Continence: A Matter of Dignity Causes, Signs and Prevention

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Geriatric Education Center of Greater Geriatric Education Center of Greater PhiladelphiaPhiladelphia

Continence: A Matter of Dignity

Causes, Signs and Prevention

By

Marie Mangino, MSN, CRNP, GNP-BCPresident, Vincent Healthcare, Inc.

Wendy W. Fox, MOT, OTR/LAssistant Professor of Occupational TherapyUniversity of the Sciences, Philadelphia PA

Jennifer A. Reinhold, BA, PharmD, BCPSAssistant Professor of Clinical Pharmacy University of the Sciences in Philadelphia

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AcknowledgementsAppearing in Video:

Name Appearing as

Bob Swensen……….Mr. BanksRuth Alpert…………Mrs. BanksSusaye Lawson…… SusayeNate Lazowick…….Mr. WilliamsKevin Brown……… Carl, DCSW Dinnie Childs………Piano PlayerClarese Herbert……Mr. William’s

friendMan at Piano………Arjun BhojwaniNancy Web…………Mrs. PowellEric Stewart……….Mike, grandsonRuth Livikoff………Ruth, DCSW

Name Appearing as

Dick Brown………………Mr. ClarkDeanna Penn…………….SupervisorSangeeta Bhojwani…….TraineeRoby Jacobs……………..Daughter Charlene Duff……………Shopper, Gift ShopSheila Mitchell-Ayers…Shopper, Gift Shop Marie Mangino………….Trainer, as herselfTanisha Jones……………TestimonialJulie Cohlmer…………….Testimonial

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Special thanks to:

• Henrietta Roberts and Sandy Bailey, of Stapeley in Germantown for coordination of video shoot

• All the residents and staff of Stapeley in Germantown, for their participation and for permitting video production.

• Raybourn Rusk Productions

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Play video segment titled, “01

Introduction.mpg”

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Urinary Incontinence (UI) Defined

UI is simply defined as the involuntary or inappropriate loss of urine. In other words, incontinence is urine loss which happens when the person doesn’t want it to or doesn’t know it’s happening.

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Learning ObjectivesAt the end of this program you will be able

to: List the common causes of urinary

incontinence (UI) Describe the potentially serious effects of

not treating UI Recognize signs of a urinary tract

infection Discuss effective ways to prevent or

reduce episodes of UI Enhance the dignity of those in your care

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Prevalence of UI

More thank 13 million Americans have UI

85% of them are women 37% of persons over 65 and

living in the community have UI 53% of homebound have UI 30-77% of NH residents have UI

In 8 of 10 cases symptoms can be improved and in some cases function restored.

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The Facts about UI Continence is normal;

Incontinence is not Normal aging does not cause

incontinence When continence is impaired,

many simple things can be done to restore or improve functionMrs. Mendoza

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Caring for UI is Important Because:

Untreated or under-treated UI can cause: Skin breakdown and infection Falls and injuries Sleep disturbance

Mr. Phillips

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Caring for UI is Important Because: Untreated or under treated

UI can cause: Depression/social withdrawal Loss of dignity/lower quality

of life UTIs (urinary tract

infections) hospitalization death

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by Nicole Mangino

Left KidneyRight

Kidney

BladderStructure of the

Urinary Tract System

Left Kidney

Ureters

Urethra

Bladder wall muscle

Nicole Mangino 2004

Bladder

Right Kidney

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Contributors to UI: Age-Related

Changes Overactive bladder muscle Enlarged prostate (BPH) Atrophic vaginitis and

urethritis (occurs after menopause)

Reduced bladder capacity Increased post-void residual

(PVR)

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Contributors to UI:Injury and Disease

Diabetes Damage to the:

BrainSpinal Cord Bladder

Short term use of an indwelling catheter during acute illnessMrs. Banks

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Contributors to UI: Limitations in

Function Ambulation Dressing Fear of falling Choice

Mr. Williams

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Contributors to UI: Dietary Factors

Artificial sweeteners

Caffeine Alcohol Acidic Foods

Mrs. Powell

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Contributors to UI: Medications

Anticholinergics : Can affect the bladder’s ability to empty

Diuretics (water pills): Cause extra urine production

Cold medicines: Can affect the bladder’s ability to empty

Pain medicines: Can cause constipation and fecal impaction

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Contributors to UI Hydration & Physical

Conditions Not enough fluid Too much fluid Fecal impaction Acute confusion Too much alcohol or caffeine Infections/Medical illness

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UTI Symptoms in the Older Adult

Increased frequency Increased urgency New or increased UI Urine odor or cloudiness Blood in the urine Fever or chills Change in mental status

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Acute Changes in Mental Status that may

indicate UTI Sleepiness Irritability or agitation Lethargy New or increased

confusion

Mr. Green

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Things You Can Do for Older Adults with UI

Keep a log of UI events

Monitor toileting

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Things You Can Do for Older Adults with UI

Determine frequency of need

Develop a schedule and assist to toilet

Consider recent medication change

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Play video segment titled, “02 Mrs.

Banks.mpg”

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Things You can Do: Scheduling

Log actual number of “accidents” or “urinations”

Based on log results - develop schedule

Establishing and following a schedule can give a person confidence to do other things

Prompt and assist Praise the effort

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Things You Can Do Encourage change in diet

(gradually reducing and then eliminating caffeine, alcohol, sweeteners and acidic foods)

Avoid over the counter medications that can cause constipation or make continence more difficult

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Things You Can Do Assist as needed to:

Get to the bathroom or commode safely

Remove clothing Make urinals (male and female)

available as well as bed pans Position urinal or bedpan Assist w/ pericare and appropriate

products and redressing

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Play video segment titled, “03 Mr. Williams.mpg”

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Mr. Williams’ Challenge

Arthritis Personal

embarrassment Effect on family Clothing with

elastic or Velcro closures

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Things You Can Do • Establish safe bathroom setup

– Use of grab bars and/or a raised toilet seat, 3-in-1 commode

– Observe for good hygiene– Assist if needed with hygiene

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Things You Can Do Make urinals available Prompt (suggest,

encourage and remind) to toilet

Compliment effort and success

Change if incontinent

Mr. Samson

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Things You Can Do “JIC”• For outings….Be prepared!

