Challenges of Ageing: Continence, Innovation, and Nursing Practices

This report addresses the challenges of ageing, focusing on continence issues in older adults, using the case of Brian Williams as an example. It identifies contributing factors to continence problems, such as excessive fluid intake and pre-existing health conditions. The report critically analyzes innovations, programs, and initiatives that promote continence in older people, including bladder retraining, habit training, and prompted voiding. It also examines the role of registered nurses in improving personal practices, emphasizing the importance of proper diagnosis, record-keeping, communication, and compassionate care. The conclusion summarizes the key findings, highlighting the significance of awareness and proactive measures to manage continence problems in the elderly.

CHALLENGES OF
AGEING SPRING
(ASSESSMENT 3)

Table of Contents
INTRODUCTION...........................................................................................................................3
The contributing factors to Brian’s continence problems and main continence issues..............3
Critical analysis over innovation, programme or initiative that promote continence in older
people..........................................................................................................................................4
Recommendations for Registered Nurses to improve personal practices...................................6
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................8

INTRODUCTION
There are various problems and challenges faced of Ageing people but the most spreaded
diseases almost among all the old people ins continence which loss over the ability to control
Urine. The report will evaluate the case Brain William's an 82 year old man suffering continence
after his cardiac arrest. Further, it will identify the and will critically analyse the role of
promotion, innovation and initiative to establish awareness among old people about the
continence which will comprise the technique and prevention measures implemented by health
care providers. Thus, the report will outline the recommendation for registered nurses to improve
personal practices.
The contributing factors to Brian’s continence problems and main continence issues.
Brian is an aged man of 82 years suffering from various health issues but recently he was
taken to clinic due to continence problem, started five years ago after his heart operation. His
wife is 80 years who took him to clinical observation because of his bad habits and weakness of
not taking proper medication is leading to various health issues. Brian spends overall 12 hours in
bed and passes 300ml of urine in one night. Further, the intakes 8 to 9 cups of coffee in a day and
even he intakes red wine after his evening meal. Moreover, he drinks 750ml water in one night
and if someone stops him he states that his mouth feels dry. He has been advised various
medicines to make him control over its continence problems but for some fluids he feels like its
taste salty and he avoids taking such medicines. Beside the continence problem, he suffered from
various other diseases which is also a reason of his loss of control like he had knee replacement
and after few years he became physically impaired, also he has cervical spine fusion, “artery
bypass grafts”, that is, valve replacement.
The major reason for his continence problems is his excessive intake of coffee, water and
wine on the other and drinking water is good for human body but excessive intake of anything
creates trouble for humans as it leads to loss of control like in the case of Brian. Further, the
problems arise due to avoiding medications as per the prescribed routine moreover he does not
listen to control over his habits of taking red wine regularly after the evening meal which
disturbs the routine of his medicines because he cannot take medicines just after alcohol. Further,
the continence problems can be controlled by controlling over excessive intake of liquids but in
case of Brian it is clearly demonstrated that he does not have control over his habits which
sometimes bothers his wife who is also old and cannot take care about everything all the time.

The continence problems in Old people is common as the people start losing control over their
bodies because of their childish behaviours and habits of not listening to anyone. In contrast, the
problems can be controlled by taking care over daily routine like, the eating, drinking,
medication and meditation.
The continence issue in case of Brain arises due to his excessive intake of water
overnights for which he claims that he feels his mouth dry. In this blaming Brian for the loss of
control will be not rights because the health issues he had in past are the reason behind its present
problems but putting little control over bad habits like drinking 8 cups of coffees and regular
intake of wine can assist the family in controlling problems (Robinson and Cardozo, 2012).
Besides, the issues arises due this cardiac arrest and impairment because of impairment he is on
4 wheels due to which it takes time for him to reach toilet and he also needs someone to assist
him all the time. Thus, the biggest problem with the Brian is he do not bother giving importance
and establishing improvement measures for his disease like when he started using continence
pads because of non-control over urine but after few days he started feeling that the buying of
pads is really costly and he should not buy them.
Critical analysis over innovation, programme or initiative that promote continence in older
people.
Bringing innovation, programming and establishing initiative for the old people suffering
from continence problems plays a vital role in delivering high quality services to people
suffering from continence problems (Neveus, Eggert and Robson, 2010). Almost all individual in
ageing generation suffers from bladder and bowel management due to which the people lose
their control over urine. In order to promote programming and to take initiative the NHS are
focusing on raising awareness about the symptoms and problems arising due to continence,
providing appropriate and adequate medical and physical guidance, and setting targets in the
market and promoting campaigning for the aged generation. In contrast, to establish
improvement the national health care services and primary cares should focus on working
together in order to promote the services through health improvement programmes (Ficarra,
Novara and Van der Poel, 2012). Due to increasing continence, the people suffer from skin
breakdown, stress, unpleasant behaviour and emotion and physical disorders. Further, in contrast
the ultimate motive behind continence promotion is to determine the existence of continence
issues, risk reduction measures and improvement measures for bowel and bladder management

