Incontinence is a common problem among older adults which greatly affects the quality of life. Taking this course will help you understand the continence issues in ageing. Incontinence assessment, nursing care and practical tips in choosing incontinence products and assistive devices will also be addressed.
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
Often feel embarrassed, ashamed and alone
Hide their problem from society, their family and friends, even from themselves
Seldom seek for medical advice or treatment
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
40.8% reported urinary incontinence
(Hsia & Mok, 2001)
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:
45.7% of male and 45.6% of female participants reported urinary incontinence.
(Bai, Leung, Lai, Chong, & Chi, 2017)
Among elderly residents of nursing homes:
Occurrence of urinary incontinence has increased significantly over the past 20 years
23.3% in 1992
45% in 2003
54.1% in 2009
(The Hong Kong Polytechnic University, 2014)
International Continence Society (ICS) estimated 30-40% of >65 years in community has urinary leaking.
(Stenzelius et al, 2015)
From the above studies, you may find that:
The prevalence of incontinence is increasing.
Urinary incontinence is common for women and older adults.
The rate is typically higher in institutions.
Possible reasons of the INCREASING trend of incontinence:
Underestimated of the actual situation in the past decades.
People may assume that incontinence is a normal consequence of ageing.
People may be embarrassed by their incontinence or fear invasive testing, and thus, avoid evaluation.
In primary health care clinics and hospitals, medical and health personnel rarely ask patients about urinary incontinence.
People seldom initiate discussions about incontinence.
5 myths of incontinence
Understanding continence and ageing
Normal continence (to keep dry and clean) requires:
Higher cortical function (social norm to keep dry)
Awareness of need to empty (sensation)
Bladder holding capacity to avoid social embarrassment
Mobility (to toilet) and other self-care ability (e.g. undress lower garment)
Contractibility of bladder and relaxation of sphincter for emptying
Older adults may have the following challenges as they age.
Age-related changes in lower urinary tract
Malnutrition e.g. dehydration and low-fibre
Medication side effects (eg. sedation drugs, diuretics, cholinergic drugs)
Age-related changes in the lower urinary tract
Oestrogen in women (post menopause)
Prostate size in men
Nocturnal urine production due to decrease anti-diuretic hormone
Post voiding residual urine (PVRU) due to decrease bladder contractility
**Atrophic changes in vagina + reduced bladder holding capacity + bladder irritability → frequency +/- incontinence
Common features of urinary frequency/ incontinence
Urinary incontinence without awareness
Leaking of urine when coughing /sneezing
Leaking of urine when urgency
Nocturia (wake up from bed to void > 1 time during sleeping time)
Frequency of micturition (>7 times/day)
• Haematuria (blood in urine) - beware of urinary tract infection or structural pathology
• Difficulty in passing urine
These two are commonly associated with urinary retention or overflow incontinence
• Dysuria (pain during voiding)
→ Seek medical advice immediately
Impacts of incontinence in older adults
Psychological impact of incontinence among older adults
Fall (urge to toilet prone to fall)
Dehydration due to decrease fluid intake to prevent wet
Loss of self-esteem and self confidence
Worry (didn’t know how to manage)
Avoid social life
Isolation due to don’t want the others know his /her condition
Increase financial burden for absorbent products
➤ ➤ ➤ Affect quality of life! ➤ ➤ ➤
How they cope with?
(Sometimes, in a wrong way…)
Long journeys (with others)
Trips with friend
→ Social isolation
• Don’t drink water → Dehydration & concentrated urine will induce bladder irritation
• ‘Just in case’ (no urgency but go to toilet in order to prevent wet) → Reduces the ability to hold the urine if urinating too frequent
• ‘Toilet mapping’ (make sure the location of the toilet then plan the route)
→ Annoyance & anxiety
• Find seats near toilet / door
• Wear dark clothes (not easy to detect wet)
• Carry spare underwear
Frequent showering→ May cause skin irritation and bring to psychological burden
Change clothes frequently→ Annoyance & anxiety
Use of scents (cover the smell of urine)
Use of pads
If know no toilet
→ Using toilet paper as a “pad” is NOT correct. Tips on choosing incontinence products will be discussed in Chapter 4.
Impacts on caregivers
Invading their privacy when take care of perineum or penis
Increase financial burden
Affect social life
Decrease quality of life
How can caregivers help the older adults and reduce stress?
