Caregivers

Incontinence in the Elderly and the Effects on Caregivers

Age is one risk factor among many that can add to urinary incontinence. Urinary incontinence (UI) is not a part of the aging process, but it does occur more often in the elderly. The effects on the person experiencing UI range from physical, financial, and psychosocial levels. The same can be said for the family and caregivers of UI patients. According to the Journal of Aging Life Care, the impact of UI extends from the cost of care to quality of life and estimates that up to 60% of the elderly population experience UI (Emmons & Robinson, 2022). While many believe UI is inevitable as aging occurs, this myth keeps those who have symptoms from seeking treatment. By ignoring or doing nothing about UI, the patient's loved ones and caregivers suffer the same effects, including physical, mental, and financial stress.

Many people who experience UI do not seek treatment because of embarrassment or feelings of shame. They also try to hide the issue from their loved ones, caregivers, and medical care team. Therefore, the opportunity for early treatment or management is missed. Many causes of UI can be treated, and symptoms of UI can be resolved. Causes of acute (sudden onset) UI include:

• Urinary tract infections (UTI)
• Diabetes
• Medication interactions

Chronic UI often occurs because of diseases such as Alzheimer's or Parkinson's. As these diseases reach later stages, UI becomes more prevalent. Just like UI, the progression of these diseases also causes physical and social consequences.

What factors of aging cause chronic Urinary incontinence?

• Muscles in the pelvis and around the bladder weaken with age.
• An enlarged prostate
• Pelvic organ prolapse (bladder, rectum, uterus) as a result of weaken pelvic muscles
• Damage to nerves that control the bladder (Parkinson's disease, multiple sclerosis {MS} or diabetes)
• Cognitive decline (Alzheimer's and dementia)
• Other conditions that affect movement, making it difficult to reach the bathroom in time (arthritis, MS, Parkinson's, joint problems)

How to avoid Urinary incontinence?

• Managing urinary incontinence can be done with conservative therapies. These therapies will make it UI easier to care for the one suffering, the family, and the caregiver.
• Avoid caffeinated beverages as these may increase urination but do not limit water intake
• Leave a light on in the bathroom and be sure the pathway is clear of clutter
• Provide regular bathroom breaks such as every few hours
• Make certain clothing and undergarments are easy to remove
• When away from home, use adult disposable briefs, diapers, or pads
• Your medical provider can offer other management options based on specific needs, such as:
• Medication to help empty the bladder more fully when voiding
• The drug that calms an over-active bladder
• Vaginal creams with estrogen can help minimize urge or stress incontinence in women
• A vaginal ring called a pessary inserted into the vagina helps with a prolapsed bladder. This helps reduce urinary leakage.
• Injectable medications into the bladder opening can decrease stress incontinence.
• Sacral nerve stimulation helps control leakage by sending a weak electrical signal to the nerves around the bladder.
• Surgical intervention for an enlarged prostate or a procedure that lifts the bladder (for those with prolapse) can help UI.

How to manage Urinary incontinence?

Bladder control products can be useful for managing urine leakage. Adult diapers, briefs, and incontinence pads are light, moderate to maximum absorbency. Prevail is a popular brand of incontinence management products from briefs fitted with tab closure style, belted briefs, or stretch style. Prevail also offers disposable briefs for women, men, or unisex styles, including boxer briefs for men. Prevail also makes pads or liners for men and women. Absorbency in these pads is in different portions to meet the needs of the male or female anatomy. Most of these products are available in varying absorbency levels to meet individual needs. They offer specialty sizes to accommodate all body shapes, from youth to the bariatric (obese) populations. Prevail makes disposable washcloths which make clean-up easy.

For furniture and mattress protection, incontinence pads can be found in disposable or reusable forms. These are helpful, especially at night.

Overnight incontinence and How to deal with it?

Overnight incontinence may be more difficult to manage. Those conservative management tips mentioned earlier are not being done during the night. For this reason, even the UI population that works during the day with mild incontinent episodes will have increased leakage overnight. Using maximum or ultimate absorbency products is recommended overnight. Be sure to utilize the incontinence pads on the mattress, whether disposable or reusable. If using disposable, consider purchasing a Janibell Incontinence Disposable System. Applying a skin protectant such as Tena Protective Cream with Zinc before bedtime is best. This will help prevent moisture-associated skin damage. Use a perineal cleanser such as Aloe-Vesta Perineal Skin Cleanser made by ConvaTec in the morning for clean-up.

Caring for the elderly population with UI is difficult and considerably negatively impacts the caregiver. The amount of time spent watching for them daily is high in the home setting. The cost of supplies takes a toll on any household. According to the Aging Life Care Association, caregivers report difficulty with role changes (caring for parents), difficulty sleeping, financial strain, the strain on intimate relationships, and social isolation due to time spent providing care. These difficult stressors often lead to the placement of the elder with UI in an extended care facility. This decision does not come easy and causes feelings of guilt for the caregiver. It is also distressing to the elder and the entire family. Coping with this major decision can lead to depression (Emmons & Robinson, 2022).

In conclusion, seeking help in the early stages of urinary incontinence has the best outcome. Treating UI early can resolve symptoms depending on the cause of UI. A discussion with a medical professional is the best way to start. And remember, all caregivers need to take time to care for themselves, to avoid caregiver burnout. Meeting your own needs makes it easier to meet the needs of your loved one.

 

Author Profile: Christine Kijek, Registered Colorectal Nurse

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