The permanent older population has become increasingly complex and dependent in recent years, a trend that does not appear to change in the short to medium term. The instability of the inhabitants entails a number of health problems, including urinary incontinence, one of the most serious geriatric syndromes. Despite its significant impact, exacerbated during the pandemic, both residents and professionals often ignore the problem and do not even know how to deal with it.
Urinary incontinence affects 50 to 80% of older people living in nursing homes. It is associated with various physical (functional decline, bedsores, falls, infections), cognitive (dementia), and psychosocial (activity and relationship restrictions, depression) problems.
The causes of urinary incontinence are varied and include pelvic floor muscle weakness and neurological dysfunction. In the elderly, urge incontinence is the most common form and is urine leakage associated with the urge to go to the toilet, caused by increased bladder contractility. In addition, prostate problems, common in men, can cause incontinence.
In nursing homes, cognitive and functional disabilities can cause what is known as “functional incontinence”. In these cases, patients may be able to maintain abstinence, but the lack of staff to help with toileting eventually leads to cessation of urination and eventually incontinence.
Despite its impact, the problem tends to go unnoticed or untreated. People who suffer from this sometimes don’t express it out of shame, consider it a normal aspect of aging, and even think there is no solution. In addition, professionals tend to be under-trained and find this topic unmotivating. In fact, the treatment of residential incontinence is usually based only on passive containment through the use of absorbent products (especially diapers).
How to solve the problem of incontinence in geriatric residents?
For such a complex and multifactorial problem, a combination of different therapeutic strategies is recommended.
Pelvic muscle training with Kegel exercises is effective. Supervision by a physiotherapist is recommended to achieve adequate contraction of the pelvic floor. The use of biofeedback or electrical stimulation may also help. Although effective, these types of exercises are limited due to their adherence, and also in cases where an older person has cognitive problems.
Combining this type of exercise with nutritional measures (spreading fluid intake, avoiding caffeine) and overall mobility appears to be even more effective.
In nursing homes, behavioral strategies with the help of a caregiver or specialists are helpful. For example, bladder training consists of setting a specific time to urinate, starting at a higher frequency and as the older person learns to suppress the urge to urinate, the interval gradually lengthens to two to three hours.
During forced urination, the patient is asked if he feels the urge to urinate and, if necessary, he is helped to go to the toilet. These methods can be supplemented by the use of a urination diary, which takes into account the urination regimen. Although proven effective, this type of strategy is applied to a minority of residents due to ignorance or time consuming on the part of professionals.
Patient education also plays an important role. For example, to avoid possible loss of urine associated with the urgency symptom, one might explain to an older person that doing five pelvic floor contractions can reduce the urge to urinate and thus be able to go to the toilet in peace.
Drug use has not yet been conclusively proven and may cause side effects. So this doesn’t seem like a solution, at least for now.
Some of the major barriers to effective inpatient abstinence treatment are the lack of trained staff and time to care for patients due to their high workload. In addition, this training plan should include communication techniques so professionals can gain the trust of residents by allowing them to speak openly about abstinence without worrying about being judged.
Therefore, it is essential to improve the training of personnel in the management of urinary incontinence, as well as to provide adequate resources to ensure that healthcare professionals have the time and funds to provide adequate patient care.
Challenges and lines of the future
Despite the variety of solutions, there is still much to be learned in this area, which is usually little studied.
Technological advances and human resources are two fundamental areas for future development in the treatment of urinary incontinence.
Innovative approaches such as ultrasonic sensors or humidity sensors can be used to complement traditional approaches, but no effective solution has yet been found.
It is important to ensure that professionals are well trained, as well as that nursing homes are adequately funded, in order to improve the quality of life of residents and reduce the impact of this condition on their well-being. Addressing this problem effectively requires a multidisciplinary approach involving healthcare professionals, residents, families, and other members of the healthcare team.