1. Be empathetic
Understand older adult’s worries, be patience and tact to ease the older adult’s anxiety. It also helps caregivers to reduce stress level as well.
2. Get a physical examination to see if the cause of incontinence is treatable
Most conditions can be improved after medical problem had been solved.
3. Wear clothes that are easy to get on and off
Slacks with an elastic waistband can be pulled down quickly.
Enable older adult to get on the toilet faster and possibly avoid an accident.
If caregivers have to help the older adult with cleanup, easy-off garments make it simpler for you to undress and re-dress them.
4. Watch the diet
Avoid consuming caffeine e.g. coffee, tea, Chinese tea, chocolate and cold drinks, spicy foods and a lot of fresh or dried fruit.
5. Always be prepared
Pack a small bag with supplies, e.g. incontinence pads, wipes, tissue and even a change of clothes in case an accident happens when going out together.
6. Adopt a matter-of-fact approach
This technique can overcome an older adult’s shyness or embarrassment.
Use reassurance and a straightforward manner: “Oh, that’s too bad you had an accident, but don’t worry. It happens to a lot of people. Let me help you get cleaned up and into some dry, comfortable clothes.”
7. Accept help
Many caregivers who are taking all responsibility to take care of the older adults by themselves only.
Encourage them to ask for support from the home care service e.g. bathing or house cleaning or escort for attending the appointment.
Arrange some me-time to reduce the stress.
- 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.
If you were the patient, how would you like the health care worker to take care of you?
- Go to toilet or use a diaper?
If you were the health care worker, what should be your first consideration?
- Put on a diaper?
- Bring the patient to toilet?
- Any assessment can be performed?
- What kind of urinary incontinence does she suffer from?
- What are the interventions you would suggest?
(You may find the answers after studying this Chapter.)
Let’s start to understand urinary incontinence!
Types of urinary incontinence
Caused by an illness or a specific medical condition that is short-lived and quickly remedied by appropriate treatment of the condition and a disappearance of symptoms.
In the delirious patient, incontinence is usually an associated symptom that will abate with proper diagnosis and treatment of the underlying cause of confusion.
Dysuria and urgency from symptomatic infection may defeat the older adult’s ability to reach the toilet in time.
Medication that causes incontinence:
Sedative hypnotics may cause confusion and incontinence.
Diuretics lead to polyuria, frequency and urgency.
Anticholinergic agents induce urinary retention with associated urinary frequency and overflow incontinence.
Alpha-adrenergic agents can cause stress incontinence and urinary retention.
Calcium channel blockers can reduce smooth muscle contractility in the bladder and cause urinary retention and overflow incontinence.
Severe depression may be associated with incontinence.
Excessive urine production
Excess intake, endocrine conditions that induce diuresis cause polyuria and can lead to incontinence.
Limited mobility is an aggravating or precipitating cause of incontinence.
Patients with stool impaction present with either urgency incontinence or overflow incontinence and may have faecal incontinence as well.
Urge incontinence (Overactive bladder)
Overflow incontinence (Incontinence associated with incomplete bladder emptying)
Signs & symptoms:
leaking of urine when coughing, sneezing and physical activities that increased the intra-abdominal pressure
may be infrequent
involves very small amounts of urine
common in older women
degree of stress incontinence: ranges from mild to severe
Sphincter weakness due to:
- Lack of oestrogen → weakened supporting tissues and consequent hypermobility of the bladder outlet & urethra
- Vaginal delivery will damage the pelvic floor muscle during delivery
- Chronic cough will weaken the pelvic floor muscle
- Chronic straining at stool
- Radical prostatectomy (surgical removal of the whole prostate gland for prostate cancer)
Pelvic Floor Exercise
Pelvic floor exercise
- To improve the tone of the muscles in the pelvic floor which provide support to the urethra and bladder neck.
- First line treatment for stress incontinence and combined stress and urge incontinence.
- Useful for men after prostatectomy operation, where a degree of stress incontinence occur because of damage to the urethral sphincter mechanism.
- Should be practiced regularly and daily. Apply when need!
- Use of instrumentation to mirror psycho physiologic process that the individual is not normally aware of and that may be controlled voluntarily.
