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Continence: A Matter of Dignity Causes, Signs and Prevention

Continence: A Matter of Dignity Causes, Signs and Prevention. By Marie Mangino, MSN, CRNP, GNP-BC President, Vincent Healthcare, Inc. Wendy W. Fox, MOT, OTR/L Assistant Professor of Occupational Therapy University of the Sciences, Philadelphia PA Jennifer A. Reinhold, BA, PharmD, BCPS

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Continence: A Matter of Dignity Causes, Signs and Prevention

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  1. Continence: A Matter of DignityCauses, Signs and Prevention By Marie Mangino, MSN, CRNP, GNP-BC President, Vincent Healthcare, Inc. Wendy W. Fox, MOT, OTR/L Assistant Professor of Occupational Therapy University of the Sciences, Philadelphia PA Jennifer A. Reinhold, BA, PharmD, BCPS Assistant Professor of Clinical Pharmacy University of the Sciences in Philadelphia

  2. Appearing in Video: Name Appearing as Bob Swensen……….Mr. Banks Ruth Alpert…………Mrs. Banks Susaye Lawson…… Susaye Nate Lazowick…….Mr. Williams Kevin Brown……… Carl, DCSW Dinnie Childs………Piano Player Clarese Herbert……Mr. William’s friend Man at Piano………Arjun Bhojwani Nancy Web…………Mrs. Powell Eric Stewart……….Mike, grandson Ruth Livikoff………Ruth, DCSW Name Appearing as Dick Brown………………Mr. Clark Deanna Penn…………….Supervisor Sangeeta Bhojwani…….Trainee Roby Jacobs……………..Daughter Charlene Duff……………Shopper, Gift Shop Sheila Mitchell-Ayers…Shopper, Gift Shop Marie Mangino………….Trainer, as herself Tanisha Jones……………Testimonial Julie Cohlmer…………….Testimonial Acknowledgements

  3. 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

  4. Play video segment titled, “01 Introduction.mpg”

  5. 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.

  6. Learning Objectives At 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

  7. 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.

  8. 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 function Mrs. Mendoza

  9. Caring for UI is Important Because: • Untreated or under-treated UI can cause: • Skin breakdown and infection • Falls and injuries • Sleep disturbance Mr. Phillips

  10. 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

  11. Left Kidney Left Kidney Right Kidney Right Kidney Ureters Urethra Structure of the Urinary Tract System Bladder Bladder Bladder wall muscle by Nicole Mangino Nicole Mangino 2004

  12. 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)

  13. Contributors to UI:Injury and Disease • Diabetes • Damage to the: • Brain • Spinal Cord • Bladder • Short term use of an indwelling catheter during acute illness Mrs. Banks

  14. Contributors to UI: Limitations in Function • Ambulation • Dressing • Fear of falling • Choice Mr. Williams

  15. Contributors to UI: Dietary Factors • Artificial sweeteners • Caffeine • Alcohol • Acidic Foods Mrs. Powell

  16. 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

  17. Contributors to UI Hydration & Physical Conditions • Not enough fluid • Too much fluid • Fecal impaction • Acute confusion • Too much alcohol or caffeine • Infections/Medical illness

  18. 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

  19. Acute Changes in Mental Status that may indicate UTI • Sleepiness • Irritability or agitation • Lethargy • New or increased confusion Mr. Green

  20. Things You Can Do for Older Adults with UI • Keep a log of UI events • Monitor toileting

  21. Things You Can Do for Older Adults with UI • Determine frequency of need • Develop a schedule and assist to toilet • Consider recent medication change

  22. Play video segment titled, “02 Mrs. Banks.mpg”

  23. 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

  24. 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

  25. 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

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

  27. Mr. Williams’ Challenge • Arthritis • Personal embarrassment • Effect on family • Clothing with elastic or Velcro closures

  28. 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

  29. Things You Can Do • Make urinals available • Prompt (suggest, encourage and remind) to toilet • Compliment effort and success • Change if incontinent Mr. Samson

  30. 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!

  31. Skin Care To 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

  32. 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!

  33. 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

  34. 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

  35. 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

  36. Special Thanks To: Christine Bradway, PhD, CRNP, FAAN Associate Professor of Gerontologic Nursing University of Pennsylvania School of Nursing Mary Ann Forciea, MD Clinical Associate Professor of Medicine Director, Primary Care Services University of Pennsylvania Health Systems Nicole Mangino Illustrator

  37. 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

  38. 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.

  39. 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.  

  40. References and Resources • 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. NeurourolUrodyn2009;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.

  41. References and Resources Web sites: Collaborative to Support Urinary Incontinence and Women’s Healthwww.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

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