Advertisement

The Problem of Incontinence in the Elderly

  • Jonathan MarriottEmail author
Chapter
  • 1.3k Downloads

Abstract

  • Many treatment strategies either need modification or are not appropriate for patients with dementia. Treatment options will often depend on the setting of care and the availability of carers and need to be individualized.

  • Much of the assessment may need to be discussed with carers, and it is important to recognize that family members may feel uncomfortable discussing and being involved in this intimate area of care with their loved ones and vice versa.

  • Continence aids are often a mainstay of treatment. Options of modifying the environment to improve access and reduce the risk of falls and incontinence include decluttering, ensuring adequate lighting and highlighting the toilet.

  • Ensuring bowels are regular has a greater emphasis in dementia patients to avoid incontinence both of bowel and bladder.

  • Patients with Alzheimer’s disease may be managed with cholinesterase inhibitors that can cause or exacerbate urinary frequency and incontinence.

  • Medications used for urge incontinence should not be completely dismissed in patients with dementia despite their potential side effects.

References

  1. 1.
    Morrison A, Levy R. Fraction of nursing home admissions attributable to urinary incontinence. Value Health. 2006;9:272.CrossRefPubMedGoogle Scholar
  2. 2.
    Coyne KS, Wein AJ, Tubaro A, et al. The burden of lower urinary tract symptoms: evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS. BJU Int. 2009;103(Suppl 3):4.CrossRefPubMedGoogle Scholar
  3. 3.
    Gotoh M, Matsukawa Y, Yoshikawa Y, et al. Impact of urinary incontinence on the psychological burden of family caregivers. Neurourol Urodyn. 2009;28:492.CrossRefPubMedGoogle Scholar
  4. 4.
    Griffiths AN, Makam A, Edwards GJ. Should we actively screen for urinary and anal incontinence in the general gynaecology outpatients setting?—a prospective observational study. J Obstet Gynaecol. 2006;26(5):442–4.CrossRefPubMedGoogle Scholar
  5. 5.
    Teunissen D, van Weel C, Lagro-Janssen T. Urinary incontinence in older people living in the community: examining help-seeking behaviour. Br J Gen Pract. 2005;55:776–82.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Gibbs CF, Johnson TM II, Ouslander JG. Office management of geriatric urinary incontinence. Am J Med. 2007;120(3):211–20.CrossRefPubMedGoogle Scholar
  7. 7.
    Huang AJ, Brown JS, Boyko EJ, Moore EE, Scholes D, Walter LC, Lin F, Vittinghoff E, Fihn SD. Clinical significance of postvoid residual volume in older ambulatory women. J Am Geriatr Soc. 2011;59(8):1452–8. 7pCrossRefPubMedGoogle Scholar
  8. 8.
    Zimmern P, Litman HJ, Nager CW, et al. Effect of aging on storage and voiding function in women with stress predominant urinary incontinence. J Urol. 2014;192:464.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    IUGA/ICS Joint Report on the Terminology for Female Pelvic Floor Dysfunction. Standardisation and Terminology Committees IUGA and ICS, Joint IUGA/ICS Working Group on Female Terminology. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN. Neurourol Urodyn. 2010;29(1):4–20. Int Urogynecol J. 2010;21:5–26.Google Scholar
  10. 10.
    Smith PP, van Leijsen SA, Heesakkers JP, Abrams P, Smith AR. Can we, and do we need to, define bladder neck hypermobility and intrinsic sphincteric deficiency?: ICI-RS 2011. Neurourol Urodyn. 2012;31:309–12.CrossRefPubMedGoogle Scholar
  11. 11.
