Incontinence in elderly

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Continence / Wound care

Continence / Wound care

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  • 1. Bowel & Bladder Incontinence In ElderlySkin Management Perspective
    Alex Khan RN BSN CWCN CFCN
    www.woundcarenurses.org
  • 2. Objectives
    Upon completion of this presentation, all participants will be able to:
    Assess incontinence in patients
    Identify potential issues related to incontinence
    Identify skin conditions related to incontinence
    Appropriately prevent and mange issues related to incontinence
  • 3. Definitions:
    Urinary incontinence is defined as the involuntary leakage of urine.
    Fecal incontinence is the inability to control bowel movements, causing stool (feces) to leak unexpectedly.
  • 4. Epidemiology
    Community-dwelling older adults (>65) with bowel or bladder incontinence:
    35% of women
    20-30% of men
    Assisted living environments
    30-50% of women
    30% of men
    Long-term care (nursing home)
    > 50-78% of men and women
  • 5. Effects of Incontinence
    Bowel & Bladder incontinence has significant negative impact on both overall and health-related quality-of-life.
    Social isolation, Depression, Psychological distress
    Increased caregiver burden, Skin inflammation / breakdown
    Sleep disturbance, Increased risk urinary tract infection (UTI), Cost related to management of incontinence
    Increased risk of falls and fractures related to urgency / frequency, nocturia, impaired mobility and vision changes
    Increased risk of mortality associated with falls, fractures and skin breakdown
  • 6. Issues Associated with Incontinence Management
    Incontinence briefs hold moisture against the skin causing maceration and breakdown/excoriation.
    Prolonged use of catheters increases the risk of bladder infections.
    Increased cost associated with frequent diapers and incontinence pad changes.
    Incidence of contact dermatitis / yeast infection associated with incontinence.
  • 7. Incontinence Associated Dermatitis
    Skin condition commonly associated with incontinence. Skin irritation and inflammation related to exposure to urine and feces. Additional risk factors:
    • Diaper use
    • 8. Bed bound / immobility
  • Incontinence Associated Dermatitis
    Incontinence associated dermatitis in dark skin patients is difficult to identify, it has the appearance of deep dark discoloration.
  • 9. Moisture Associated Skin Damage
    Skin maceration is a sign of increased moisture exposure. Skin maceration leads to skin breakdown. This condition is also referred to as Moisture Associated Skin Damage (MASD).
  • 10. Shear & Friction
    Erosion of the skin occurs frequently and probably attributable to friction created by moving moist or saturated pads or clothing over irritated skin; or to damage from digestive enzymes present in liquid or solid stool.
  • 11. Unstageable Pressure Ulcer
    Incontinence, immobility, increased moisture, pressure and malnutrition causes serious skin conditions/wounds.
  • 12. Prevention & Management
    Frequent checks for incontinence episodes
    Turning and repositioning schedule
    No-rinse skin cleansers are preferable to soap and water
    Low air loss / pressure distribution surface
    Change cloth pads frequently
    Breathable pads must be utilized on air mattress
    No diapers while in bed
    Moisture barrier creams / Antifungal creams
    Skin protectant sprays
  • 13. Skin Treatment Products