INCONTINENCE IN THE ELDERLY

We speak of urinary incontinence when you lose urine involuntarily and objective, producing this in a time and place unsuitable and quantity or often enough to be a problem hygienic, social and psychic to the person suffering and a possible limitation of their activity and relationship.

Although UI is a common symptom that accompanies many processes, and affects the entire population range by far is more common among children and adults, sesgándose for distribution to women if we present sex. When we correct UI cases suffered illness, will be among those with neurological processes.

It is not clearly defined the prevalence of this disease, differing greatly depending on the population studied, their scope or assumed UI concept for quantification. In different studies, it is established that approximately 10-20% of those older than 65 years may have it, a figure that would rise to 35-40% if we refer to the hospital environment-institutionalized

 IU NURSE ASSESSMENT

Anamnesis

We must make an individualized assessment, both the characteristics of incontinence, and the impact that this comes in the elderly and its intone.

Although the history is usually very useful, especially for filial to the UI, this is not defining, having objectified and quantified (some authors, however, estimate a correlation between the clinical urodynamic bladder instability around 50 -80%)

We will pick the time of onset of incontinence, type, intensity and frequency of the episodes, triggering events and concomitant symptoms and diseases, traumatology and surgical history or genito-urinary and gynecological. It is essential to collect drug history

It is often useful for 3-4 days employment records incontinence, also known as bladder diaries or records of frequencies, which guide us about the intensity, urgency, triggers, schedule, etc.. Although logically its effectiveness will depend on the cooperation of the affected or their caregivers

Physical Examination

Neurological examination: primarily cognitive assessment and lower limbs (Mini-Mental, march, muscle tone, motor function, sensation, anal and bulbocavernosus reflex ...)

The nurse should assess abdominal distension and bladder. Anal sphincter tone, fecalota, prostate. Exploration Pelvic controversial in older children looking genital atrophy.

Investigations

In all cases, the nurse must assess and / or request elemental analysis and urine culture. We highlight the lack of consistency between asymptomatic bacteriuria and UTI in the elderly. Also discard analytically some endocrinological causes of polyuria by glucose, electrolytes, calcium and serum creatinine. In the male may be useful quantification of prostate specific antigen (PSA).

Finally and in summary we can say that nursing diagnoses related to urinary elimination eight. Undoubtedly, the nursing diagnoses formulated with NANDA taxonomy understand that the big problem is competition urinary incontinence is nursing, the 8 diagnoses, six of us talk about incontinence (functional, stress, urge, and emergency risk, total and reflects), out of this concept are twofold: first diagnosis "general": Impaired Urinary Elimination, and the urinary retention, (which in turn is closely related reflex incontinence).

The mechanism of urinary continence is basically reduced to a set of pressures where, if the system maintains a sphincter pressure higher than that at that moment is in the bladder, no urination occurs. If this situation is reversed in a conscious and voluntary urination call it, and if it is involuntary or unconscious, is called incontinence.

In my opinion this is a serious problem that affects a lot of elderly people and they must have our understanding as professionals we are.

BIBLIOGRAPHY:

-    Kathryn L. Burgio, PhD; Julie L. Locher, MA; Patricia S. Goode, MD; J. Michael Hardin, PhD; B. Joan McDowell, PhD, CRNP; Marianne Dombrowski, DO; Dorothy Candib, MD

      « Behavioral vs Drug Treatment for Urge Urinary Incontinence in Older Women» 1998http://jama.jamanetwork.com/article.aspx?articleid=188273 

- McDowell BJ, Burgio KL, Dombrowski M, Locher JL, Rodriguez E

     An interdisciplinary approach to the assessment and behavioral treatment of urinary incontinence in geriatric outpatients.   1992

      Available on: http://europepmc.org/abstract/MED/1556364

- Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., 
"Stress Incontinence" 2012 
Available on: http://www.nlm.nih.gov/medlineplus/ency/article/000891.htm