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

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 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

8. 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