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CASE STUDY


Continence Management: Arming Caregivers with Knowledge to Improve Outcomes.


Written by Michelle Christiansen MS, PA, CN-E, CCDS, VA-BC


Introduction Incontinence is the involuntary and uncontrolled loss of urine and/ or stool that represents a hygienic, distressing, social problem to the individual. Millions of adults experience incontinence1


yet do


not report it. Affecting people of any age and gender, incontinence impacts all aspects of people’s lives and can be costly if not proactively identified, assessed and managed.2


An aging population,


with an increasing prevalence of incontinence, creates a need for continence promotion, education and training that can lead to better management and better outcomes.


Cost/financial burden Incontinence presents a significant financial burden to the individual and to society. In the United States, the cost of bladder incontinence among adults in 2000 was estimated at $19.5 billion,3


with $14.2 billion incurred by


community residents and $5.3 billion by institutional residents.4


A majority


(50%–75%) of the costs are attributed to resources used for incontinence management or ‘‘routine care’’ such as absorbent pads, protection, and laundry.5


The 2010 average annual


cost for fecal incontinence was estimated at $4,110 per person for patients who had fecal incontinence for more than one year with at least monthly leakage of solid, liquid, or mucus stool: $2,353 for direct medical and nonmedical expenses and $1,549 for indirect costs associated with productivity loss.6


symptom severity was associated with higher annual direct costs.


Quality of life Individuals who are incontinent may carry an emotional burden of shame and embarrassment in addition to the physical discomfort and disruption of their lives that occur with episodes of incontinence.7 Bladder and bowel incontinence significantly impacts quality of life and this impact increases with greater severity of incontinence. Research has found an association between incontinence and declining mental health8


and increased risk of the


onset of psychological distress9 depressive symptoms.10


and Incontinence


is a predictor of functional limitations11 and is associated with an increase in falls, which may result in injuries and mobility impairment.12


Incontinence


adds to the psychological and physical burden of caregivers13


factor for nursing home placement, hospitalization, and death.14


There are a number of reasons why incontinence develops:


• Weak bladder/muscles around the bladder


• Blocked urinary passage • Damage to the nerves that help control the bladder


• Diseases that limit movement • Neurological • Pharmacological


Greater incontinence


Pace of onset Many cases of urinary incontinence present as a gradually progressive disorder. Progression from very mild symptoms to more severe and debilitating urine loss may take several years. The resident may come to medical attention only


and can be a risk


after experiencing a progressive worsening of symptoms. In others, symptoms may appear suddenly and may or may not be associated with a specific inciting event, such as genitourinary tract infection.


Types of incontinence Many people think a person is either continent or incontinent. They do not realize that there are many different types of incontinence: • Urge — involuntary leakage accompanied by or immediately preceded by urgency


• Stress — loss of a small amount of urine with physical activity


• Mixed — combination of stress and urge incontinence


• Overflow — leakage of small amounts of urine when bladder has reached its maximum capacity


• Functional — inability to hold urine • Bowel — occasional leakage of stool while passing gas to a complete loss of bowel control


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