Incontinence is Nothing to Sneeze At Caring Experiences on Managing the Elderly with Incontinence
Mr Ricarte B Acena
(The Salvation Army Peacehaven Nursing Home)
Incontinence can be embarrassing and a life-altering problem, it can be slightly bothersome or totally debilitating as well, which may have a profound impact on the quality of life. However, incontinence is not something our residents necessarily have to live with.
In the nursing home, our primary goal is to effectively manage or even reverse incontinence. Another one of our goals is to return individuals to their daily routine without any inconvenience related to incontinence. Based from our experience, our most challenging obstacle in managing incontinent residents is under-staffing. Another common problem is the communication barrier between old generation residents and the foreign workers. In addition, we also experience having residents who already prefer using a diaper instead of going to the toilet. On the contrary, and with higher prevalence, we learned that incontinence can have severe emotional effect to the patients. Residents, especially those who are new to incontinence, feel humiliated, so they isolate themselves until depression sets in. We also observed, that psychologically, some of them started to cut back on drinking liquids and therefore risk dehydration, just to avoid wetting. So, we thought, how do we manage them successfully?
I recall real-life strategies in managing our incontinent residents. First, we should educate our nurses. By understanding more about the causes and treatments of the different kinds of incontinence, nurses can open the opportunity for a more comfortable dialogue with residents over the sensitive issues surrounding elimination problems. Therefore, currently, we are strongly advocating that incontinence should not be accepted as a normal occurrence in the elderly, and that relying on diapers to manage incontinence is an unfortunate practice. Next, we need to reassure our residents that they are not alone and need not suffer the indignities of incontinence. That way, we are already establishing rapport with them as well as gaining their cooperation. Our continence society initiates the whole process, up to the identification of potential residents for rehabilitation. Next, we will then make a focused incontinent care plan, implement and evaluate it to find out if it is effective or not.
Among others, measures that we observed and have proven to be effective in managing incontinence is to first establish good rapport and get the residents’ cooperation so we can literally wean them off their diapers. One concrete example is we actively assist them in timed urination using the urinal. Incontinence management needs the virtue of patience and a passion to go the extra mile. At this point in time, actively reassuring and encouraging the residents are the nurses’ primary focus. Then, once bladder retraining is successful, and the residents get their confidence back, we then train them to be independent in using their urinals until they are fully independent of going to the toilet. We assist them by titrating and monitoring their fluid intake. We also actively promote their physical exercise, we control their diet and we keep and monitor their blood sugar under control if they are diabetic.
Finally, with equal importance, is for a nurse (or caregiver) to give his or her full support to the resident to develop a good attitude or routine and urge his residents to urinate regularly with a strong sense to educate them not to ignore their restroom urges. Rehabilitative training for incontinence residents with dementia is a great challenge. Once both parties have achieved and realised that they have touched each other’s lives, they will both feel happiness and fulfillment, and that is just one of the greatest experiences that I can only describe.