– Take a “JIC” bag – Just In Case• Extra set of clothes• Incontinence products (briefs, liners, underwear)

• Gloves, moist wipes, hand sanitizer• Absorbent pads to protect furniture• Air deodorizer• Plastic bag

• Being prepared reduces anxiety for both the client and the caregiver!

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Skin CareTo prevent skin breakdown:

Work towards improved continence

Promptly change absorbent undergarments and clean perineum and buttocks

Use a skin barrier Promptly report any

change in skin

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Product Use for UI Least restrictive Most dignified

Individual product preference Proper fit Regular underwear w/ liner Pull-up Brief (adult absorbent product) Proper fit ensures best protection

and is most cost effective!

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Things You Can Do• Simple clothing changes

make toileting a lot easier!– Velcro closures on

shirts/pants/shoes makes on/off less effortful

– Elastic waistbands and roomier fit ease up/down of pants

– Add rings onto zippers

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Final Case Scenario• Ms. Hill has rheumatoid

arthritis with severe deformities of her hands

• She has difficulty with such things as door knobs and buttons on her clothes

Mrs. Hill

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Learning Objectives Review

Can you now: List the common causes of urinary

incontinence (UI) Describe the potentially serious effects of

not treating UI Recognize signs of a urinary tract

infection Discuss effective ways to prevent or

reduce episodes of UI List ways to enhance the dignity of those

in your care

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Special Thanks To:Christine Bradway, PhD, CRNP, FAAN

Associate Professor of Gerontologic Nursing

University of PennsylvaniaSchool of Nursing

Mary Ann Forciea, MDClinical Associate Professor of Medicine

Director, Primary Care ServicesUniversity of Pennsylvania Health Systems

Nicole ManginoIllustrator

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References and Resources• American Medical Directors Association. (2012). Urinary Incontinence in the Long Term Care Setting Clinical Practice Guideline. Columbia, MD: AMDA.

• DuBeau, C.E., Kuchel, G.A., Johnson.T., Palmer, M.H., Wagg, A. Incontinence in the frail elderly. In Abrams, P, Cardozo, L, Khoury, S, Wein, A. (2009). 4th International Consultation on Incontinence. Health Publication Ltd. 963-1024.

•DuBeau CE, Simon SE, Morris JN. The effect of urinary incontinence on quality of life in older nursing home residents. J Am Geriatr Soc 2006;54:1325-33.

•Fink HA, Taylor BC, Tacklind JW, Rutks IR, Wilt TJ. Treatment interventions in nursing home residents with urinary incontinence: a systematic review of randomized trials. Mayo Clin Proc 2008;83:1332-43

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References and Resources

• Genao, L. & Buhr, G.T. Urinary tract infections in older adults residing in long-term care facilities. Annals of Long-Term Care: Clinical Care and Aging. 2012;20(4):33-38.

• Hagglund, D. (2010). A systematic literature review of incontinence care for persons with dementia: the research evidence. Journal of Clinical Nursing. 2010;19,303-312.

• Kraus SR. Bavendam T. Brake T. Griebling TL. Vulnerable elderly patients and overactive bladder syndrome. Drugs & Aging. 2010; 27(9):697-713.

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References and Resources• Landefeld CS, Bowers BJ, Feld AD, et al. National Institutes

of Health state-of-the-science conference statement: prevention of fecal and urinary incontinence in adults. Ann Intern Med 2008;148:449-58.

• Lee, S.Y., Phanumus D. & Fields S.D. Urinary incontinence: a primary care guide to managing acute and chronic symptoms in older adults. Geriatrics 2000; 55(11): 65-72.

• Matthews, S.J. & Lancaster, J.W. Urinary tract infections in the elderly population. The American Journal of Geriatric Pharmacotherapy 2011; 9: 286-309.

• Newman, D.K., & Wein, A.J. Managing and treating urinary incontinence. 2nd ed. 2009; Baltimore, MD: Health Professions Press.

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• Offermans, MP, Du Moulin MF, Hamers JP, Dassen T, Halfens RJ. Prevalence of urinary incontinence and associated risk factors in nursing home residents: a systematic review. Neurourol Urodyn 2009;28:288-94.

• Saliba D, Solomon D. Rubenstein L. Young R. Schnelle J. Roth C. Wenger N. Feasibility of quality indicators for the management of geriatric syndromes in nursing home residents. Journal of the American Medical Directors Association 2005; 6(3 Suppl):S50-9, 2005.

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Web sites:Collaborative to Support Urinary Incontinence and

Women’s Health www.stressUI.org

National Association for Continence: www.nafc.org

Australian Government Department of Health and Aging http://www.bladderbowel.gov.au/all/bladderproblems.htm

National Kidney and Urologic Diseases Information Clearing House http://kidney.niddk.nih.gov/index.aspx

http://www.stressui.org/

http://www.nafc.org/

http://www.bladderbowel.gov.au/all/bladderproblems.htm

http://www.bladderbowel.gov.au/all/bladderproblems.htm

http://kidney.niddk.nih.gov/index.aspx

Documents

Continence: A Matter of Dignity Causes, Signs and Prevention