Bowel & Bladder Incontinence In Elderly Skin Management Perspective Alex Khan RN BSN CWCN CFCN Jesse Lewis RN CWCN & Deanna Andel RN BSN CWCN

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

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.

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

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

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.

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 Bed bound / immobility Skin condition commonly associated with incontinence. Skin irritation and inflammation related to exposure to urine and feces. Additional risk factors: Diaper use 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.

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).

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.

Unstageable Pressure Ulcer Incontinence, immobility, increased moisture, pressure and malnutrition causes serious skin conditions/wounds.

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

Skin Treatment Products