Regaining Quality of Life Through Urinary Continence Management

A home health nurse received a referral from a local medical practitioner to visit Nina, who was reported to be an alert but “failing” petite, 78-year-old woman. Nina had fallen several times in the past 6 months and had experienced two falls in the past week. However, the actual cause for these falls was unclear. Nina was to be evaluated for injury, blood for diagnostics was to be drawn, and a physical assessment performed for a possible short-term respite admission to a long-term care (LTC) facility. At this time no Mini Mental Status Exam was ordered. An initial brief over-the-phone history with the daughter provided more information and the impetus for the home visit. Recently, the duties of obtaining food and other house and personal supplies for Nina had fallen on daughter Martha’s shoulders. However, because Martha lived on the other side of town, daily visits for follow-up with her mother were difficult. Additionally, Martha’s job required her to travel out of state several times a month. Martha felt that although her mother would “most likely deny the fact,” the reason for the recent falls and sudden loss of independence was somehow related to urinary incontinence (UI). Martha was concerned her mother’s previous occasional episodes of UI had been increasing and were now becoming a health and safety concern. Martha was leaving in 2 weeks on a business trip overseas and would be gone for 2 months. The daughter felt that during her lengthy absence, her only recourse was to place her mother in an LTC for close monitoring and a full medical workup. During the initial home visit, Martha was present in the living room with her mother. The nurse learned that Nina had been independent and active until just recently. Although Nina, a widow, lived alone, she had been active in many social clubs, had many friends, had been able to drive her car, loved dancing, and had experienced no problems with activities of daily living or instrumental activities of daily living.Nina considered herself well and felt fortunate that her only medication was one tablet of hydrochlorothiazide every day. As the nurse began the hands-on physical examination, Nina stated she was unhurt and that she “had just slipped in some water on the floor,” causing her to fall. The orthostatic blood pressure readings, pulse, temperature, skin, fall risk, baseline neurological checks, and mobility assessments were completed with no abnormal findings recorded. Nina denied dizziness or irregular heartbeat, and no edema of the feet, hands, eye orbits, or buttocks was observed by the nurse. The nurse then asked for a urine specimen and drew lab work for a complete blood count with differential, electrolytes, and a nonfasting blood sugar. It was during this time that Nina began to cry and admitted she was having more difficulty in “holding” her urine. She revealed she was often “wet” and was embarrassed to go out in public, as she could no longer control her urine. She had begun to try the various incontinence garments available at the local drugstore but, because of her petite size, was unhappy with the fit and the results and constantly worried about leaking and odor. Nina had begun to withdraw from her active lifestyle and social network and preferred to stay at home. She then shared her concerns surrounding the stigmatization associated with incontinence and the impact the incontinence episodes were having on her personal and interpersonal relationships. Unfortunately, even Nina’s homebound status had become a problem. Nina revealed she did not always “make” it to the bathroom in a “timely fashion” and that the urine had “dripped and run” down her legs and onto the floor. She then admitted the most recent falls were a result of these types of occurrences. Minassian, Drutz, and Al-Badr (2003) reported that the International Continence Society (ICS) revised its definition of UI in 2002 to be “the complaint of any involuntary