and to ensure the effectiveness of treatment programmes. Similarly, the programmes aim at
improving the health issues arising due to continence problems by serving the quality of life and
promoting the high standard to maintaining the hygiene in the society (Gormley, Lightner and
Vasavada, 2012). Moreover, in this the choice of treatment depends on the morbidity and
mortality. In accordance to this, the improvement measures only depend on behaviours and
attitude of the individual towards the issue because there are few people who do not bother
improving their control and on the other hand there are people who struggle over mental power
and meditation to understand the effectiveness of initiative of improving health problems like
continence. However, in the contrary except for programming and promoting awareness the
health care system took initiative of distributing continence Pads to assist the old people
suffering from the problems of loss of control. These initiatives are taken to promote continence
care among aged people who cannot appropriately respond to toilets on time. Such initiative is
important because the aged generation loses the ability to access over toilet facilities and need
someone to assist them all the time. In contrasts, there are various therapies initiated to promote
the effective control over bladder and bowel habits (Neveus, Eggert and Robson, 2010).
Implementing the techniques to deal with the patient suffering from continence problems assist
the practitioners in handing them with care. These therapies comprise the pelvic floor
rehabilitation and bladder re-education in which the people learn to enhance and increase the
ability to control and store urine. In accordance to this there are four major techniques used
under bladder re-education which are as follows:
Bladder retraining: This is based on the making aged people learn about establishing
control over urine intervals where people are made to increase their capacity by making them
control over up to 3 or 4 hours. In accordance to the training is based in the deferral techniques
and like, deep and slow breathing, counting, planning and specially contraction of pelvic floor
muscles. These are the techniques which helps the aged people in diverting their mind and
establishing control as per regular routine.
Habit training: In habit training the old people are trained to improve their eating and
drinking habits including their medication and, meditation. In this training session, healthy
routine diet and physical activities are promoted according continence among old people (Patel,
Coelho and Coughlin, 2010).

Timed voiding: The initiative taken for aged people suffering from continence in making
them learn control over routine habits of urinating. Establishing control and diverting minds of
old people help them in easily adapting changes like, mediation, minor physical exercises etc.
Binding the routine habits with time is the best techniques to make old people learn control
(Ficarra, Novara and Van der Poel, 2012).
Prompted voiding: In this the hearth care providers establishes a treatment program in
which the providers first focus on collecting information regarding the habits of people like, fluid
intake, alcohol, caffeine, frequency and consistency in bowel movements and bladder
management (Steiner, Morton and Walsh, 2011). Further, it also includes the understanding over
surgical history and the past health issue like, cardiac arrest, diabetes, bladder surgery and
urinary infection (Prompted Voiding for Management of Urinary Incontinence Among Older
Adults 2014). Further, in this the health care providers makes people determine functions of their
body and need to urinate on time. In this, the chances of accidents decrease and this specially
required for individuals suffering from Dementia.
However, in the contrary it is important for health care centres to promote the awareness
about the treatment of continence problems like the continence diet plan should be, intake of
adequate fluid up to two litres that is 7 yo 8 glasses a day, diet rich in fibre content which
comprises cereals, bread, fruits, vegetables and wholegrain (Wei, Dunn and Sanda, 2010).
Further, it important for old people to regularly involve in pelvic floor muscle exercise, toileting
program, appropriate medication and usage of pads and catheters. Moreover, the heath care
providers focuses on taking initiative by promoting the awareness regarding prevention from
continence problems which are as follows:
 Intake of adequate amount of fluid.
 Proper diet to prevent constipation
 Regular medication and meditation
 Physical exercises
 Implementing good urinating habits.
Henceforth, the innovation, programme and appropriate initiatives to promote continence in
older people act as tonic for creating awareness among society about the diseases. It is important
for people to understand the prevention and improvement measures in to develop the mental and
physical ability to deal with continence problems (Burkhard,Kessler and Studer, 2016).

