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.
References
- 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.
- Urinary Incontinence. (2011). National Institute on Aging. Health and Aging. Retrieved from http://www.nia.nih.gov/health/publication/urinary-incontinence
- What is incontinence? (2012).National Association for Continence. Retrieved from http://www.nafc.org/bladder-bowel-health/what-is-incontinence
Image Source: http://renuamedical.com/sites/default/files/incontinence-l1.png
Regina is Special Projects Coordinator, Texas AHEC East, University of Texas Medical Branch, Regina.knox@txaheceast.org
Join us for a real-time discussion about questions raised by this essay on any Wednesday morning at 8:15 to 8:45 a.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.
December 12, 2012 at 11:04 am
Transcript from Weekly Discussion on Againg (12-12-12)
[06:12] Rodger Markova: Hello Kay. How are you?
[06:15] Professor Kay Texan: The water’s cold today!
[06:15] Rodger Markova: Yes, really cold here. Chicken’s water was frozen this morning
[06:16] Professor Kay Texan: Gary and I just got back from chicken duty.
[Chatting about SL viewers]
[06:22] Professor Kay Texan: I was very interested in today’s topic.
[06:23] Professor Kay Texan: The topic made me think of Diane Heliker’s research with story sharing and elders. She might want to participate!
[06:25] Rodger Markova: Hello Jamie
[06:25] jamiefalling: Hello 😉
[06:25] Rodger Markova: Welcome
[06:25] Professor Kay Texan: HI Jamie, I’m Kay!
[06:28] jamiefalling: May I join you?
[06:28] Rodger Markova: Yes please
[06:29] Rodger Markova: Our topic of discussion is the blog shown on the screen above the fireplace
[06:31] Rodger Markova: Hello Regina
[06:32] ReginaJKnox: Hello
[06:36] Rodger Markova: Jamie, the three of us work at UTMB in Galveston, Texas
[06:37] jamiefalling: im just a normal citizen with elderly parents
[06:38] ReginaJKnox: Jamie are you the primary care giver for your parents?
[06:38] jamiefalling: well they are still living at their house and fairly independent. I live about 15 mins away
[06:39] ReginaJKnox: OK. that’s fairly close
[06:39] jamiefalling: Dad is fading mentally while mums body is giving out but I do a lot for them… take them to doctors appointments … grocery shopping paying bills, etc.
[06:40] ReginaJKnox: Is there like a home health aide that provides care when you are at work? Does your mother have any issues with going to the restroom.
[06:41] jamiefalling: Its actually my father but he hasn’t had an accident yet in public
[06:42] jamiefalling: No external support yet
[06:42] ReginaJKnox: In my research on incontinence I found out that fear of accidents in public can contribute to social isolation.
[06:43] jamiefalling: oh yes
[06:43] Professor Kay Texan: That’s easy to see how that would happen.
[06:44] jamiefalling: He always goes to the toilet just before leaving home
[06:44] Professor Kay Texan: Does he use protective pads?
[06:45] jamiefalling: Well we tried but he was too uncomfortable… I think it irritated his skin
[06:45] Professor Kay Texan: Some people use the term adult diapers, but I don’t like that language.
[06:45] Professor Kay Texan: Regina, what do you call them?
[06:46] ReginaJKnox: In my nursing assistant course, our instructor told us to refer to them as briefs
[06:46] Rodger Markova: That’s a good term, neutral.
[06:46] Professor Kay Texan: That’s good.
[06:47] ReginaJKnox: During our clinicials, we learned how to help patients change them. When I say “help” I mean do it for them because they were not able to.
[06:48] Professor Kay Texan: I think that’s where the importance of knowledge of incontinence comes in.
[06:48] jamiefalling: so they are mentally not aware of what’s happening ?
[06:48] ReginaJKnox: Some are
[06:48] Professor Kay Texan: Or have lost control
[06:49] jamiefalling: Why do more women get it then men?
[06:49] Rodger Markova: Sometimes it can be reversed or reduced too
[06:49] jamiefalling: Wow, it can ??
[06:49] Professor Kay Texan: Yes, there are exercises for the pelvic floor
[06:50] ReginaJKnox: Yes. Incontinence is not an illness itself
[06:50] Professor Kay Texan: More women than men because of childbirth
[06:50] jamiefalling: What about women who don’t have sex for a long time
[06:51] Professor Kay Texan: There may have been tears in the pelvic floor during childbirth.
[06:52] ReginaJKnox: Idk on the sex. I don’t think it matters.
[06:52] Professor Kay Texan: There is a surgical repair called a cyctocele repair that can help
[06:53] Professor Kay Texan: The cystocele repair is for women.
[06:54] Rodger Markova: I wonder if there is anything for men
[06:54] Professor Kay Texan: I don’t think there is anything similar for men.
[06:54] ReginaJKnox: You can ask you father’s PCP
[06:54] Professor Kay Texan: It’s so linked to the anatomy of the female pelvic floor.
[06:55] jamiefalling: Is it true that there are doctors who specialize in treating elderly. We just go to a general practioner
[06:55] Professor Kay Texan: Yes, there is a gerontologist and a urologist for specific issues.
[06:56] Rodger Markova: A physician who specializes in geriatrics might have more ideas
[06:56] jamiefalling: How do I know which ones do?
[06:56] Rodger Markova: Geriatrics is a specialty so they are categorized so. You can look them up in a directory, perhaps from your insurance company
[06:57] ReginaJKnox: My apologies. I have a meeting at 9am. I have to go. I enjoyed the convo. Thank you
[06:58] Professor Kay Texan: I’m need to get going too!
[06:58] Professor Kay Texan: Thanks Rodger and Regina. Bye Jamie
[06:58] jamiefalling: bye bye
[06:58] Rodger Markova: Jamie thank you for joining us today
[07:00] jamiefalling: are you having any sessions on dementia soon?
[07:00] Rodger Markova: I don’t know. The blogs are written by different people and they pick the topic, but we can always deviate from the blog to another topic
[07:01] jamiefalling: ok 🙂
[07:01] Rodger Markova: Blogs are posted on Friday and you can check. You are always welcome
[07:01] jamiefalling: thanks that’s great. I’m glad I came across it
[07:02] Rodger Markova: I’m happy you came
[07:02] jamiefalling: Have a good day