- Help regain control over the muscles in the bladder and urethra.
- Can be helpful when learning pelvic muscle exercises.
- Tension free vaginal tape is common and effective surgery nowadays.
- Aims to support the mid-urethra and increase urethral resistance.
o is a feasible option in the management of poor emptying.
o can be taught to the caregiver if older adult is invalid or has poor manual dexterity.
- Indwelling catheterization
o are always considered as a last resort in continence management.
Urinary leakage caused by:
- Failure to recognize the need to use the toilet (cognitive impairment)
- Failure to remember to use the toilet (dementia)
- Lack of motivation to use the toilet (depression)
- Decreased ability to use the toilet (physical and mobility limitation, e.g. stroke or frailty)
- Poor access to toilet
When the toilet is too far away or has obstacles e.g. steps.
- Lack of privacy
When the older adult “being forced” to use bedpan or bedside commode with only a curtain to separate them from the view of others.
- Unconducive toilet facilities
Badly maintained toilets with foul odour or dirty seats discourages the older adult to “hang on”, this may lead to retention or incontinence.
- Negative attitudes of caregivers
If incontinence is accepted as part of aging and normal in the older adults, it becomes ignored. Minimal effort will be given to promote continence.
- Unfamiliar environment
Cognitively impaired older adults often become more confused with changes in environment and usually fail to locate the toilet even if they have been shown the way.
Environmental factors are NOT associated with any pathologic condition of urinary system or voiding mechanism.
- a toileting program that combines scheduled voiding with "prompting" from a caregiver
- to improve bladder control for people with or without dementia using verbal prompts and positive reinforcement
- appropriate for older adults with all types of UI and in individuals who may have impaired cognitive function.
- a local study: https://www.sciencedaily.com/releases/2014/01/140106132955.htm
- a fixed time interval toileting assistance program that has been promoted for the management of people with urinary incontinence who cannot participate in independent toileting.
- suggest to be practiced in residential care settings, especially for clients with cognitive impairment.
Before asking the older adult to put on a diaper, what else can we do?
Helping the older adults with incontinence
Helping the older adults with incontinence
A combination of stress and urge 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?’
continence assessment is necessary to understand the cause and make any decision on managing the problem of incontinence.
Past medical history
- medical conditions that may co-exist with or contribute to incontinence.
Past surgical history
- any post-operative complications from urethral dilation, TURP, bladder neck surgery or other urological history?
Past obstetric history
- no. of pregnancies, children’s birth weights, type of deliveries, menstrual status
- women are particularly vulnerable to stress incontinence ∵ pelvic floor damage during child birth & post-menopausal hormone decline.
Past gynaecological history
- e.g. abdominal hysterectomy, vaginal hysterectomy, pelvic floor repair
- For details, refers to DIPPERS: Pharmaceutic
Onset of incontinence
Common features on urinary frequency and incontinence (pls refer to Chapter 1)
Precipitating factor (any leaking of urine at below situations?)
- e.g. coughing, laughing, lifting, urgency
Incontinence aids (use aids for absorbing urine?)
- Frequency, normal bowel habits, character (hard, palate, soft, loose, watery?), constipation, PR bleeding (any bleeding after bowel opening?)
Amount and type of fluid intake
- Be aware of the bladder irritating beverages e.g. alcohol, coffee, Chinese tea and cold drinks
- Should NOT restrict fluid intake to avoid incontinence
- Any impaired mental function e.g. depressed, stressed or experiencing family or social problem
- Examine and determine older adult’s mobility, manual dexterity and eyesight.
- Restricted mobility may precipitate incontinence by limiting the ability to reach the toilet in time.
- Manual dexterity is required for undressing upon reaching the toilet.
Attitude towards incontinence
- Attitude towards incontinence present a major problem in tackling it.
- Passive acceptance of incontinence as an inevitable part of aging → affect compliance to the treatment plan.
Palpation of the lower abdomen to reveal a palpable bladder.
- Examine the vagina to detect:
o vaginal discharge
o atrophic vaginitis/ urethritis
o prolapse such as cystocele, rectocele & uterine prolapse
- Examine the tone of pelvic floor muscles and the older adult’s ability to perform slow and fast twitch ability.
- Observe for skin tags or haemorrhoids that might make defecation painful. A digital rectal examination is necessary to check for impacted stool, enlarged prostate or a lax anal sphincter.