Recommendations for Registered Nurses to improve personal practices.
In order to establish improvement measures and promote the awareness about the
prevention it is important for registered Nurses to improve their personal practices with the
patients suffering from Continence patients. It important for RN's to keep a regular check and
should maintain a record of urinating habits of patients. Further, it is important for Nurses to
ensure and establish a strict control over intake of adequate fluid and diet. Effective health care
system plays a vital role in delivering the satisfactory services to old people and for this the
structure and the design of system should prove smooth and easy flow of information between
the heath practitioner and patients. There are various practices which should be followed by RN
in order to improve the level of their services which are, Diagnosing the disease of patients
appropriately, maintaining the record of health recovering, keep a check over recovery,
communicating right with service users, treating the old people with care and love in case of
continence (Ficarra, Novara and Van der Poel, 2012).The most important duty of Nurses should
be the time management in which the individuals should be liable to take patients to wash room
in time changing pads and providing them the routine for properly exercising. Personally the
nurses should feed uncomfortable while changing continence pads of old people and should teat
them with love instead making them feel Awkward.
CONCLUSION
The report summarized the challenges faced by aged people suffering from Continence
which is lost control over urinating. It evaluated the case of Brain William in which he used to
intake adequate water but excessive caffeine and most dangerous was the consumption of 1 glass
wine regularly after the evening meal. The report outlined the programme, innovation and
appropriate initiatives taken by health care providers to promote awareness about continence in
older people which comprised adequate intake of fluid, proper fibre diet, physical exercises etc.
The report concluded by providing recommendation like, treating patients with love and hope
and also maintaining the record of patients urinating habits which are necessary for registered
nurses to implement in their personal practices.

REFERENCES
Books and Journals
Robinson, D. and Cardozo, L., 2012. Overactive bladder: diagnosis and management. Maturitas.
71(2). pp.188-193.
Gormley, E.A., Lightner, D.J., and Vasavada, S.P., 2012. Diagnosis and treatment of overactive
bladder (non-neurogenic) in adults: AUA/SUFU guideline. The Journal of urology.
188(6). pp.2455-2463.
Ficarra, V., Novara, G., and Van der Poel, H., 2012. Systematic review and meta-analysis of
studies reporting urinary continence recovery after robot-assisted radical prostatectomy.
European urology. 62(3). pp.405-417.
Austin, P.F., Bauer, S.B., and Yang, S.S., 2014. The standardization of terminology of lower
urinary tract function in children and adolescents: update report from the
Standardization Committee of the International Children's Continence Society. The
Journal of urology. 191(6). pp.1863-1865.
Neveus, T., Eggert, P., and Robson, L., 2010. Evaluation of and treatment for monosymptomatic
enuresis: a standardization document from the International Children's Continence
Society. The Journal of urology. 183(2). pp.441-447.
Patel, V.R., Coelho, R.F., and Coughlin, G., 2010. Continence, potency and oncological
outcomes after robotic‐assisted radical prostatectomy: early trifecta results of a high‐
volume surgeon. BJU international. 106(5). pp.696-702.
Steiner, M.S., Morton, R.A. and Walsh, P.C., 2011. Impact of anatomical radical prostatectomy
on urinary continence. The Journal of urology. 145(3). pp.512-514.
Wei, J.T., Dunn, R.L., and Sanda, M.G., 2010. Prospective assessment of patient reported urinary
continence after radical prostatectomy. The Journal of urology. 164(3). pp.744-748.
Burkhard, F.C., Kessler, T.M., and Studer, U.E., 2016. Nerve sparing open radical retropubic
prostatectomy—does it have an impact on urinary continence?. The Journal of urology.
176(1). pp.189-195.
Online
Prompted Voiding for Management of Urinary Incontinence Among Older Adults 2014. [Online].
Available through: <https://www.managedhealthcareconnect.com/news/prompted-
voiding-urinary-incontinence-older-adults>. [Accessed on 25th October 2017].