Abstract: Incontinence in the Nursing Home

Joseph G. Ouslander, MD, and John F. Schnelle, PhD. "Incontinence in the Nursing Home." Annals of Internal Medicine 122 (March 1995) 6: 438-49.

Objectives:
* The authors discuss how to diagnose and treat urinary and fecal incontinence in the nursing home population. To this end, they review the prevalence and morbidity of incontinence, the types and causes of incontinence, methods of assessing incontinence and approaches to therapy for incontinent patients (including bladder retraining, drug therapy, surgery, pads and undergarments, and catheters and catheter care).

Conclusions:
* "Urinary incontinence affects approximately half of nursing home residents. . . rates may range from 40% to 70% or even higher in facilities with a functionally impaired resident population. In contrast to urinary incontinence among ambulatory community-dwelling geriatric patients, urinary incontinence among nursing home residents is more severe and more commonly associated with fecal incontinence."
* "Urinary incontinence in the nursing home is associated with substantial morbidity and cost. . . . Nursing home staff generally consider urinary incontinence in the nursing home to be one of the most onerous and difficult conditions for which they care, and they perceive that they spend a disproportionate amount of time on the care of incontinent residents."
* "The economic costs of urinary incontinence in the nursing home have been estimated to be close to $5 billion annually, including the costs of staff time, laundry, and supplies."
* Urinary incontinence among nursing home residents can be caused by a variety of factors, some of which are reversible.
* Methods of coping with urinary incontinence must be tailored to the individual patient, as residents of nursing homes suffer from a variety of different medical conditions which affect the viability of incontinence management approaches.
* "Significant degrees of urinary retention can occur without symptoms or signs of obstruction or bladder contractility problems." Post void residual volume should be evaluated as part of the basic assessment of bladder and bowel function required for all newly admitted nursing home residents. ". . .A portable ultrasound device [the BladderScan^®] is now available that can noninvasively measure residual urine volume with reasonably good accuracy in incontinent nursing home residents."
* ". . .when moderately elevated urine volumes are detected (for example, 150 to 300mL), repeated determinations may be appropriate. In these situations, ultrasonography may be especially valuable in avoiding the need for repeated catheterizations."
* Ultrasound determination of postvoid residual can also play a role in the bladder retraining process (which helps patients return to a normal pattern of voiding and continence).

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