Guest blogger: Regina J Knox, MPH, CHES

Caregivers of older adults know that it is normal to experience every emotion imaginable all in the same day. Intrigue, as you listen to life experiences; joy, as you share laughable moments full of humor and wit; empathy, for memories of a love lost long ago… and fear. Yes, fear! The fear that comes from having to assist a resident with “personal matters.”  Let’s face it, no one likes the thought of changing another person’s “unmentionables” after they are over the age of about two.

As a new nursing assistant, I learned how to assist residents with Activities of Daily Living (ADLs) such as bathing, shaving and getting dressed. These are the things most people consider to be extremely personal and intimate. One of the more difficult tasks entrusted to nursing assistants involves caring for patients who suffer from incontinence. Before taking the nursing assistant course, I really had no idea what incontinence was or how many people are affected by it. Incontinence is the inability to control urine or bowel elimination. It impacts approximately 25 million adults of all ages, with a majority of them women (NAFC, 2012).

Although the prevalence of incontinence increases with age, contrary to popular belief, it is not a normal stage of aging (NAFC, 2012). This knowledge gap and misconceptions about incontinence and aging can be found in the most unlikely places. For example, in a study conducted in four skilled nursing facilities, half of the staff believed that bladder disorders were a normal part of aging (Ehlam, 2002). The National Association for Continence (NAFC) states that incontinence is a symptom, “not a disease in itself” and can be treated.  However the treatments available (behavioral, pharmacological and surgical) may not be appropriate when more severe health conditions exist, especially for older patients. Older adults who are incontinent are more at risk for urinary tract infections, skin problems and social isolation.

Despite the anxiety felt by nursing assistants, personal care is a routine part of their job. In the study previously referenced, researchers found that providing continuing education about incontinence helped change the attitudes of staff. They were more likely to be diligent in carrying out a plan of care related to urinary incontinence (Ehlam, 2012). Comparable studies show similar results, proving that knowledge and attitude are often translated into practice. As a public health educator, this validates the importance of health literacy programs for healthcare providers as well as the general public to dismiss negative myths about the aging process. Doing so will help improve the treatment and care of older adults, including those with incontinence. Maybe one day we can learn to discard those feelings of fear and anxiety that we tend to associate with aging.


  1. Ehlam, K., Wilson, A., Dugger, R.. et al. (2012). Nursing Home Staff Members’ Attitudes and Knowledge about Urinary Incontinence: The Impact of Technology and Training. Urologic Nursing., 32, 4, 205-213.
  2. Urinary Incontinence.  (2011). National Institute on Aging. Health and Aging. Retrieved from
  3. What is incontinence? (2012).National Association for Continence. Retrieved from

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Regina is Special Projects Coordinator, Texas AHEC East, University of Texas Medical Branch,

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