1. Urinary Incontinence in Older Adults

2. Objectives Identify the prevalence of urinary incontinence and the risk factors associated with involuntary loss of urine. Identify the prevalence of urinary incontinence and the risk factors associated with involuntary loss of urine. Identify the causes of transient incontinence. Identify the causes of transient incontinence. Identify the types of persistent urinary incontinence, with associated signs and symptoms Identify the types of persistent urinary incontinence, with associated signs and symptoms

3. Objectives Discuss assessment options for urinary incontinence Discuss assessment options for urinary incontinence Discuss treatment options for urinary incontinence. Discuss treatment options for urinary incontinence. Assess the appropriate use of indwelling urinary catheters. Assess the appropriate use of indwelling urinary catheters.

4. Definition Urinary incontinence – involuntary loss of urine sufficient to be a problem Urinary incontinence – involuntary loss of urine sufficient to be a problem Prevalence: Prevalence: –Affects 13 million Americans –15% to 30% of noninstitutionalized older adults (19% men; 39% women) –50% of those in nursing facilities

5. Urinary Incontinence…. Increases with age; Not a normal part of the aging process, and second leading risk factor for institutionalization Increases with age; Not a normal part of the aging process, and second leading risk factor for institutionalization Risk Factors: immobility, impaired cognition; delirium, medications, estrogen depletion, diabetes stroke, high-impact physical activities Risk Factors: immobility, impaired cognition; delirium, medications, estrogen depletion, diabetes stroke, high-impact physical activities

6. Causes of Transient Incontinence DIAPPERS –Delirium –Infection –Atrophic vaginitis or urethritis –Pharmacology –Psychological Disorders –Endocrine disorders –Restricted mobility –Stool impaction or constipation

7. Types of Incontinence Urge incontinence – strong urge to void Urge incontinence – strong urge to void Stress incontinence – increase intra-abdominal pressure Stress incontinence – increase intra-abdominal pressure Overflow incontinence – overdistended bladder Overflow incontinence – overdistended bladder Functional incontinence – physical / psychological impairment Functional incontinence – physical / psychological impairment Mixed incontinence – combination of 2 or more types Mixed incontinence – combination of 2 or more types

8. Assessment Options Screening due to increased prevalence Screening due to increased prevalence Referral process Referral process Clinical trials Clinical trials Bladder Record Bladder Record

9. Bladder Diary Urinary Incontinence Try This Assessment Series Urinary Incontinence Try This Assessment Series available on Hartford Institute website at www.hartfordign.org

10. Treatment Options Modify Hospital Environment – call bells nearby; avoid restraints and no siderails; elevated toilet seat, urinal or bedpan Modify Hospital Environment – call bells nearby; avoid restraints and no siderails; elevated toilet seat, urinal or bedpan Behavioral Therapies – scheduled toileting; habit training; avoid bladder irritants (coffee, alcohol) Behavioral Therapies – scheduled toileting; habit training; avoid bladder irritants (coffee, alcohol) Pharmacological Treatments – tricyclics; Anticholinergics; calcium channel blockers, etc. Pharmacological Treatments – tricyclics; Anticholinergics; calcium channel blockers, etc.

11. Indwelling Catheters Indications: –Monitoring acutely ill patients –Manage terminally or severely ill –Manage urinary retention –Manage urinary incontinence Contraindications: –Urinary incontinence not associated with full- thickness pressure ulcers

12. Risks Of Indwelling Catheter Urinary Tract Infection Urinary Tract Infection Bacteriuria Bacteriuria Trauma to urethra Trauma to urethra

13. Summary Prevalence and risk factors associated with urinary incontinence Prevalence and risk factors associated with urinary incontinence Causes of transient incontinence Causes of transient incontinence Types of urinary incontinence and its associated signs and symptoms Types of urinary incontinence and its associated signs and symptoms Assessment options Assessment options Bladder Diary Bladder Diary Treatment options Treatment options