Volume chart/ Bladder diary
- the single most useful tool in assessing the older adult’s level of incontinence.
- acts as a record to be interpreted with the other findings of the continence assessment and diagnosis and to plan care.
International Prostate Symptom Score (IPSS)
- It has 7 questions and provides a score ranging from 0-35. (https://www.hkua.org/IPSS/)
- Identify the voiding or storage problems and from the total score can reflect the severity of lower urinary tract symptom.
International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI short form)
- It has 4 questions and provides a score range from 0-21. (https://iciq.net/iciq-ui-sf)
- With the higher score indicating greater severity of symptom
Urinalysis and culture
- collect mid-stream urine for culture and microscopy
- It is a cheap, simple and non-invasive test.
- Procedure: voids into a funnel attached to a transducer that converts the velocity of urine flow into a graphic curve.
- Identify abnormal voiding pattern from the flow curve.
- It is done after voiding and is a reflection of bladder contractility.
- Over 100ml is significant in older adults.
- Renal Function Test (RFT): to detect any kidney problems and show how well the kidneys are working.
- Prostate Specific Antigen (PSA): if high PSA showed abnormal prostate gland, need to exclude prostate cancer by further investigation.
- To rule out faecal impaction.
Urodynamic study (UD)
- If the causes cannot be confirmed from clinical sign and symptom, then perform UD.
- Look inside the urethra and bladder by the instrument.
Importance of early recognition of common problems
Older adults often have more than one factor contributing to their incontinence.
Be constantly alert for the common underlying problems which can cause urinary incontinence.
Identify the signs and symptoms of UTI, confusion, chronic cough, impaired mobility, impaired manual dexterity, an enlarged prostate, the side effects of drugs and the existence of neurological disorders.
Get support for early treatment.
- End of Chapter 2-
Chapter 3: Faecal incontinence
Types of faecal incontinence
Nature of stools
1. Faecal urgency
Reduce rectal compliance
Improve rectal compliance
Anal sphincter exercises
Assess previous bowel habit
Develop individual bowel programme
2. Faecal stress
Pelvic floor weakness anal sphincter damage
Anal sphincter exercises
Identity cause of diarrhoea
Give anti-diarrhoea agents
4. Constipation with overflow
Inadequate diet & fluids medication
Spurious diarrhoea hard pellets
Prevent further impaction
High fibre diet & adequate fluids
Adequate toilet facilities
Treat pain or cause of pain
Lack of privacy
Toilet too high/low
Toilet not recognized
Distance to toilet
Toilet sign posting
Damaged internal sphincter
Inadequate external sphincter
Soft formed stool
Anal sphincter exercises; or
Constipate and use enemas/ suppositories 3 times a week
A full history is required because the development of faecal incontinence in the older adults can have many interacting causes.
Past medical history: CVA, Dementia, DM?
Past surgery history: Inflammatory diseases or bowel surgery
Chapter 4: Continence Management in Long Term Care
The important roles of nurses in managing incontinence
- advocate for health and well being
- collaborate multi-disciplinary professionals for care plan
- educate the older adults, their relatives and other caregivers to manage incontinence problem
- early detection
- perform assessment and diagnostic tests
- administer treatment
- monitor the result of the care plan
Prevention of urinary incontinence in nursing home
If you were the resident of long term care, would you like to wear a diaper?
As caregivers, should we give diapers for our clients as the first step of care for the prevention of urinary incontinence?
Could we use alternative in a hospital setting or nursing home?
How could we respect older adults’ dignity?
We have the following strategies for prevention of urinary incontinence.
Improving the environment
Ensure the privacy and safety
Provide each resident with an appropriate chair
Provide each resident with a bed of the correct height
Provide railings and bars to help residents to reach and use the toilets safely and without fear
Provide lighting to help residents to reach and use the toilets safely and without fear
Provide signs to help residents reach the toilet without losing the way and recognize the correct door when they arrive
Ensure the floor surface helps residents reach the toilet without falling and without fear
Provide simple clothing that helps residents go to toilet easily on their own
Provide residents with toilets that are clean and acceptable condition
Encouraging good bladder habits
Adequate fluid intake
- make an assessment of how much fluid the residents are drinking each day
- aware of contraindication in particular cases.
