Urinary incontinence is a common symptom among residents of long-term care facilities but is frequently left untreated, resulting in a high incidence of falls among other problems. Incontinence is one of the leading reasons for placement of older adults into institutionalized care. Although its prevalence increases with age, incontinence is not considered a normal part of aging. Because urinary incontinence is a symptom of a condition and may be reversible, it is important to understand the underlying causes and to address them to the extent possible. If the underlying condition is not reversible, it is important to treat or manage the incontinence to try to reduce complications. In general, there are 4 main types of incontinence:
- Stress Incontinence – occurs when pressure is applied to the bladder, which causes urine to leak. It typically happens on occasions when one is laughing, sneezing, or exercising.
- Urge Incontinence– occurs when there is a sudden and intense urge to urinate, and the inability to control it causes urine to leak. This is common among the elderly, especially for those who suffer from urinary tract infection and diabetes.
- Overflow Incontinence–occurs due to either poor bladder contraction or blockage of the urethra. It can be identified by frequent or constant dribbling of urine due to a bladder that does not completely empty following voiding.
- Functional Incontinence– occurs when a physical or mental impairment causes difficulty in urinating at the appropriate time.
Whether the resident is incontinent of urine on admission or develops incontinence after admission, the steps of assessment, monitoring, reviewing, and revising approaches to care (as needed) are essential to managing urinary incontinence and to restoring as much normal bladder function as possible. A majority of r residents who suffer from incontinence also suffer from dementia or have limited mobility. These conditions all lead to these resident’s full reliance on nursing staff to manage the incontinence. When not managed well, incontinence can lead to several injuries and illnesses:
- Falls
- Skin breakdown
- Urinary tract infections
- Sleep disturbances
- Psychosocial complications
When considering treatment options, it is important to involve the resident and/or their representative in care decisions, and to consider whether the resident has an advance directive in place. The first steps toward assuring that a resident receives appropriate treatment and services to restore as much bladder function as possible or to treat and manage the incontinence are to identify residents experiencing initial symptoms of incontinence or those at risk of developing urinary incontinence and completing an accurate, thorough individualized assessment. This is followed by implementing appropriate, person-centered interventions that address the incontinence, including determining the resident’s functional capabilities and underlying factors that can be removed, modified, or stabilized, then closely monitoring the effectiveness of the care planned interventions.
Facility practices that may promote achieving the highest practicable level of functioning, may prevent or minimize a decline or lack of improvement in degree of continence include providing treatment and services to address factors that are potentially modifiable, such as:
- Managing pain and/or providing adaptive equipment to improve function for residents suffering from arthritis, contractures, neurological impairments, etc;
- Removing or improving environmental impediments that affect the resident’s level of continence (e.g., improved lighting, use of a bedside commode or reducing the distance to the toilet);
- Treating underlying conditions that have a potentially negative impact on the degree of continence (e.g., delirium causing urinary incontinence related to acute confusion);
- Possibly adjusting medications affecting continence (e.g., medication cessation, dose reduction, selection of an alternate medication, change in time of administration); and
- Implementing a fluid and/or bowel management program to meet the assessed needs.
References
- Incontinence Management for Nursing Homes. Retrieved 2021. Centers for Medicare & Medicaid Services. NCA – Biofeedback for Urinary Incontinence (CAG-00020N) – Tracking Sheet (cms.gov)
- Newman, Diane. (2021). Urinary incontinence in long-term care facilities: current clinical practice. https://www.clinicaladvisor.com/home/meeting-coverage/gapna-2021/effects-urinary-incontinence-long-term-care-settings/
Make plans to join Proactive for the webinar session Standards of Care for Incontinence, UTI and Catheters on December 15 or December 21, 2021.
