Abena urinary incontinence in older people

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The importance of continence assessment in older people. Older people have a high prevalence of both urinary and faecal incontinence and this is increasing due to the growing number of older people in the population. Incontinence can have far reaching implications for Katherine Wilkinson MA, those affected, RN, DN, FAE730/7 causing anxiety, shame and embarrassment which can result in older people becoming socially isolated. Incontinence is also known to be associated with an increased risk of falls in older people and skin problems. Incontinence can be the last straw for family members caring for an older person, and is often the reason for admission to a care home. An assessment by a skilled health care professional can enable appropriate treatment to be initiated which may improve or cure the incontinence. Where necessary individually selected containment products can be used to improve dignity and quality of life. NICE has published guidance for the assessment and management of urinary incontinence in men and women, yet recent audits by the Royal College of Physicians showed that there are still many gaps and shortfalls in the standard of

continence care provided to older people in the UK.

How does the bladder work? The urinary bladder is a hollow, muscular organ that has two functions, to store urine and to empty when required. Bladder control requires a complex coordination of the bladder muscle (known as the detrusor), urethra, pelvic floor muscles and the nervous system and there is much potential for things to go wrong, which can result in bladder dysfunction and incontinence. The “normal” bladder can hold approximately 500 mls of urine, and most people will feel the first sensation that they need to pass urine when the bladder is about half full. As the bladder fills, it sends messages via the sensory nerves to the brain. If it is not convenient to pass urine the brain sends an inhibitory message back to the bladder, telling it to “hold on”. When the person has found an appropriate place to void, the brain sends an activating message to the bladder, stimulating the parasympathetic nerves which cause the detrusor muscle to contract and empty the bladder.

Age related changes to the urinary system The bladder and associated structures undergo age related changes which can affect the individual’s bladder function and continence status.


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