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6 Tips to Address Incontinence and Reduce Falls
April 22, 2024It’s estimated that 85% of all nursing home residents have some form of incontinence, and this condition contributes to the risk of falls in these individuals. Aligning recognition and treatment for incontinence and fall prevention can help maximize safety and quality of life for residents.
Start with these steps:
1. Make sure team members understand urinary incontinence. For instance, they should know the difference between the types of incontinence: stress, urge, overflow, functional, and mixed. They also need to know signs of urinary incontinence to watch for, such as rashes, wet skin, and/or damp/wet bedding or clothing.
2. Talk with residents about toileting habits and issues. “I find residents to be fairly forthcoming if we ask them if they have any problems with leakage or accidents. Often, they don’t tell anyone because no one ever asked,” said Melissa Blackburn, MSN, APRN, NP, adding, “They may even think it’s a normal part of aging.” It is important to ask about things like how often they urinate, if the frequency has changed recently, and if they experience urgency or even have trouble getting to the bathroom in time. These conversations should be held in the resident’s room or other private space, she stressed.
3. If someone is incontinent, prioritize ways to keep them safe. This may include limiting fluid intake in the afternoons and evenings, bladder training, or scheduled toilet trips. It is also important to address some issues that may be contributing to incontinence such as alcohol or caffeine intake, consuming foods that are high in spice or
sugar, use of certain medications (such as heart and blood pressure medications or sedatives), taking large doses of vitamin C, and/or the presence of a urinary tract infection.
4. Have protocols to guide staff. These should be designed to help them identify what is causing the incontinence so they can then make a diagnosis and set up a plan to reduce incontinence episodes and reduce fall risk. A fall risk protocol, said Martha Klay, MSN, APRN, NP, should help the team determine the root cause of falls and identify appropriate measures to prevent future falls. Interventions may include moving frequent fallers closer to
the nurses’ station or cleaning the inner ear (which can contribute to improved balance). At the same time, there should be guidance on testing and treatment for urinary tract infections. “There is an issue with overuse of antibiotics to manage UTIs, so we have a protocol for nursing staff to guide them on when testing and treatment is appropriate for UTIs,” said Klay.
5. Focus on person-centered treatment plans. “Every person’s incontinence can be different,” said Blackburn, adding, “You need to look at each resident’s situation, habits, diagnoses, medications, risks, etc. and develop a care plan that is most likely to be successful for them.” Of course, it is also important to have protocols for falling that look at medications and timing of administration, especially diuretics. It also is useful to look at promising treatments and products that can reduce the risk of falls in residents with urinary incontinence.
6. Work with the consultant pharmacist on ways to help manage incontinence and reduce fall risk. “It is important to have someone looking at medications related to urinary incontinence and falls on a regular basis. For example, Blackburn said, “Prazosin is used to manage PTSD and nightmares, but it also can make people urinate more; and this can be overlooked if you’re not looking at all drugs and their potential contribution to the risk of falls.”
Addressing urinary incontinence and its contribution to fall risk presents an excellent opportunity for quality improvement and Quality Assurance and Performance Improvement (QAPI) projects. “It can be exciting for staff to do something research oriented and address an issue that can improve resident safety and quality of life,” said Klay. At the same time, it encourages team members to broaden their scope of work; and it can energize them and
increase teamwork.