THE ELDERLY
Senior patients can face extra challenges not the least of which is fear of loss of independence with an ostomy. It’s especially important that elderly patients (and their families, if possible) receive adequate instruction and coaching on appliance management before they leave hospital. As with almost all new patients, the senior person with ostomy will receive home care for a period of time to help them and their family adjust. The elderly patient’s ET and doctor will assess how much assistance the person may need. Older patients are as capable of managing an ostomy as those much younger, but they may need more time to learn and remember new routines. As we grow older, our skin loses elasticity and becomes thinner and drier, thus becoming prone to wrinkles and irritation. These changes can become problems for those who must wear an appliance all the time. To prevent leakage as the skin becomes more wrinkled, one should stand up straight when changing the appliance (using a mirror may help you see what you are doing). The skin over the entire body tends to bruise more easily and heal more slowly as we age. Seniors need to be more careful when removing an appliance. Use two hands to remove the barrier -- one to hold the skin down so it isn’t being stretched unnecessarily, and the other to pull the flange off. Arthritis and lessening dexterity can make it more difficult to snap a two-piece appliance together. You might consider a one-piece appliance to make this easier. Using scissors to cut the flange hole can get harder if your hands are stiff; order appliances with a pre-cut opening if cutting is becoming a chore.

GAY AND LESBIAN PEOPLE WITH OSTOMIES
Gay and lesbian people with ostomies have all the same issues as the straight population, with the added concern that some may be uncomfortable seeking support outside of the gay community. Please -- be upfront with your nurse or doctor about your orientation. It will help them avoid assumptions regarding your sexual activities and social situation. If you wish to speak with another gay person with an ostomy, ask your ET nurse. They’ve had gay patients before and can often put you in touch with them. In addition, your local UOAC chapter can often connect you with a gay or lesbian member or associate. If your surgery has or is going to involve the anus/rectum, it’s imperative that sexually active gay men discuss this with their surgeon as this activity may no longer be an option.

MUSLIM PEOPLE WITH OSTOMIES
The Islamic faith has very definitive rules that must be followed in preparation and during the time of prayers. The question has arisen about the wearing of a pouch during the time of prayer. Mr. Mohamed Hanafy Ahmed, when he was the General Manager of ConvaTec, Middle East, petitioned Fatwa Commission of the AL-AZHAR University for a ruling. The Fatwa Commission is the official Islamic body governing such matters worldwide and is located in Cairo, Egypt. The following submission is an English translation of the official response as a service to people with ostomies from the Islamic faith.
Question - “There is a large group of patients afflicted by colon and bladder cancer where the malignant tumor has to be removed together with the vital organ of the body so as to prevent the spread of disease. In such cases the natural opening of the body is by-passed and replaced by a stoma in the abdomen to work as an outlet through which urine or stool is emitted in an involuntary manner. Pouches used for collecting such matter are replaced when necessary. At the time of prayers, the stoma patient is unable to change the pouch. Is it possible for such a patient to pray while the pouch is carrying such excrements and what is the rule in such a case ?”
Answer - Praised be Allah, Lord of all creatures and peace and prayers be upon the master of messengers Mohamed, his Kin and his followers. “In answer to this question, we reply that whoever is in such a situation is considered to have a religiously legitimate excuse. Since a stoma patient cannot replace the pouch for each prayer, he may perform absolution at the onset of each prayer interval. He may then pray as many times as he may wish during this prayer interval. At the onset of a new prayer interval, the absolution performed in the last interval is no longer valid and the stoma patient should perform a new absolution for the new prayer interval and so on (for each of the five prayer intervals.)
Chairman of Fatwa Commission of AL-AZHAR
Abd Allah Abd-Alkalik Al Mishad
8 Jumada 1, 1407
8 January 1987