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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Continence: A Matter of Dignity
Care of Chronic and Complex UI
By
Marie Mangino, MSN, CRNP, BC
President, Vincent Healthcare, Inc.Consultant, Penn Nursing Consultation
Service
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
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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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
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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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Review of “Causes, Signs and
Prevention”The first module covered the following objectives as learner outcomes:
List the common causes of Urinary incontinence (UI)
Describe the potentially serious effects of not treating UI
Recognize signs of a UTI Discuss effective ways to prevent
or reduce episodes of UI and enhance dignity
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Learning ObjectivesAt the end of “Care of Chronic and Complex Urinary Incontinence” you will be able to:
List the major types of chronic UI and the common signs and symptoms of each
Explain the importance of preventing constipation in older adults with UI
Discuss creative approaches to more complex cases of older adults with UI
Provide care to prevent or reduce episodes of UI and enhance dignity
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Types of Chronic UI
Stress Urge /Overactive
bladder Overflow Functional Mixed
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Stress UI
Small amount of urine leakage Loss of urine with increased
pressure in the abdomen from: Coughing Sneezing Laughing Lifting Standing
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Stress UI : How You Can Help?
Set toileting schedule based on a log and stick to it
Expect small leaks; use a liner
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Stress UI : How You Can Help?
Change more frequently Use skin barrier
Mrs. Levy
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Urge UI (Overactive Bladder)
Involuntary loss of urine and a strong urge to urinate that occurs suddenlyMay be incontinent on the way
to the bathroom May be incontinent of a large
amount of urine
Mrs. Powell w/walker
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Urge UI (Overactive Bladder):
How You Can Help Encourage person to avoid
bladder irritants Stick to personalized
schedule Watch for signs of need to
toilet Keep urinal or commode
handy Expect heavier wetting with
longer period of dryness
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Mrs. Powell’s Success
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Case of Mrs. Powell
Remind the person to avoid bladder irritants (including sodas, caffeine, alcohol and artificial sweeteners)
Help by establishing a toileting schedule and sticking to it
Watch for signs of need to toilet
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Overflow UI Continuous or periodic leakage of small
amounts of urine Tension in bladder forces muscles to
leak small amounts, either continuously or off and on
Caused by either Blockage at the exit of the bladder (large
prostrate) Bladder, nerve or
muscle damage
Mr. Stanley
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Overflow UI: How You Can Help
Allow time to stand and wait Report complaints of
discomfort Report inability to urinate for
more than 8 hours or urination every hour
Watch for signs of mental status change
Maintain schedule for toileting
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Functional UI
Due to chronic functionalimpairment:
Confusion Physical disabilities Combination
Mr. Clark
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Functional UI: How You Can Help
Set toileting schedule based on the log and stick to it
Encourage clothing that is easy to remove
Assist as needed Praise successes and
effort
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Challenging Situations
Dementia Inappropriate
toileting Denial
Unsafe attempts to toilet
Chronic constipation
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
The Challenges of Dementia and UI
Inappropriate toileting
Denial of incontinence
Mr. Clark
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Dementia and UI: How You Can Help
Never judge or disagree, accept the person’s explanation for wet clothing
Focus on Changing and cleaning Dignity and respect
Prompt (remind and encourage) to use the toilet, assist to get there, then prompt again
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Right Time, Right Place
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Case of Mr. Clark
Focus on: Dignity and respect Changing and cleaning
if needed Prompt (remind and
encourage) to use the toilet, assist to get there, then prompt again
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
UI and Unsafe Attempts to Toilet
Due to: Difficulty Walking Poor vision Poor safety
judgment
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Unsafe Attempts to Toilet: How You Can
Help Use individualized
toileting schedule; be there ahead of time
Do not rely on call bell Do not wait until the
person tries to get up
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Unsafe Attempts to Toilet: How You Can
Help Use safe footwear Use proper eyeglasses
when walking; assist person wearing bifocals
Provide a bedside commode or urinal to reduce the need to walk alone
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Chronic Constipation and UI
Presence of stool in the pelvis Takes up room in the pelvis
so bladder cannot fill up Causes need to urinate
more often Increases incontinent
episodes
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Chronic Constipation and UI: How You Can
Help Report it Encourage
Fluid intake Activity Foods rich in fiber
Avoid constipating food
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Objectives Review
Can you now1.List the major types of chronic
UI and the common signs and symptoms of each?
2.Explain the importance of preventing constipation in older adults with UI?
3.Discuss creative approaches to more complex cases of UI in older adults?
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Closing
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Special Thanks To:Christine W. Bradway, PhD, CRNP
Assistant 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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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
References and ResourcesBurgio, K. L., Robinson, J. C. & Engel, B. T. (1986). The role of biofeedback in Kegal exercise training for stress urinary incontinence. American Journal of Obstetrics & Gynecology, 154: 58-64. •Choe, J. M. (1999). Freedom regained: Female urinary incontinence can be overcome. Columbus, Ohio: Anadem Publishing; 117-171. •Clinical practice guideline number 2: Urinary incontinence in adults. Rockcville Md: US Department of Health and Human Services Agency for Health Care Policy and Research; 1996. AHCPR publication 96-0682. •Gibbons, L. & Choe, J. M. (2005). Helping women quell urinary incontinence. The Clinical Advisor, 7 (5), 21-28.
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
References and ResourcesLanga, et al, (2002). Informal caregiving time and costs for UI in older individuals in the US. Journal of the American Geriatrics Society, 50,(4): 733-737.Lee SY, Phanumus D. & Fields S.D. (2000). Urinary incontinence: a primary care guide to managing acute and chronic symptoms in older adults. Geriatrics, 55(11): 65-72. Morkved, S. Bo, K. & Fjortoft, T. (2002). Effect of adding biofeedback to pelvic floor muscle training to treat urodynamic stress incontinence. Obstetrics & Gynecology, 100; 730-739. Multiple authors (2004). Special issue: Urologic care of the older adult. Urologic Nursing, 24, 247-333. Teunissen, T.A.M., de Jonge, A., van Weel, C., & Lagro-Janssen, A.L.M. (2004). Treating UI in the elderly—conservative measures that work: A systematic review. Journal of Family Practice, 53 (1), 25. .
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
References and Resources
Web sites:
Collaborative to Support Urinary Incontinence and Women’s Health www.stressUI.org
National Association for Continence: www.nafc.org
National Institute of Diabetes & Digestive & Kidney Diseases: www.niddk.nig.gov
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© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter© 2006 University of Pennsylvania Delaware Valley Geriatrics Education © 2006 University of Pennsylvania Delaware Valley Geriatrics Education CenterCenter
Leadership and Staff:
Lois K. Evans, DNSc, RN, FAANSeries Associate Editor Viola MacInnes IndependenceProfessorSchool of Nursing University of Pennsylvania
Sangeeta BhojwaniAssociate Director, Series Assistant EditorDVGECUniversity of Pennsylvania
Laura RaybournSally Rusk, ConsultantsRaybourn Rusk Productions
Kathleen Egan, PhD Series EditorDVGEC Program Administrator Director, DVGEC University of Pennsylvania
Mary Ann Forciea, MDSeries Associate EditorClinical Associate Professor of MedicineDivision of Geriatric Medicine, University of Pennsylvania