1. Nursing Assistant Monthly Copyright © 2012 Delmar, Cengage Learning. All rights reserved. September 2012 Urinary incontinence (UI) and dementia

2. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. September 2012 Urinary incontinence and dementia Is it reversible? This is the first question that needs to be asked.  Reversible types of urinary incontinence include: –urinary tract infection –chronic constipation –medication side effect

3. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. September 2012 Urinary incontinence and dementia Types of incontinence  Stress: sudden leak of urine during sneezing or coughing  Urge: “overactive bladder”  Overflow: bladder cannot empty due to blockage or nerve damage  Functional: physically cannot get to the bathroom in time  Combination of all of the above problems

4. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. September 2012 Urinary incontinence and dementia Why worry about incontinence? Can result in:  Skin breakdown  Falls and injuries (trying to get to the bathroom)  Sleep disturbance  Embarrassment, loss of dignity  Dehydration—avoid drinking to prevent “accidents”

5. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. September 2012 Urinary incontinence and dementia Why not use a urinary catheter?  Urinary catheters have a place mostly in acute care.  Urinary catheters give bacteria a “superhighway” to the bladder—great risk of infection!  Urinary catheters can cause trauma. –Example: confused person pulls on the tube  Urinary catheters were never meant for long-term use.

6. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. September 2012 Urinary incontinence and dementia Caregiver strategies for UI in dementia Depends on the level of dementia  Toileting is most important!  Anticipate the need to urinate based on timing of fluid intake  Watch for behavioral cues –Pacing, agitation, restlessness

7. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. September 2012 Urinary incontinence and dementia A word about diapers  Toileting is still important: –to promote continence –to promote bowel function –as a matter of dignity

8. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. September 2012 Urinary incontinence and dementia Observe and report  Report to the nurse any of the following: –Urine that is dark, concentrated, odorous –Resident complains of pain when urinating or appears to be in distress –Urinary frequency –Skin redness or rash in the perineal area –Any sign of skin breakdown –Anything that concerns you, or does not look right

9. Copyright © 2012 Delmar, Cengage Learning. All rights reserved. September 2012 Urinary incontinence and dementia Preserving dignity Think of how you would want to be treated if you became incontinent.  Ensure comfort when toileting  Provide enough time—don’t rush the resident  Never dress or bathe a resident while toileting  Maintain privacy even for confused residents