NRSG266 - Principles of Nursing Contexts of Ageing Assessment Answer

Introduction

Good morning, everyone. The topic chosen for today’s presentation is “Understanding and caring for the person experiencing urinary incontinence associated with advanced aging”. Urinary incontinence loss is a symptom of this illness, which can range from minor leaks to total loss of bladder control. A considerable fraction of the older population, particularly those who are experiencing advanced aging, are affected by the prevalent and frequently upsetting condition of urinary incontinence (Milsom & Gyhagen, 2019). The pathophysiology of urine incontinence will be discussed in the presentation that follows. The impact of urine incontinence among the elderly and the potential repercussions of inadequate management of the problem will be discussed after this. This will lastly be followed by a discussion of two nursing strategies that can be relevant in managing the issue in focus.

Pathophysiology

The pathophysiology of urinary incontinence in advanced aging involves intricate changes in the bladder muscles, connective tissues, hormones, and nervous system. Age-related declines in detrusor muscle function can lead to incomplete emptying and urge incontinence, while weakened supportive tissues contribute to stress incontinence. Hormonal shifts, particularly in women, can decrease urethral closing pressure, enhancing stress incontinence risk. Neurological alterations disrupt bladder-brain communication, causing detrusor overactivity and urgency. Prostate enlargement in men may obstruct urine flow, leading to overflow incontinence. Additionally, cognitive impairment, inflammation, medications, and physical limitations can exacerbate functional incontinence (Wyndaele & Hashim, 2017).

Impact on the Elderly and RLT Model

Urinary incontinence significantly impacts older adults within the Roper-Logan-Tierney Model. Physically, it hampers mobility and endangers skin integrity. Psychologically, it triggers feelings of embarrassment and anxiety. Socially, it leads to isolation and compromises overall life quality. While the model focuses less on cognitive aspects, mismanagement could worsen cognitive issues. Emotionally, it fosters shame and a diminished sense of control. Poor management exacerbates these challenges, escalating discomfort, isolation, and emotional distress. Effectively addressing urinary incontinence becomes paramount, safeguarding physical well-being, mental health, social interactions, and the comprehensive life experience of older adults (Holland & Jenkins, 2019).

Nursing Strategies

One relevant nursing strategy involves promoting pelvic floor muscle exercises, commonly known as Kegel exercises. This approach focuses on educating and encouraging older adults to perform targeted exercises aimed at strengthening the muscles that support bladder control (Rodas & García-Perdomo, 2018). The rationale behind this strategy lies in the fact that pelvic floor muscle exercises can significantly enhance the strength and endurance of the muscles responsible for maintaining continence. Particularly effective for stress and urge incontinence, these exercises empower individuals to regain control over their bladder function and reduce instances of leakage (Lasak et al., 2018). A study by Radzimińska et al. (2018) underscores the efficacy of structured pelvic floor muscle training programs. The study demonstrated substantial improvements in incontinence episodes and overall quality of life among older women who underwent such training.

Another nursing strategy involves implementing scheduled voiding routines and bladder training techniques. This approach aims to reestablish control over bladder function through structured interventions. Scheduled voiding entails establishing a regular toileting schedule to prevent the bladder from becoming overly full, thereby reducing the risk of accidents. Bladder training, on the other hand, involves gradually increasing the time intervals between voiding sessions, enhancing bladder capacity and reducing frequency (Gibson, 2021). Empirical support for this strategy is evident in a report by Gibson et al. (2021). The report highlighted the effectiveness of structured bladder training programs in diminishing daily incontinence episodes and enhancing participants' ability to postpone voiding.

Conclusion

In conclusion, the intricate interplay of physiological changes contributing to urinary incontinence in advanced aging demands a comprehensive nursing approach aligned with the Roper-Logan-Tierney Model. This condition's far-reaching impact on physical, psychological, and social well-being emphasizes the urgency of effective interventions. Lastly, by advocating pelvic floor exercises and implementing structured voiding routines, nurses empower older adults to regain control and reduce the burden of incontinence. Thank you for your attention. Now, I am open to any questions you may have regarding this important topic.

References

Gibson, W., Johnson, T., Kirschner‐Hermanns, R., Kuchel, G., Markland, A., Orme, S., & Wagg, A. (2021). Incontinence in frail elderly persons: Report of the 6th International Consultation on Incontinence. Neurourology and Urodynamics , 40 (1), 38-54. https://doi.org/10.1002/nau.24549

Gibson, W. (2021). Management of incontinence in the frail elderly. Obstetrics, Gynaecology & Reproductive Medicine , 31 (3), 63-71. https://doi.org/10.1016/j.ogrm.2021.01.003

Holland, K., & Jenkins, J. (Eds.). (2019). Applying the Roper-Logan-Tierney Model in Practice-E-Book . Elsevier Health Sciences. https://books.google.co.in/books?hl=en&lr=&id=erKMDwAAQBAJ

Lasak, A. M., Jean-Michel, M., Le, P. U., Durgam, R., & Harroche, J. (2018). The role of pelvic floor muscle training in the conservative and surgical management of female stress urinary incontinence: Does the strength of the pelvic floor muscles matter?. PM&R , 10 (11), 1198-1210. https://doi.org/10.1016/j.pmrj.2018.03.023

Milsom, I., & Gyhagen, M. (2019). The prevalence of urinary incontinence. Climacteric , 22 (3), 217-222. https://doi.org/10.1080/13697137.2018.1543263

Radzimińska, A., Strączyńska, A., Weber-Rajek, M., Styczyńska, H., Strojek, K., & Piekorz, Z. (2018). The impact of pelvic floor muscle training on the quality of life of women with urinary incontinence: A systematic literature review. Clinical Interventions in Aging , 957-965. http://dx.doi.org/10.2147/CIA.S160057

Rodas, M. C., & García-Perdomo, H. A. (2018). From Kegel exercises to pelvic floor rehabilitation: A physiotherapeutic perspective. Revista Mexicana de Urología , 78 (5), 402-411. https://www.medigraphic.com/cgi-bin/new/resumenI.cgi

Wyndaele, M., & Hashim, H. (2017). Pathophysiology of urinary incontinence. Surgery (Oxford) , 35 (6), 287-292.

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