By Micha Shalev
Elderly incontinence represents a major challenge for the long-term care (LTC) industry. It negatively impacts seniors on many levels and has a significant economic impact on the service provider both in terms of the support care required and direct-expense costs.
Urinary incontinence (UI) is defined as the complaint of any involuntary leakage of urine. In LTC facilities, more than 50 percent of persons experience UI either occasionally or on a regular basis and many would argue the rate is even higher. UI is a contributing factor to skin breakdown, falls, urinary tract infections, social isolation, frustration, anxiety, calling out, and wandering.
A Continence Care Program brings numerous benefits to long-term care communities and individuals with memory impairment. Education and behavioral changes increase the likelihood that individuals can maintain continence, regain continence, or lessen the severity of incontinence. Those people considered at highest risk of developing incontinence are given tools for maintaining control, while others gain new freedoms by addressing reversible factors that may have induced incontinence. Even those with persistent incontinence can learn ways of treating or managing incontinence well.
Individual benefits of controlling incontinence include:
•Improved quality of life, with a greater sense of independence and self-sufficiency;
•Fewer transfers from admissions to hospitals or a long-term care nursing home;
•Lengthier stays in assisted living with the opportunity to age in place;
•Fewer complications and decreased morbidity factors associated indirectly with incontinence, such as falls and fractures, dehydration, and urinary tract infections.
Long-term care community benefits:
•Retain seniors for longer periods by postponing or eliminating the need for nursing home transfers because of persistent or unmanageable incontinence.
•Improve staff morale through training, which will allow facility caregivers to play an active role in enabling seniors to maintain their continence, reverse factors causing their incontinence, or more effectively manage their incontinence.
An education program specifically for seniors and family members should include the principles of “choice, dignity and individuality” to help senior maintain independence and quality of life to the greatest extent possible.
Key points to be integrated include:
•Lifestyle changes that can decrease incontinence and voiding symptoms;
•Self-toileting programs;
•Identification of products that can manage urine leakage, maintain skin integrity and increase activity such as: absorbent, reusable products and disposables;
•Perineal care is recommended with each change;
•Skin barriers and wound care ointment ;
•External catheters for men — Texas catheter with secure method of application;
•Intermittent catheterization — with a doctor’s recommendation and order. Supplies are usually covered by insurance; and
•Pelvic organ support devices.
Framing of attitudes include:
•Helping seniors and their families understand that incontinence is not a normal part of aging;
•Inform seniors and their family members of the variety of approaches to maintain continence. When one approach is not successful, another may be tried;
Encourage seniors to share with caregivers:
•Their efforts to maintain continence;
•Their frustrations when coping with incontinence; and
•Their successes and their appreciation of staff support.
Incontinence need not be accepted as an inevitable, ever-increasing expense in LTC facilities. By educating staff and scheduling for more routine toileting, as well as implementing more robust mobility training programs, the elderly can achieve higher levels of continence.
Micha Shalev MHA is the owner of Dodge Park Rest Home and the Adult Day Club at Dodge Park, 101 Randolph Road. Worcester. He can be reached at 508-853-8180, by e-mail at m.shalev@dodgepark.com or view more information at www.dodgepark.com. Archives of articles from previous issues can be read at www.fiftyplusadvocate.com.
