Demystifying Urinary Incontinence in Older Adult
It is a common belief
that urinary incontinence (UI) is an expected outcome of ageing in older
adults. The purpose of this paper is to disprove the myth that all older adults
experience urinary incontinence as an age-related change. I have chosen to
demystify this myth because I have considered the myth to be true
previously. This paper will examine
age-related changes, risk factors and functional consequences related to UI. This paper will also discuss determinants of
health related to UI, a wellness outcome and nursing implications related to UI
in older adults. My personal learning experience from completing this
assignment and clinical implications of urinary incontinence in older adults
will also be reviewed.
Urinary Incontinence in Canada
UI is defined as the
unintential passage of urine at inappropriate times (Testa, 2015). According to
Ramage-Morin and Gilmour (2013), approximately 512,000 Canadians experience UI,
with a higher prevalence amongst women.
There are several
types of UI, including stress, urge, functional, overflow, reflex and mixed
(Bardsley, 2016). Stress incontinence is the involuntary or unplanned passing
of urine during exertion or activity, such as lifting, jumping, coughing or
laughing. (Ostle, 2016). Urgency incontinence is the sudden or critical urge to
urinate (Testa, 2015). Overflow incontinence is the bladder overfilling and
emptying due to pressure in the bladder (Bardsley, 2016; Testa, 2015).
Transient incontinence is urinary incontinence secondary to an underlying
medical condition, such as a urinary tract infection, fecal constipation, or
hypertension. (Testa, 2015). Functional incontinence is the involuntary passing
of urine due to not accessing the washroom in time, due to physical, mobility
or cognitive impairment (Enberg & Li, 2017; Testa, 2015).
The functional consequences theory regards age-related
changes in older adults and looks at the risk-factors an older adult is
experiencing to create either a positive or negative functional consequence (Hirst,
Lane & Miller, 2015). Recognizing these, a nurse may recommend a nursing
intervention to make a positive functional consequence. In
the functional consequences theory, an age-related change added with a risk
factors is a negative functional consequence (Hirst et al., 2015).
Age-Related Changes & Risk Factors
As we age, our bodies
begin to go through biologic ageing, in which there is a slow but progressive
decline in physiological function (Hirst, Lane & Miller, 2015). With this,
age-related changes are an inevitable part of ageing. Age-related changes in
the urinary system include decreased elasticity and holding capacity in the
bladder (Koops & Woodridge, 2017).
In older adult women, the levels of estrogen supplied to the urethra,
bladder and pelvic muscles are depleted, which results in the muscles to become
weakened. In older adult men, their prostates enlarge, which may result in
benign prostatic hyperplasia (BPH). BPH may cause urethral obstruction and
urinary retention (Koops & Woodridge, 2017).
Modifiable risk factors include
increased weight, cigarette smoking, alcohol and caffeine consumption and low
fluid intake (Bardsley, 2016; Ostle, 2016).
Non-modifiable risk factors for developing UI include family history, menopause,
damage during childbirth and certain illnesses including diabetes mellitus,
heart failure, stroke, Parkinson’s disease and Dementia (Engberg & Li, 2017; Koops &
Wooldridge, 2017; Testa, 2015). Along with this,
certain medications, including ones to treat these ailments, may increase the
risk of UI, including diuretics, calcium channel blockers, ACE inhibitors and
& Li, 2017). Environmental
issues also pose as a risk factor in UI, such as the inability to reach the
bathroom in time-related to physical restraints (Bardsley, 2016; Testa,
A negative functional
consequence that may occur in an older adult experiencing UI is decreased
quality of life-related to social isolation (Ramage-Morin & Gilmour, 2013).
Older adults experiencing UI may have less desire to participate in activities
outside the home, such as volunteering, participating in recreational clubs or
attending religious services (Ramage-Morin & Gilmour, 2013). This in turn
may lead to anxiety, depression and loneliness (Ramage-Morin & Gilmour,
2013; Spencer et al., 2017). According to Spencer, McManus and Sabourin
(2017), there is an increased risk of falls associated with UI. There is also
an elevated risk of pressure sores, infections and skin breakdown in older
adults experiencing UI (Ramage-Morin & Gilmour, 2013).
Determinants of Health
health practices and coping skills, physical environment and social support are
some of the key determinants of health that may affect UI (Government of
Canada, 2011). As discussed earlier, UI is not an age-related change. It is
also believed that UI is untreatable, or treatable only with surgical
procedures. As this is a common belief, older adults who experience UI may not
seek treatment as they feel it is an expected outcome with aging (Norton,
Dodson, Newmann et al., 2017). Educating older adults on UI may also encourage
those experiencing UI to recognize it as a concern to their health, to seek
treatment and adhere to treatments (Norton, Dodson, Newmann et al., 2017).
Creating continence education, providing individualized care, and providing
self-managed education on UI may help UI symptoms and quality of life (Norton,
Dodson, Newmann et al., 2017).
practices and coping skills is a determinant of health that may impact UI
(Government of Canada, 2011). As older adults who experience UI often feel
shameful or embarrassed, it is reported they sometimes isolate themselves as a
coping mechanism or as a way to prevent further embarrassment (Ramage-Morin
& Gilmour, 2017; Norton, Dodson, Newmann et al., 2017). Educating older
adults and the community on UI may help reduce the stigma associated with it. A
program on continence education may be introduced to community members to help
enhance knowledge of UI and help create a positive attitude towards UI (Norton,
Dodson, Newmann et al., 2017).
environment is another determinant of health that plays a role in UI. In
functional UI, environmental factors prevent older adults from reaching the
bathroom in time. Addressing these concerns may be a simple intervention, such
as raised toilet seat, handle bars and accessible clothing (Enberg & Li,
2017; Norton, Dodson, Newmann et al., 2017). In community centers, this may be
addressed by having improved signage and visibility for bathrooms to ensure
patrons are able to locate bathrooms more efficiently (Enberg & Li, 2017).
