Urinary Incontinence

Aging and independent? Home Care How To’s

Reviewed by: Joanne Poje Tomasulo, M.D., ACOG

Incontinence is often the issue that robs older people of their independence. “Younger generations need to become knowledgeable about continence issues,” said Nancy Muller, executive director of the National Association for Continence (NAFC). “Your involvement may be a lifeline for a family member who is having a problem.”

There are often other medical issues, of course. “In folks who have difficulty staying in their homes with urinary incontinence, it’s usually just one of several things going on,” said C. Seth Landefeld, M.D., chief of geriatrics at the University of California at San Francisco. “There may be mobility issues—walking problems. There may be cognitive issues; the person may be less able to do things on his or her own mentally than previously, even if there is no dementia.”

Nor is incontinence just a question of embarrassment. It’s a safety issue. “Especially at night, the bathroom is the most common site of serious falls and injuries for older people,” said Dr. Landefeld. Said NAFC’s Nancy Muller, “Falls cause fractures, which put people in the hospital and sometimes, into a downward spiral.”

So helping an aging parent, relative or friend deal with continence issues isn’t just a nice thing to do; it may keep him or her independent at home. It may even save a life. The first step is to have a frank discussion, mentioning your concerns and asking your loved one about his or her wishes. Then, develop a plan together. Be sure to reach out to other family members, and to national and local organizations dedicated to helping older Americans who want to stay at home.

No one home care plan will fit all situations. But there may be a lot you can do to help your older loved one live with more dignity, safety, and autonomy. For example:

• Consider the geography of the bathroom. “Have the bathroom be as close as possible to where an older person spends most of his or her time,” said Dr. Landefeld. “Many have to get up during the night.” If there are stairs involved, consider having a stair lift installed. “It costs money, but by and large a lot less than going to a nursing home,” said Dr. Landefeld. Physical changes such as adding a higher toilet and/or grab bars in the bathroom may make it easier to get to the toilet safely and quickly. “Having a commode next to the bed may be helpful,” said Dr. Landefeld. “Some prefer wearing a diaper to bed, in case there is an accident.”

• Shop for new clothes. Clothes with fewer fasteners are easier to remove, so it won’t take as long for your relative to be ready to use the toilet.

• Look at everything with an eye toward safety. “Lose the scatter rugs, and the slippers,” said NAFC’s Nancy Muller. “Make sure there are night lights, and a flashlight by the bed.”

• Provide scheduling help. Using an alarm that automatically rings every 2 hours during the daytime can remind your loved one to go to the bathroom before there is an urge. This type of scheduling also helps train the bladder.

• Have a bedtime ritual. “Elevate the feet two hours before going to bed,” suggests Muller. “You’ll get the fluid back up toward the heart, get it pumped to the kidneys, and so it’s easier to empty the bladder before bedtime.”

• Evaluate medications with your loved one’s doctor. Perhaps a new diuretic for high blood pressure is contributing to continence problems. “If the doctor doesn’t know that your parent is having a problem with bladder control, he or she wouldn’t think about this,” said Muller. “But there are usually lots of options with medications.”

• Get treatment. Encourage your loved one to have conversations with his or her doctor about incontinence issues, so a treatment program can be begun.

• Get help. Being a caregiver can be overwhelming and it won’t do anyone any good if you get burned out. If you are the primary caregiver for your loved one, be sure to work in some time for yourself. If another relative isn’t able to help from time to time, look into professional in-home care for a few hours a week.

Caring for someone you love who is living with incontinence can be difficult. If it wasn’t, incontinence wouldn’t be one of the top reasons people are admitted to nursing homes. By developing a home care plan, you can help keep your loved one living independently and with dignity for years to come.