    Stewart WF, Van Rooyen JB, Cundiff GW, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20:327–36.PubMedGoogle Scholar
  12. 12.
    DuBeau CE, Kuchel GA, Johnson T II, Palmer MH, Wagg A. Incontinence in the frail elderly: report from the fourthth international consultation on incontinence. Neurourol Urodyn. 2010;29(1):165–78.CrossRefPubMedGoogle Scholar
  13. 13.
    Bacsu CD, Chan L, Tse V. Diagnosing detrusor sphincter dyssynergia in the neurological patient. BJU Int. 2012;109(Suppl 3):31–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Foley AL, Loharuka S, Barrett JA, Mathews R, Williams K, McGrother CW, Roe BH. Association between the Geriatric Giants of urinary incontinence and falls in older people using data from the Leicestershire MRC Incontinence Study. Age Ageing. 2012;41(1):35–40.CrossRefPubMedGoogle Scholar
  15. 15.
    Santini S, Andersson G, Lamura G. Impact of incontinence on the quality of life of caregivers of older persons with incontinence: a qualitative study in four European countries. Arch Gerontol Geriatr. 2016;63:92–101.CrossRefPubMedGoogle Scholar
  16. 16.
    Weiss JP, Bosch JL, Drake M, Dmochowski RR, Hashim H, Hijaz A, Johnson TM, Juul KV, Nørgaard JP, Norton P, Robinson D, Tikkinen KA, Van Kerrebroeck PE, Wein AJ. Nocturia Think Tank: focus on nocturnal polyuria. Neurourol Urodyn. 2012;31:330–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Feldstein CA. Review Article: Nocturia in arterial hypertension: a prevalent, underreported, and sometimes underestimated association. J Am Soc Hypertens. 2013;7(1):75–84.CrossRefPubMedGoogle Scholar
  18. 18.
    Gardiner AB. The effects of ageing on the gastrointestinal system. Nurs Resid Care. 2013;15(1):30–3.CrossRefGoogle Scholar
  19. 19.
    Yared J, Gormley EA. The role of urodynamics in elderly patients. Clin Geriatr Med. 2015;31:567–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Cody JD, Jacobs ML, Richardson K, Moehrer B, Hextall A. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev. 2012;10:CD001405.PubMedGoogle Scholar
  21. 21.
    Dumoulin C, Hay-Smith EJ, Mac Habée-Séguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2014;5:CD005654.Google Scholar
  22. 22.
    Karon S. A team approach to bladder retraining: a pilot study. Urol Nurs. 2005;25(4):269–76.PubMedGoogle Scholar
  23. 23.
    Bardsley A. Drug therapies for postmenopausal urinary incontinence. Nurse Prescrib. 2015;13(2):80–6.CrossRefGoogle Scholar
  24. 24.
    Sanford M. Mirabegron: a review of its use in patients with overactive bladder syndrome. Drugs. 2013;73(11):1213–25.CrossRefPubMedGoogle Scholar
  25. 25.
    Cruz F, Nitti V. Clinical data in neurogenic detrusor overactivity (NDO) and overactive bladder (OAB). Neurourol Urodyn. 2014;33(Suppl 3):S26–31. ISSN: 1520-6777CrossRefPubMedGoogle Scholar
  26. 26.
    Wilson M. Clean intermittent self-catheterisation: working with patients. Br J Nurs. 2015;24(2):76–85.CrossRefPubMedGoogle Scholar
  27. 27.
    Hägglund D. A systematic literature review of incontinence care for persons with dementia: the research evidence. J Clin Nurs. 2010;19(3/4):303–12.CrossRefPubMedGoogle Scholar
  28. 28.
    Starr JM. Cholinesterase inhibitor treatment and urinary incontinence in Alzheimer’s disease. J Am Geriatric Soc. 2007;55:800–1.CrossRefGoogle Scholar

Copyright information

© The Editor(s)  2018

Authors and Affiliations

  1. 1.Department of Aged Care and Palliative CareEasternhealth—C/O Peter James CentreBurwoodAustralia
  2. 2.Department of Aged CareNorthern Health—C/O Bundoora Extended CareBundooraAustralia

Personalised recommendations