UNIT 4: COMMON DISORDERS IN THE AGING 4.7 GERIATRIC SYNDROMES: URINARY INCONTINENCE

Urinary continence is a basic function that should keep healthy elderly, regardless of age. It is important to stress that urinary incontinence is not a normal phenomenon of aging.

Urinary incontinence can be defined as "any urine leakage that cause discomfort to the patient" (Abrams P, 2002). It is part of geriatric syndromes, constituting a cause of disability and impaired quality of life.

The prevalence of urinary incontinence is higher in women, and it depends on the level of care: 30% in community, hospital 30%, chronic residential units or 50%. Among the risk factors for urinary incontinence in women include diabetes mellitus, lack of estrogen and high BMI restitution. Additionally, cognitive impairment increases its effects, although not a risk factor (Thüroff JW, 2011).

In the initial evaluation is recommended to ask:

- You lose urine when you do not like? Do you have you problems with your bladder, unintentionally gets wet? Or do you have small leaks of urine upon exertion, such as laughing or sneezing?

Also in the initial assessment must be excluded concomitant urinary incontinence causes acute (<4 weeks duration) such as urinary tract infection, diabetes, vaginal atrophy, fecal impaction, polypharmacy, etc. (PS Yim, 1996)

The impact generated by this health problem can be many and varied. Not directly depend on the severity of the leak. Influence of individual factors (age, sex, comorbidity, functional status, lifestyle), as well as the type of incontinence (especially emergency).

Importantly, the impact can affect different areas of the patient: (JS Brown, 2000).

- Medical: urinary tract infections, skin ulcers, infections, ulcers, falls, fractures, urinary tract infections

- Psychological: loss of self-esteem, anxiety, depression, isolation

- Social isolation, greater need for family support, greater need for health resources, increased risk of institutionalization, dependence on the caregiver ycarga

- Economic: increased costs of care and complications

Estrogen deficiency is a common cause of nocturia and urinary incontinence in women, so it is necessary to systematically investigate this deficiency before considering other therapies.

Before a diagnosis of stress urinary incontinence or urgency should indicate pelvic floor exercises and bladder training (RCOG Press at the Royal College of Obstetricians and Gynaecologist, 2006). Shipping should be considered if espcial (Thüroff JW, 2011):

- Frail elderly

- Added significant factors: hematuria, pain, etc..

- Coexisting disease: functional impairment, dementia

- Initial response to insufficient treatment

The following segment is about an incontinence nurse at Fremantle Hospital in Western Australia.

REFERENCES:

• Treaty of geriatrics for residents. Spanish Society of Geriatrics and Gerontology. [Home Site] [accessed May 18, 2013] Available at: http://www.segg.es/tratadogeriatria/main.html

• Clinical Practice Guideline: Assessment Comprehensive Geriatric Gerontological Ambulatory Elderly. Mexico: Ministry of Health, 2011. Available at: http://sgm.issste.gob.mx/medica/medica_documentacion/guias_autorizadas/Geriatr%C3%ADa/IMSS-491-11-valoraci%C3%B3n%20geronto-geriatrica/IMSS-491-11-GER%20Valoraci%C3%B3n%20geronto%20geriatrica.pdf