The information in this "Want to know more" section is organized according to the following major components of the NURSING PROCESS:
The goals related to Urinary Incontinence (UI) with older adults are:
Urinary Incontinence (UI) is not a normal consequence of aging. UI is the involuntary loss of urine sufficient to be a problem.
Stress UI is defined as an involuntary loss of urine associated with activities that increase intra-abdominal pressure. Symptomatically, individuals with stress UI usually present with complaints of small amounts of daytime urine loss that occurs during physical activity or with increased intra-abdominal pressure, e.g., coughing, sneezing. Stress UI is more common in women, but also can be found in older men, e.g., post prostatectomy incontinence (Fantl, et al., 1996).
Urge UI is characterized by an involuntary urine loss associated with a strong desire to void (urgency). In addition to urgency, signs and symptoms of urge UI most often include urinary frequency, nocturia and enuresis, and UI of moderate to large amounts. Bladder changes associated with aging make older adults particularly prone to this type of UI (Fantl, et al., 1996).
Overflow UI is an involuntary loss of urine associated with over distention of the bladder, and may be caused by an under active detrusor muscle or outlet obstruction leading to over distention and overflow. Individuals with overflow UI often describe dribbling, urinary retention or hesitancy, urine loss without a recognizable urge, or an uncomfortable sensation of fullness or pressure in the lower abdomen. A common condition associated with this type of UI is BPH (Fantl, et al., 1996).
Functional UI is caused by non-genitourinary factors, such as cognitive or physical impairments that result in an inability for the individual to be independent in voiding. For example, acutely ill hospitalized individuals may be challenged by a combination of an acute illness and environmental changes. This, in turn, makes the voiding process too complex resulting in a functional type of UI (Fantl, et al., 1996)
Transient UI is characterized by the sudden onset of potentially reversible urinary symptoms.
Atypical Presentation
Older adults will not offer a "textbook" clinical presentation. For example, UTI's typically cause dysuria and fever. The older adult with a UTI is more likely to present with UI and/or affective changes supporting the imperative that nursing staff investigate the causes of UI.
Assessment Parameters
UI Nursing Care Strategies
Patients
Health Care Providers
Institution
Reference
Reprinted with Permission from Springer Publishing Company. Dowling-Castronovo, A., & Bradway, C. W. (2003). Urinary incontinence. In M. Mezey, T. Fulmer, I. Abraham (Eds.), D. Zwicker (Managing Ed.), Geriatric nursing protocols for best practice (2nd ed., pp. 83-98). New York: Springer Publishing Company, Inc.
Last updated - May 2005