Understanding and Treating Urinary Incontinence in Older Adults

1. Understanding and Treating Urinary Incontinence in Older Adults Caitlin Gallagher SPT

2. Learning objectives After reviewing the content of this presentation and participating in the accompanying discussion, attendees will: • Be able to describe the prevalence of urinary incontinence and how it varies with age and gender • Be able to distinguish between the major types of incontinence and the associated symptoms • Be able to describe the relationship between mobility, urinary incontinence and falls • Be able to determine the appropriate approach/emphasis for treatment of UI based on the type of UI

3. What is urinary incontinence? • Urinary incontinence (UI) is defined as the involuntary leakage of urine • Types and associated symptoms • Urge- leakage associated with a strong urge to void, may be referred to as OAB • Stress – leakage associated with an increase in intra-abdominal pressure (sneezing, coughing, increased activity, laughing) • Mixed- a combination of stress and urge UI • Functional – associated with a true mobility or fine motor deficit (unzipping/unbuttoning/ WC bound/dependent) • In the literature this is often not teased apart, and is often a part of urge UI

4. Who deals with urinary incontinence? • Far more women than men are affected by UI • The risk of developing UI increases with age • ~1/3 of women over the age of 70 have symptoms of UI

5. Outcome Measures • Incontinence • ICIQ –SF • Urogenital Distress Inventory –SF • Incontinence Impact Questionnaire – SF • Pelvic Floor Impact Questionnaire – SF • Quality of Life • SF-36, SF-12

6. Modifiable Lifestyle Factors • BMI • Exercise

7. Relationship between mobility and urge urinary incontinence • Ossebo Trial • “ A significant deterioration in all the standard mobility and balance test results according to the severity of UI” with poorer results for women with urge or mixed UI • Lack of cause/effect

8. Relationship between mobility and urge urinary incontinence • (Tak, 2012) Looked at older institutionalized women and found that the group exercise/educational program did improve physical performance but this did not translate into a significantly difference in UI. • (Vinsnes et al, 2012) An individualized physical activity and ADL training program appears to control or reverse the deterioration of UI overtime in nursing home residents.

9. Urinary incontinence and falls risk • There is a significant association between falls and UI (especially urge and mixed types, not stress) • Likely explanations • Rushing • Increased cognitive demands • Nocturia

10. Pelvic Floor Muscle Training • Pelvic floor muscles are the “floor of your core” • Kegels • Emphasize full contraction and full relaxation • Avoid excessive co-contractions • Pelvic floor muscles are skeletal muscles and respond similarly to basic training principles • progressive overload • specificity of training

11. Pelvic Floor Muscle Training • Types of training • Strength (8-12 max contractions, moderate speed) • Endurance (sub-max contractions, high reps, short rest, also changing from gravity free to anti gravity position will challenge endurance) • Coordination (The “knack”- timing with specific actions)

12. Pelvic Floor Muscle Training • Contributors to effective training • Delivered by healthcare professional • Confirmation of correct voluntary PFM contraction • 3 months of training appeared most common • Emphasizing appropriate training principles (discussed above) • Increased amount of supervision is better • Did not appear to be a significant difference between individualized vs group supervision • Did not appear to be significant difference between training positions • Adherence strategies appeared to improve outcomes • Direct contractions appeared more effective than indirect training (co contraction based on core/hip strengthening)

13. Discussion • Resident Case? • How could Carolina Meadows reach out to residence regarding UI?