The Unspoken Fall Risk: Urinary Incontinence

Ladies and Gentlemen, I am so delighted to share in summer’s joy this July as we celebrate 4th of July Holiday, a very different celebration than last July. Thanks to the COVID-19vaccination program, cases, hospitalizations and loss of life have all declined. Hopefully you are fully vaccinated, unless not indicated because of your health conditions, enjoying the company of your family and friends and maybe even visiting restaurants or going to see a movie.

Over that last couple of years, I have written to you about many fall risk factors, interventions to help reduce your risk of falls, exercises resources for your easy access and more. One fall risk factor that is important, and often uncomfortable to discuss, is urinary incontinence.

Urinary Incontinence.

Urinary incontinence (UI), the voluntary loss of urine, is highly prevalence condition in older adults 60 years and older, ranging from 9.9% to 36.1% in population-based studies (World Health Organization [WHO], 2017, p. 1). According to WHO, women are twice as likely to have UI than older men.

For years, researchers have studied the relationship between UI and fall risks, i.e. urinary frequency, nocturia (toileting at night), and rushing to the bathroom to avoid urge incontinence most likely increasing the risk of falling. These risk factors combine to result in falls, falls with injury, especially falls in bathrooms. Yet, many studies have had conflicting results due to study design, methodological issues, or sampling issues. However, the most recent systematic literature review, has confirmed that urinary incontinence is an important risk factor for falls in both general and older populations. In other words, this is not just an older adult population issue (Moon, et al., 2021). Falls can occur for several reasons – such as losing balance while trying to get out of bed or the chair to get to the bathroom; slipping on a wet floor trying to get up from the toilet; or, losing balance when trying to undress quickly to toilet. Maybe you are or have experienced a near fall or a fall as a result of such conditions. Our concern for you, all older adults, is your greater risk for injury when you fall – serious injury, loss of function, or possibly life, and keeping you safe by reducing your risks. Urinary continence is treatable.

Symptoms

Incontinence always involves urinary leakage. The symptoms of leakage helps to explain the type of incontinence, which varies. Symptoms of incontinence include urine leaking when you cough, sneeze, laugh, lift something heavy or exercise. These symptoms are associated with stress incontinence. Others symptoms can include an intense urge to urinate followed by involuntary loss of urine, needing to urinate often day and night. These symptoms are linked to a type of incontinence referred to as urge incontinence. This type of incontinence is often caused by urinary tract infections or other conditions. Another type of incontinence occurs when your bladder does not empty completely and you start to have dribbling – this is overflow incontinence.

There are other types of incontinence that you can learn about here.

If you are having any such symptoms, it is really important to let your Harmony Team know that you are having these problems and your primary care provider.

Why am I addressing this fall risk factor with you? Some older adults deny this problem, try and treat it themselves.

Many older adults will not discuss their concerns about bladder accidents, and you maybe that person.Ladies and gentlemen, there are differing medical and urological reasons for urinary incontinenceand types of incontinence, which can be evaluated and treated to reduce the frequency of incontinence and correct the underlying causes. Urinary incontinence is a fall risk factor that can even be eliminated with proper treatment. But if you are trying to manage on your own, are you using incontinent briefs?

Incontinent Briefs

As I mentioned, often times, older adults try to manage and contain bladder accidents before talking to their primary provider. These actions will involve trying incontinence pads and/or briefs.

Not all incontinent pads or briefs are the same. An incontinence specialist can help you trial and make a selection for male and female products.The products that you wear during the day may be different than those you wear at night. If you need to wear incontinent briefs at night, there are absorbent briefs to wear that have super absorbent material to maintain skin dryness so that you can sleep, neutralize the urine to reduce skin irritation and protect from bed wetting. All efforts should be made to reduce your getting up at night to toilet, and help you rest with uninterrupted sleep. Nocturia, getting up to toilet at night, is a fall risk factor. We want to reduce your risk of falling, while managing your incontinence. Overall, it is important to change your incontinence pad or brief once soiled or according to product instructions to avoid skin irritation, odor or possible urinary tract infection.

I hope this information is helpful to you. But remember, your Harmony Team recommends that you NOT manage your bladder incontinence on your own. Talk to your Harmony Team your Primary Care Provider.Help is just a phone call away.

Your Harmony Team is committed to reducing your fall risks, to help you prevent falls, and promote your function and independence.

Your Harmony Team is here to help you!

Thank you for reading this message.

Pat Quigley
060721

References :

Moon, S, Chung, H.S., Kim , Y.J., Kim, S.J., Kwon, O., Lee, Y.G., Yu, J.M., & Cho, S.T. (2021). The impact of urinary incontinence of falls: The impact of urinary incontinence on falls: A systematic review of meta-analysis. PLoS One, 16(5): e0251711.

Types of Urinary Incontinence. Harvard Health Publishing. Harvard Medical School. (2021). Available: https://www.health.harvard.edu/bladder-and-bowel/types-of-urinary-incontinence Accessed Jun 6, 2021

World Health Organization. (2017). Evidence-profile: Urinary incontinence. Integrated Care for Older People (ICOPE). Guidelines on community-level interventions to manage declines in intrinsic capacity. Available: https://www.who.int/ageing/health-systems/icope/evidence-centre/ICOPE-evidence-profile-urinary-incont.pdf Accessed June 6, 2021

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