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• Constipation, diarrhea, loss of bladder or bowel control, or vomiting

• Changes in urination or bowel movements, including frequency, smell, appearance, and quantity, and pain or difficulty urinating or moving the bowels

• Changes in skin appearance, including rashes, sores, tenderness, dryness, moistness, itchiness, pallor (paleness), jaundice (yellowing of the skin and whites of the eyes), or swelling

• Unexplained weight loss or gain

• Changes in appetite

Incontinence

Incontinence, the inability to control the passage of urine (urinary incontinence) or stool (fecal incontinence), usually is caused by an underlying disease or condition. Urinary and fecal incontinence can occur separately or together. Do not accept incontinence as a normal part of aging. An older person who is experiencing problems with incontinence should be examined by a doctor as soon as possible.

Incontinence can be a major problem when caring for a person at home. One way to deal with incontinence is to establish a toilet routine: encourage the person to go to the bathroom at frequent, regular intervals (for example, every 2 to 3 hours). Provide help promptly to prevent accidents. Make sure that the toilet facilities are readily accessible and easy to use. If the person is confined to bed, make sure that a commode, bedpan, or handheld urinal is within easy reach.

A number of incontinence aids, such as absorbent incontinence pads, disposable briefs, and condom catheters are available from drugstores and medical supply companies. Ask your doctor about them.

If a person has both urinary and fecal incontinence, loss of bladder control usually occurs before loss of bowel control. His or her doctor will examine the person to find the underlying cause.

Depression

A person who is ill or disabled is at high risk for depression. In older people, early detection and treatment of depression are extremely important because of the high risk of suicide. If you notice that the person you are caring for has any of the following signs or symptoms for more than a few days, talk to his or her doctor immediately:

• Changes in appetite (decrease or increase)

• Weight loss or weight gain

• Changes in mood or emotions

• Lack of responsiveness or attentiveness

• Loss of interest in favorite activities

• Feelings of hopelessness or helplessness

Some people incorrectly assume that symptoms of depression are a normal part of aging or mistake symptoms of depression for Alzheimer’s disease (see page 688), dementia (see page 689), or another illness. If the diagnosis is depression, it can be successfully treated with medication, psychotherapy, or a combination of both, at any age.

Fever

Although a fever is not usually dangerous, notify the person’s doctor if the person you are caring for has a fever. Always check with the person’s doctor before giving aspirin or an aspirin substitute. The doctor may prescribe a medication to reduce the fever. If the person’s temperature continues to rise after he or she has been given medication to reduce it, call his or her doctor immediately. Never try to raise the temperature of a person who has a fever (such as by turning up the heat or putting extra blankets or other coverings on him or her). Raising a person’s temperature abnormally high can cause seizures or loss of consciousness.

To help reduce the person’s temperature, sponge his or her face, neck, trunk, arms, and legs with lukewarm water and let it evaporate on the skin. Evaporation brings down the temperature of the skin. Encourage the person to drink plenty of water, a sports drink, fruit juice, or broth to replace the fluids that will be lost through the excessive perspiration that accompanies a fever.

Vomiting

Medications and treatments such as radiation therapy can cause nausea and vomiting. However, because vomiting can also be a sign of an illness or underlying health problem, tell the doctor if the person you are caring for is vomiting, especially if he or she is vomiting repeatedly.