,968 Posts

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

CherylRNBSN

Specializes in critical care, Med-Surg. Has 14 years experience. 182 Posts

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

eleectrosaurus

Specializes in Cardiac/Neuro Stepdown. Has 1 years experience. 149 Posts

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

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TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 16 years experience. 226 Articles; 27,608 Posts

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. 1,620 Posts

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.

Cali_Nurse_209

Cali_Nurse_209

265 Posts

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

SuzieeQ

Specializes in Geriatrics, retirement, home care.. Has 3 years experience. 61 Posts

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