Understanding Continence Issues and Caregiving

Introduction

Caregiving for an older adult can feel like a burden to the family caregiver. As a result, there becomes a change in the children’s roles in becoming care providers for elderly adults. Incontinence management makes this role financially, emotionally, and physically demanding. The burden of caretaking leads to stress, fatigue, and muscle strain. Incontinence is not a natural process of aging and is treatable. It is essential to talk to a physician regarding the symptoms of incontinence. This blog will review the different loads of caregiving and provide tips for the caregiver.

Economic Impact of Absorbent Products

Body-worn absorptive products and furniture cover absorbent products are the most prevalent treatment to contain urinary and fecal incontinence. These product categories are available in disposable and reusable and are costly. Therefore, there is an economic impact on the caregiver. In addition, Medicare and Medigap do not cover the cost of reusable and disposable supplies. Some private insurances and most Medicaid insurances cover urinary incontinence supplies. Caregivers should check with the insurance company to verify any coverage for products. Local non-profit organizations such as diaper banks, local Offices of Aging or senior centers, United Way, Good Will, and local churches may assist individuals who cannot afford the products. Caregivers should look for sales or buy in bulk at wholesale companies. The Internal Revenue Service has specific guidelines for possible tax deductions for purchased incontinence supplies.

 

Controlling Odors

Unpleasant odors can lead to anxiety, embarrassment, and social isolation. Therefore, it is essential not to limit fluid intake to decrease urinary incontinence episodes. Unless the individual is on a physician-ordered fluid restriction, maintaining proper hydration can reduce urine odors. Concentrated urine causes increased odors and leads to urinary tract infections. In addition, certain foods such as asparagus, Brussel sprouts, fish, garlic, and onions can cause odors to urine and stool. Sulfa and diabetic medications may also cause an increase in odors. Caregivers should address any concerns with the healthcare provider.

Maintaining skin hygiene will also assist in decreasing odors: no-rinse pH balanced cleansers and bath wipes used after each incontinent episode. In addition, the use of soap and water and scrubbing the skin to remove odors caused further irritation to the skin. The application of zinc-based skin creams or ointments aid in the prevention of skin breakdown.

 

Behavior Modifications

  • Scheduled voiding: Individuals with dementia may need a voiding scheduling program. In addition, keeping a bladder diary can help establish a toileting schedule based on urination patterns.
  • Prompted voiding: Individuals with dementia that can follow basic commands may also benefit from prompted voiding. For example, this method combines scheduled voiding and reminding the individual to go to the bathroom.
  • Dietary modifications: Limitation of fluid three hours before bedtime may help with the need to get up during the night to urinate. Artificial sweeteners, citrus foods and drinks, and spicy foods may need to be modified or eliminated to prevent urinary urgency.

 

Impaired Mobility

Impaired mobility can lead to incontinence by not making it to the bathroom in time and difficulty removing clothes for toileting. Therefore, bathroom modifications such as wheelchair accessible, grab bars, and raised toilet seats to make it easier to access for toileting. In addition, improved lighting for the visually impaired may be helpful. Finally, easy-to-remove clothing and body-worn abortive products for easy removal may also decrease incontinent episodes. In addition, a bedside commode or urinals may be provided. 

 

Travel Tips

  • Keep extra clothes and incontinence products in a tote bag if needed. 
  • Advanced identification of accessible toilet facilities decreases anxiety and incontinent episodes to prevent social isolation. 
  • While traveling, acquire seat locations near a restroom or plan restroom breaks to avoid an incontinent episode. 

 

Caregiver Stress Management

  • Urinary incontinence is an involuntary act and is not intentional behavior. 
  • Caregivers should prioritize self-care to prevent caregiver burnout. Online and in-person support groups for caregivers can provide advice to manage certain situations.

 

Conclusion

Incontinence places an added burden on the caregiver. However, urinary incontinence is a treatable condition. Therefore, it is essential to work together with health care providers to develop a plan of care focused on the caregiver and the older adult. Care plans focus on avoiding neglect preventing complications relating to incontinence and caregiver burnout.

 

Resources

 

References

 

Davis, Nicole J. PhD, MSN, AGPCNP-BC, GNP-BC; Wyman, Jean F. PhD, MSN, GNP-BC, FAAN Managing Urinary Incontinence, AJN, American Journal of Nursing: February 2020 – Volume 120 – Issue 2 – p 55-60

doi: 10.1097/01.NAJ.0000654340.42201.54 

 

Davis, Nicole J. PhD, MSN, AGPCNP-BC, GNP-BC; Wyman, Jean F. PhD, MSN, GNP-BC, FAAN; Gubitosa, Suzanne MS, BSN, AGPCNP-BC, CWOCN, CFCN; Pretty, LaTonya MSN, BSN, AGPCNP-BC, CMSRN Urinary Incontinence in Older Adults, AJN, American Journal of Nursing: January 2020 – Volume 120 – Issue 1 – p 57-62

doi: 10.1097/01.NAJ.0000652124.58511.24 

 

Payne D. Managing incontinence in people with dementia. Br J Community Nurs. 2020 Sep 2;25(9):430-436. doi: 10.12968/bjcn.2020.25.9.430. PMID: 32881611.

Ramamoorthy A, Sadler BM, van Hasselt JGC, Elassaiss-Schaap J, Kasichayanula S, Edwards AY, van der Graaf PH, Zhang L, Wagner JA. Crowdsourced Asparagus Urinary Odor Population Kinetics. CPT Pharmacometrics Syst Pharmacol. 2018 Jan;7(1):34-41. doi: 10.1002/psp4.12264. Epub 2017 Dec 14. PMID: 29239147; PMCID: PMC5784735.

 

Specht, Janet K. Pringle PhD, RN, FAAN 9 MYTHS OF INCONTINENCE IN OLDER ADULTS, AJN, American Journal of Nursing: June 2005 – Volume 105 – Issue 6 – p 58-68

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