Trends in aging: Exploring the ruby stage

By Wendy McHaney
May 23, 2014 at 12:23 a.m.

Today's column continues through the Senior Gems approach to care based on the Allen Cognitive Disability Theory. My previous columns discussed the first four stages - sapphire, diamond, emerald and amber.

This next series of columns will explore mid to late-stage dementia, also known as the ruby stage. My last column highlighted the safety issues with a person in the ruby stage, and today's column addresses continence management for a ruby.

At this stage, it is quite common for people to lose control of their bladder, their bowels or both. Treatable medical conditions, such as urinary tract infections and constipation, can cause incontinence as well as side effects of medication.

However, because of the progression of the disease, incontinence is quite often a result of not remembering where the bathroom is and not being able to recognize the need to use the bathroom. Since rubies will not be able to verbally communicate their need to use the bathroom or don't know they need to use the bathroom, it is important to recognize nonverbal cues, such as:

Tugging on clothing

Facial expressions

Sudden silence or hiding behind furniture

The following are ways to help manage a ruby's continence and provide a comfortable environment:

Determine daily routine: Determine when the ruby is going on their own. This may result in some accidents, but it will help you get a sense of their toileting pattern and help set a schedule.

Set a toileting schedule: Once you have determined their pattern, make a schedule and stick to it. When planning activities, include transition time to the bathroom as well as toileting based on your client's routine.

Clear a path: Be sure a path is clear to the bathroom. Although rubies should not be unattended in the bathroom, a clear path is still needed to ensure a safe and timely trip to the bathroom.

Be supportive: If an accident happens, do not scold. A ruby is generally unaware that an accident has occurred. And remember to use cues when assisting in clean up of a ruby.Next week's column will address nutrition and health risks with a ruby.

Senior Helpers is presenting free workshops and support groups at Copperfield Village, 501 E. Larkspur Drive, every other Thursday from 10:15 to 11:15 a.m. Call 361-894-8901 for more information about these workshops.

Previous columns on the stages of dementia as well as other trends in aging can be found at

Sources: SH Franchising Senior Gems training materials

Wendy McHaney is a certified senior adviser and the owner and director of operations of Senior Helpers. For more information about Senior Helpers, visit



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