Urinary Incontinence Assessment in Older Adults: Part I – Transient Urinary Incontinence
By: Annemarie Dowling-Castronovo, PhD, RN, GNP-BC
Associate Professor, Evelyn L. Spiro School of Nursing, Wagner College
WHY: The symptom of urinary incontinence (UI) is the report of involuntary loss of urine sufficient to be a bother while the sign of UI is observed urinary leakage. Depending on the setting, up to two-thirds of older adults experience UI. Yet, UI should not be considered a normal consequence of aging. Despite available treatment options, UI is not adequately assessed and managed in the older adult population. UI is associated with falls, obesity, skin impairments, urinary tract infections, limited functional status, depression, impaired cognition, poor self-rated health, social isolation, and increased caregiver burden. Proper assessment identifies the type of UI: transient (acute) or established (chronic). Try This:® UI Part I focuses on assessing for contributing causes of transient UI, which is significantly under addressed both in clinical practice and in the health care literature. Try This:® UI Part IIfocuses on established UI. Transient UI is generally defined as a new-onset UI that, if left untreated, may lead established UI.
BEST TOOLS: Whether transient or established UI is suspected, a bladder diary is recommended for collecting information during both assessment and evaluation. Bladder diaries should collect the following data: UI episodes, associated activities during UI episodes, void times and volumes, fluid intake, absorbent product usage, and bowel movement episodes (Abrams et al., 2002; Haylen et al., 2010). Research (Honjo et al., 2009) suggests including urinary perception and feeling of bladder fullness. The mnemonic DIAPPERS (or TOILETED, an alternative mnemonic) provides a framework for focusing the assessment of possible causes of transient UI.
TARGET POPULATION: UI screening is appropriate at any age, but especially for older adults due to increased prevalence. Specific to transient UI, the at-risk patient population includes those with immobility, impaired cognition, depression, certain medication usage (e.g. diuretics and anticholinergics), stool impaction, environmental barriers, diabetes, infection, and estrogen depletion (Fantl et al., 1996; Milson et al., 2013; Resnick & Yalla, 1985).
VALIDITY AND RELIABILITY: The bladder diary has not been validated (Bright et al., 2011), but is still considered an important tool to collect historical data essential to the diagnosis and management of UI. A 7-day bladder diary is a reliable tool (Jeyaseelan et al., 2000; Locher et al., 2001), but is challenging to obtain in clinical settings due to its length; a three-day or two-day diary is more practical (Bright et al., 2011; Tincello et al., 2007). The DIAPPERS or TOILETED mnemonics can be helpful since a valid and reliable tool for distinguishing among possible causes of transient UI is not available (Resnick & Yalla, 1985; Staskin & Kelleher, 2013).
STRENGTHS AND LIMITATIONS: Bladder diaries, or records, continue to be the standard tool for assessing patterns of UI episodes. While the bladder diary requires validation testing in varied populations, its brevity and ability to be self-administrated are strengths for use in clinical settings. Practitioners may find either mnemonic, DIAPPERS or TOILETED, a useful memory aide to recall the most common causes of transient UI.
FOLLOW-UP: Transient UI requires aggressive assessment and treatment of reversible causes. If left untreated, transient UI may transition to established UI. It is essential for nurses to regularly assess for transient UI and treat reversible causes across all health care settings.
MORE ON THE TOPIC:
Best practice information on care of older adults: www.ConsultGeri.org.
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Note: This is an archived guideline for historical purposes.
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