Avoid bladder-irritating beverages, e.g. Chinese tea, coffee, tea, cold drinks
Educate the residents to stop ‘just in case’.
When the caregivers help residents to go to toilet, reassure them that there is plenty of time and encourage them to empty their bladder completely.
Identify continent residents who are struggling to get to the toilet, help them and at the same time encourage them to ask for help when next they go to the toilet.
Encourage residents to tell you when they are constipated so that you can help them by increasing fluid and fibre intake and ensure they get more exercise.
Encourage pelvic floor exercises.
- pelvic floor supports the bladder and urethral sphincter.
- plays a vital role in maintain good urethral closure → prevent urine leakage
Image source from: edemenca.si
Care for people with dementia and incontinence
Problems of people in the later stages of dementia:
not realizing they need to urinate
forgetting to go to the bathroom
not being able to find the toilet
To minimize the chance of accidents, the caregiver should:
Avoid giving drinks like caffeinated coffee, tea, and sodas, which may increase urination. But don’t limit water.
Keep pathways clear and the bathroom clutter-free, with a light on at all times.
Make sure you provide regular bathroom breaks (Timed voiding).
Supply underwear that is easy to get on and off.
Use absorbent underclothes for trips away from home.
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.
Assess perineal skin condition and integrity regularly
Maintain good hygiene to prevent skin breakdown and maintain skin integrity.
- Esp. immobile → at major risk for skin breakdown
- Thorough cleansing of the entire genital area at least twice a day.
- Gentle cleansing of the skin after each soiling.
- Avoid force and friction during cleansing.
- Patted dry skin with a soft towel gently but thoroughly after cleansing.
Take bath or shower daily especially in hot season.
- Use water and mild unperfumed soap
- Avoid soap if dry skin, dermatitis or pruritus. Strong soap may destroy sebum, provoke skin reaction and cause discomfort
- Avoid bubble bath ∵ cannot rinse the skin completely
Apply a moisturizing lotion or cream for dry skin.
- Use a moisture barrier product (e.g. barrier cream or castor oil) if skin irritation is present or at risk.
- Re-apply the moisture barrier product after each incontinent episode and every 12 – 24 hours.
Avoid using talcum powder ∵irritate and tend to form lumps when dampened by urine causing encrustations in the groin skin folds.
Replace absorbent incontinent product frequently to keep skin dry. Avoid using plastic pants.
If the skin is becoming sore, factors other than the incontinence should be investigated:
- Sensitive to the materials of incontinent pad or appliance, e.g. latex of a penile sheath
- The pad may be too rough.
- Appliance may be too tight.
- Plastic in conduct with wet skin.
- Candida infection.
Minimize skin injury caused by friction or shearing forces through proper positioning, turning and transfer techniques.
Use of continence of aids & appliances
aim to minimize the effect of incontinence & enhance the quality of life
assessment is needed before use
The incontinence itself: Type, amount, pattern and timing, precipitants of incontinence
Mobility: The chair bound/ bedbound/ ambulant patient have different needs
Manual dexterity: If dexterity is poor, some products cannot be managed easily or independently
Local anatomy: Features of genital skin condition or anatomy may indicate certain items
Mental function: A confused or demented person may not be able to manage a complex aids
Personal hygiene: Washable and reusable items are inappropriate for those unlikely to wash them properly
Personal preference: Some people take a like or dislike to certain products
Availability: An easily and reliably available is important
Domestic facilities: People with poor facilities for washing and drying may find using washable products difficult
Selection of aids & appliances
How to select incontinence products
Can maintain patient’s dignity and enable him/her to achieve “social continence”
Can contain the excreta completely to prevent any leakage and disguise any odour.
Be comfortable to wear and protect vulnerable skin from soreness, chafing or pressure sores.
Be easily managed by older adults and caregivers.
Be easy either to dispose of, or wash and clean, as appropriate.
Be reasonably priced and easily available.
Can be used by both sexes.
In a wide range of shapes, sizes and degree of absorbency to cater individual’s needs.