Social support is a
determinant of health that is directly impacted by nurses. Older adults may
feel ashamed or embarrassed by the UI, which may impact their quality of life
(Bardsley, 2016; Norton, Dodson, Newmann et al., 2017; Ostle, 2016). Social
support has been shown to improve health-seeking behaviour in those
experiencing UI (Norton, Dodson, Newmann et al., 2017). Nurse’s may offer
support to older adults experiencing UI by forming and fostering a positive
nurse-client relationship. Nurses may perform assessments and offer holistic
interventions to help diagnose and treat UI (Norton, Dodson, Newmann et al.,
2017). Nurses may also help social supports by including family and friends
into education and treatment options with older adults as this has been shown
to improve the likelihood of seeking treatment for UI (Norton, Dodson, Newmann
et al., 2017).
Nurses are an
integral part of the health care team. Nurses offer holistic interventions and
can perform assessments for the community (Hutchings & Sutherland, 2014).
As education is a key determinant of health for UI, education should begin with
those often conducting the education: nurses. Nurses themselves may benefit
from education on UI in both nursing school curriculums and in clinical
settings (Hutchings & Sutherland, 2014). Understanding UI, implications of
care and providing evidence-based guidelines into practice may help students
and practicing nurses provide client-centered care and improve client’s quality
of life (Hutchings & Sutherland, 2014). Nurses may offer a holistic
approach to treat UI, in turn developing a therapeutic nurse-client
relationship, which may help foster adherence and offer the client support
(Spencer et al., 2017). In addition, nurses educated on the age-related changes
and risks factors of developing UI may be able to identify potential risk
factors in their patients and intervene early to reduce their risk (Hutchings
& Sutherland, 2014; Spencer et al., 2017).
A priority health
promotion for the community would be education. Educating the community on what
UI is, risk factors, treatment options and that it is not an expected outcome
of ageing could encourage those experiencing UI to seek treatment and may help
reduce stigma (Norton, Dodson, Newmann et al., 2017). Education on the topic at
a community level may help shed light to the topic at hand to help reduce
stigma to the issue and help caregivers and loved ones offer support to those
who are experiencing UI to help improve relationships and quality of life
(Hutchings & Sutherland, 2014; Ramage-Morin & Gilmour, 2013).
As some risk factors discussed
previously are modifiable, addressing these concerns and offering nursing
interventions for health promotion may help reduce UI. Consuming small amounts
of fluids and high amounts of caffeinated, high sugar and alcoholic beverages
has been linked to increased risk of experiencing UI (Ramage-Morin &
Gilmour, 2013; Spencer et al., 2017).
Educating on appropriate amounts and types of fluids may help reduce the risk
of developing UI. This would also be a positive functional consequence as
clients may be less dehydrated by drinking more appropriate beverages versus
alcoholic and caffeinated beverages (Bardsley, 2016; Ostle, 2016; Testa, 2015).
Also, an increased BMI has been found to a risk factor of UI. Addressing this
risk factor by educating on balanced food diet and regular exercise may help
reduce the risk of developing UI (Ostle, 2016).
By educating clients on the benefits of diet, exercise and a healthy
weight, clients may adhere to a healthier life style, which may impact not only
their UI, but their overall health (Ostle, 2016; Spencer et al., 2017).
Wellness Nursing Diagnosis
To provide better client-centered
care, a nursing diagnosis specific to the client should be created. Readiness
for enhanced urinary elimination would be an appropriate wellness diagnosis for
a client experiencing UI and interested in learning about improving their
urinary elimination wellness (Carpenito, 2013). A nursing care plan directed at
the client’s specific needs and goals and should help to prevent or reduce
negative functional consequences affecting UI in older adults (Hirst et al.,
2015). Interventions related to this nursing diagnosis include education, cessation
of smoking, timed bathroom routine, pelvic floor exercises or household
modifications to make reaching the washroom more accessible (Bardsley, 2016; Enberg
& Li, 2017; Ostle, 2016). Possible outcomes for the nursing diagnosis
include daily recommendation, straw coloured urine with no odor, established
bathroom routine etc. (Carpenito, 2013).
My Learnt Experience
From completing this
assignment, I have learnt that UI is not an age-related change and nursing
implications related to older adults experiencing UI. As a health care aide, I
would occasionally experience families feeling embarrassed when their loved one
was incontinent and would react in a negative way. One of the most distressing
comment that was shared with me by a family members was “I hope I die
before I have to wear a diaper again”. Not only has that comment affected
me, it gave me the impression that UI was an inevitable and expected
consequence of aging. With this
experience and studies from the course, I will take the lessons learned and
apply them to my clinical practice. Being aware of the functional consequences
theory and nursing practice with older adults, I know that if I was put into a
similar situation, I would discuss the comment with the family member and offer
education on UI with them, making them aware that UI is not an anticipated
outcome of aging. I also hope to educate my peers, clients and their families
on UI and how this topic is of great significance to nursing practice.
Although UI is thought to be an
expected outcome of aging, extensive research has shown that it is not. The
myth that all older adults experience UI has been disproved. In this paper,
age-related changes and risk factors, as well as the functional consequences
theory was discussed and how this plays into the quality of life of older
adults. The determinants of health related to UI and how these impacts coping with
UI was discussed. Education is an essential component that nurses may use to
confront the issue of UI and promoting health in older adults. An appropriate
wellness diagnosis was presented, along with outcomes and interventions. It is
essential that not only nurses, but clients and the community are made aware
that UI is not an age-related change.