Feature Story

AHCPR releases new caregiver guide on urinary incontinence

Today there is even more help available for millions of Americans who suffer from urinary incontinence (UI), or the involuntary loss of urine. A new guide for caregivers, such as certified nursing assistants in long-term care facilities and home health aides, on the treatment of UI is now available. This, and a companion piece for directors of nursing to use in training caregivers, are based on a clinical practice guideline sponsored by the Agency for Health Care Policy and Research (AHCPR) and released earlier this year.

Urinary incontinence is one of the primary contributing reasons that people enter long-term care facilities. Through a partnership with the American Health Care Association and the American Medical Directors Association, the new guides were developed and will be disseminated to medical directors and directors of nursing in long-term care facilities. Use of the guide also will help caregivers improve the quality of life for persons being cared for at home and in hospitals.

Researchers estimate the Nation spends at least $16 billion a year to care for people with UI, up from $10 billion in 1990. Urinary incontinence is estimated to affect more than 13 million adults—most of them older women—but actual prevalence may be higher because it is widely underreported and underdiagnosed.

Urinary incontinence has a variety of causes, including pelvic muscle instability, side effects of medications or caffeine, or other conditions such as a urinary tract infection or constipation. It also can be caused by a lack of mobility or not being able to reach the bathroom in time. The caregiver guide stresses the need to maintain a regular toileting schedule and provide aids such as walkers and toilet supports to help people get to and use the toilet.

The guide also emphasizes the need for caregivers to communicate with the doctor or nurse what they know about the affected person's health and medications. This will help the doctor or nurse determine the underlying cause of UI and develop a treatment plan.

The companion piece for directors of nursing is designed to be used with the caregiver guide to help train caregivers in the causes and treatments of UI. It highlights the need for teamwork between the caregiver, director of nursing, and other professionals involved in the care of affected persons.

Both the caregiver guide, Helping People With Incontinence (AHCPR Publication No. 96-0683), and the companion piece for directors of nursing, Establishing, Implementing, and Continuing an Effective Continence Program in a Long-Term Care Facility.

There are also other guideline products—the Quick Reference Guide for Clinicians (AHCPR Publication No. 96-0686) and the Consumer Version, Understanding Incontinence, which is available in English (AHCPR Publication No. 96-0684) and in Spanish (AHCPR Publication No. 96-0685). The caregiver guide will be available in Spanish in late 1996.

The full guideline, Urinary Incontinence in Adults: Acute and Chronic Management, is available online and in print. Single and bulk copies of the guideline may be purchased from the U.S. Government Printing Office (stock number 017-026-00155-7; $6.00 per copy).

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