Chapter 1: Introduction
Incontinence has been regarded as a geriatric giant and a major health care problem among older adults. It is one of the most unpleasant and distressing symptoms an individual can suffer.
Let’s start with a case scenario
For those affected with incontinence problem
Prevalence of incontinence
Asia Pacific Continence Advisory Board Survey (APCAB) 1998
A local community continence promotion programme of elderly centres in 2000
Among 363 elderly women attended the program
A local study in subsidized long-term care services in 2010
Among 5301 Chinese adults aged ≥ 60 in HK (average age = 80.4), who had completed an initial screening instrument:
From the above studies, you may find that:
Possible reasons of the INCREASING trend of incontinence:
Understanding continence and ageing
Normal continence (to keep dry and clean) requires:
Older adults may have the following challenges as they age.
Age-related changes in the lower urinary tract
**Atrophic changes in vagina + reduced bladder holding capacity + bladder irritability → frequency +/- incontinence
Common features of urinary frequency/ incontinence
→ Seek medical advice immediately
Impacts of incontinence in older adults
➤ ➤ ➤ Affect quality of life! ➤ ➤ ➤
How they cope with?
Use of pads
Impacts on caregivers
How can caregivers help the older adults and reduce stress?
1. Be empathetic
2. Get a physical examination to see if the cause of incontinence is treatable
3. Wear clothes that are easy to get on and off
4. Watch the diet
5. Always be prepared
6. Adopt a matter-of-fact approach
7. Accept help
- End of Chapter 1-
Chapter 2: Urinary incontinence
An 80-year-old woman with mild dementia was admitted to the medical ward because of high-grade fever. She had confusion and unable to recognize that she was in the hospital. She was yelling and wanted to go home. Health care worker gave her the incontinence pad because she wet her bed all the night.
Let’s start to understand urinary incontinence!
Types of urinary incontinence
Signs & symptoms:
Urge incontinence (Overactive bladder)
Signs & symptoms:
Overflow incontinence (Incontinence associated with incomplete bladder emptying)
- Bladder outlet obstruction
o Lower urinary tract symptomatology (LUTS)
o Enlarging Prostate, i.e. Benign prostatic hyperplasia (BPH) in men
- Acontractile bladder e.g. Diabetic autoneuropathy
Before asking the older adult to put on a diaper, what else can we do?
Helping the older adults with incontinence
Assessment of urinary incontinence
It’s not uncommon to see a patient who was admitted to a hospital would be put on a diaper to solve the problem of incontinence. However, should we ask the question ‘Does the patient has transient or persistence incontinence before giving him/her a diaper?’
Importance of early recognition of common problems
- End of Chapter 2-
Chapter 3: Faecal incontinence
Types of faecal incontinence
A full history is required because the development of faecal incontinence in the older adults can have many interacting causes.
Other investigations may include
Prevention of faecal incontinence
Constipations has long been associated with impaction and is the most common cause of faecal incontinence.
Please refer to MOOC 8 Bowel Changes for more information.
- End of Chapter 3-
Chapter 4: Continence Management in Long Term Care
The important roles of nurses in managing incontinence
Prevention of urinary incontinence in nursing home
If you were the resident of long term care, would you like to wear a diaper?
We have the following strategies for prevention of urinary incontinence.
Improving the environment
Encouraging good bladder habits
Image source from: edemenca.si
Care for people with dementia and incontinence
Problems of people in the later stages of dementia:
To minimize the chance of accidents, the caregiver should:
For moderate and severe dementia cases, it’s hard for them to manage functional incontinence by learning pelvic floor exercise and bladder training. Timed voiding may consider as a solution.
Conservative treatment is preferred: skin care and use of continence aids are recommended.
Individuals with intractable incontinence are often immobile and at major risk for skin breakdown. Skin care is very important in day-to-day care.
- Esp. immobile → at major risk for skin breakdown
Use of continence of aids & appliances
Selection of aids & appliances
Types of incontinence aids
1. Absorbent products
2. Collection appliances
3. Bed protection
4. Gerontech devices
Changing diapers and use of urinary sheath
Multidisciplinary care approach
- acts as a case coordinator
- medical assessment
- rehabilitation on mobility
• Occupational therapist
- prescription of aids and appliances to enhance continence ability
• Social worker
- counselling emotional unstable or depressed older adults
- End of Chapter 4-
Chapter 5: Indwelling urinary catheter care
Indications for indwelling urinary catheter
Indwelling urinary catheter should be used after a thorough assessment of individual person needs and after considering other potential alternatives.
Care of the catheter
Frequency of changing catheter
Frequency of changing drainage bag
- End of Chapter 5-
Quiz, feedback and certificate
Relevant Cadenza Training Materials
The videos in this course provide information for educational purposes only. The videos do not provide medical recommendations or diagnoses and are not substitutes for medical advice. It is crucial that you talk with your healthcare providers to discuss any questions you may have and seek them for medical advice, before you make any medical decisions. As the videos are only for educational purposes, we will not be responsible for any decisions you will make or consequences you will have based on the information they provide. In no event shall the Funder have any liability of any kind to any person or entity arising from or related to any actions taken or not taken as a result of any of the contents herein.
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