- Two pieces system- involving the part and pads to keep in position
- One piece system- the pad is incorporated in the part itself
Types of incontinence aids
1. Absorbent products
Disposable pads and reusable pants
Disposable mobile pants
2. Collection appliances
Hand-held urinals (Male & female)
Penile Sheaths (Paul’s tube)
- Adhesive coated on sheath lining to make it adhesive
- Foam strip coated with adhesive on both sizes for internal fixation of sheath
- Contraindication for penis sheath
o Retracted penis
o Skin sensitively
o Lack of manual dexterity
o Mental capacity – difficult in putting it or without the help of a caregiver
- useful for those with dribbling incontinence
3. Bed protection
made of cellulose padding with a waterproof backing for protect the mattress
4. Gerontech devices
Portable toilet frame
Toilet seat lift
Shower commode chair
Foldable shower chair
Wearable device for incontinence
Gerontechnology products for incontinence
Changing diapers and use of urinary sheath
Changing diaper in a standing position
Changing diaper in a lying position (Assisted by 1 and 2 persons)
Wearing incontinence pant
How to use urinary sheath
Multidisciplinary care approach
- acts as a case coordinator
- nursing management
- medical assessment
- medical treatment for revisable condition
- rehabilitation on mobility
- pelvic floor training
• Occupational therapist
- prescription of aids and appliances to enhance continence ability
- environmental modification
- functional transfer training
- manual dexterity training
• Social worker
- counselling emotional unstable or depressed older adults
- referral on community health care services
- caregiver support group
- End of Chapter 4-
Chapter 5: Indwelling urinary catheter care
Indications for indwelling urinary catheter
Severe illness - monitoring of urine output is necessary
Post-operative drainage after urological or gynaecological surgery
Terminal ill - quality of life will be improved
Intractable urinary incontinence - alternative management has been unsuccessful
Neurological deficits leading to incomplete bladder emptying
For those having bladder outlet obstruction
Indwelling urinary catheter should be used after a thorough assessment of individual person needs and after considering other potential alternatives.
Image source from: www.roswellpark.org
Care of the catheter
Care of catheter drainage system
Frequency of changing catheter
Life span of the catheter depends on catheter material and the recommended period by the product company
Routine changing of the catheter at fixed time intervals
Interval for changing catheter should be individualized for each person
Catheters should be changed proactively according to the individual’s usual pattern of catheter life rather than replaced after they are blocked
Change the catheter immediately if:
- expulsed catheter
- damage catheter
Frequency of changing drainage bag
Changing bag when:
- changing catheter
- dirty and smelly
Too frequent changes will incur:
- unnecessary expense
- unnecessary disconnection of the closed drainage system
Review the reason of catheterization and older adult‘s condition regularly and remove the catheter as soon as possible
Be aware of high incidence of:
o recurrent retention of urine
o incomplete emptying the bladder
o recurrent urinary tract infection
o urinary incontinence
After removing the catheter, check post voiding residual urine to assess the ability to empty the bladder effectively
Maintain high fluid intake and avoid constipation
- End of Chapter 5-
Bai, X., Leung, D.Y.P., Lai, C.K.Y., Chong, A.M.L., & Chi, I. (2017). Mediating effect of decline in social activities on urinary incontinence and negative mood: Do sex and marital differences exist? Geriatrics and Gerontology International, 17(11), 1829–36.
Batmani, S., Jalali, R., Mohammadi, M. et al. (2021). Prevalence and factors related to urinary incontinence in older adults women worldwide: a comprehensive systematic review and meta-analysis of observational studies. BMC Geriatrics 21, 212. https://doi.org/10.1186/s12877-021-02135-8
Norton, C. (1996). Nursing for continence (2nded). U.K. Beaconsfield.
Pang, M.W., Leung, H.Y., Chan, L.W., & Yip. S, K. (2005). The impact of urinary incontinence on quality of life among women in Hong Kong. Hong Kong Medical Journal, 11, 158-63.
Poi P. (1995). Giants of Geriatrics II – Incontinence. In: Srinivas P, editor. Proceedings of First National Symposium On Gerontology. (pp.92-7). Kuala Lumpur: University Malaya.
Stenzelius, K., Molander, U., Odeberg, J., Hammarström, M., Franzen, K., Midlöv, P., Samuelsson, E., & Andersson, G. (2015). The effect of conservative treatment of urinary incontinence among older and frail older people: a systematic review. Age Ageing, 44(5):736-744. https://doi.org/10.1093/ageing/afv070.
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.