精品老人尿失禁的照护技巧课件.ppt

老人尿失禁的照護技巧The Techniques of Caring the Aging with Urinary Incontinence 王炯珵 恩主公醫院泌尿科 Chung Cheng Wang Department of Urology En Chu Kong Hospital State of the Science on Urinary Incontinence Nurses have in their toolboxes some help for first-line UI intervention and screening [Diane Newman, 2002 July] The first priority is to increase awareness among nurses. [Mary Palmer, 2003AJN] Noninvasive behavioral interventions can be effective in long-term care setting But staff compliance was problematic [Palmer MH 1997] Epidemiology 20 million American have UI [Abram P 2002] 22% of women aged 65 and older had UI in daily life [Tseng 2000] More than 50% of nursing home residents [Fantl J,1996] Differences in Gender Female: male = 2:1 [Hunskaar S 2001] stress or mixed UI: female Pure urge UI: equal Postvoid dribbling, nocturnal enuresis: male [Temml C 2000] Women were more likely to regularly use strategies for UI management [Johnson TM 2000] Risk Factors in Women Gravidity and parity One vaginal birth: 2.5 times for UI [Nygaard IE 1994] Breech presentation, use of forceps, tearing, central episiotomy, oxytocin Pelvic organ prolapse Gynecologic surgery Menopause Obesity [Roe B 1999] Risk Factors in Men A history of radical or transurethral prostatectomy [Umlauf 1996] The first year of admission to a long-term care facility [Palmer MH 1991] Causes of urge UI in elderly men: UTI, prostate inflammation, bowel dysfunction [Herzog AR 1990] UI in the Frail Elderly Frail: decline in physical activity [Bortx WM 2002] Frail elderly: 65, UI, can not go out without assistance, dementia, admitted to a long-term care facility [Fonda D 1998] Risk Factors in Frail Elderly Multiple medical morbidities Immobility Cognitive impairment (dementia) Screening Routine assessment for UI can be easily incorporated into the general history questions [Feneley RC BJU 1997] Screening by risk factors Urge UI + Nocturia 2 + daytime voiding frequency of 2hr = 90% detrusor overactivity on UDS [Gray M, 2