Question

1. Conduct research on geriatric problems with bowel elimination, urinary incontinence, and dehydration. Write a one-page report on your findings. Please cite the source of your findings.

Answer 1

Bowel problems in elderly people faecal incontinence, constipation, diarrhoea.FI is “the involuntary loss of liquid or solid stool that is a social or hygienic problem” elderly people, FI is also associated with reduced mobility, cognitive impairment, co-morbidity, urinary incontinence.

Constipation is defined as an abnormality of stool bulk, hardness or frequency and might be associated with straining ]. It is however common to take laxative use as a marker for constipation in clinical studies. Prevalence of constipation is reported as between 50-74% in institutionalized elderly people in an evidence-based review . Chronic diarrhoea is defined as the frequent passage of unformed stool for more than three weeks .

Constipation among elderly people is related to loss of mobility, medications, underlying diseases, impaired anorectal sensation, and ignoring calls to defecate .Low fibre intake and limited fluid intake have also been implicated as causes of constipation.Diarrhoea is related to infections, faecal impaction/constipation, co-morbidity or side effect of medications

Urinaryincontinence:_

Urinary incontinence means a person leaks urine by accident . Urinary incontinence is more common in older people, especially women. Incontinence can often be cured or controlled.Urinary urge incontinence (detrusor hyperactivity, spastic bladder) is the most common type of incontinence in late middle to older age.

Causes.:_

Weak bladder muscles;Overactive bladder muscles

Weak pelvic floor muscles,Damage to nerves that control the bladder from diseases such as multiple sclerosis, diabetes, or Parkinson’s disease.

Blockage from an enlarged prostate in men

Diseases such as arthritis that may make it difficult to get to the bathroom in time

Pelvic organ prolapse, which is when pelvic organs (such as the bladder, rectum, or uterus) shift out of their normal place into the vagina. When pelvic organs are out of place, the bladder and urethra are not able to work normally, which may cause urine to leak.

Management of urinary incontinence

Pelvic muscle exercises (also known as Kegel exercises) work the muscles that you use to stop urinating. Making these muscles stronger helps you hold urine in your bladder longer.

Medications:-

Anticholinergics. These medications can calm an overactive bladder and may be helpful for urge incontinence. Examples include oxybutynin (Ditropan XL), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare) and trospium (Sanctura). Mirabegron (Myrbetriq).

Diet:_

Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fibre. Drink plenty of fluids, enough so that your urine is light yellow or clear like water.

scheduled toilet training.

Dehydration:-Older people are vulnerable to dehydration due to physiological changes in the ageing process,.Dehydration is more common in those with cognitive impairment and changes in functional ability. Swallowing difficulties, dementia and poorly controlled diabetes are more common in older people and are all associated with poor hydration.

Reduced renal function is also a risk factor. The kidneys play a vital role in fluid regulation but their function deteriorates with age, and the hormonal response to dehydration (which is key to fluid balance) may be impaired.Inadequate fluid intake is a major contributor to preventable dehydration. Poor oral intake of fluids can be related to the inability to feed independently and having poor availability and access to fluids. .

Signs of dehydration

Signs of dehydration include dryness of the mouth, lips and tongue, sunken eyes, dry inelastic skin, drowsiness, confusion or disorientation, dizziness and low blood pressureMonitoring fluid intake is a good guide to ensuring good hydrationDehydration is also indicated with a reduced and more concentrated urine output.

Common complications associated with dehydration also include low blood pressure, weakness, dizziness and increased risk of falls.

Strategies may include:

Staff training to recognise the importance of hydration.

Determine an individualised daily fluid intake goal

Provide preferred fluids

Have fluid available at all times

Make sure water is fresh and looks palatable — perhaps by adding a few slices of lemon or orange or ice cubes.

Offer fluids regularly throughout the day

Offer fluids at routine events such as before physiotherapy or other activity or medication rounds

Offer a variety of hot and cold fluids

Provide assistance if required

Provide aids for drinking if needed such as special cups

Offer at least a full glass of fluid with medications.