Interdisciplinary Approach to Continence Improvement

Editor’s note: This text-based course is a transcript of the webinar, Interdisciplinary Approach to Continence Improvement, presented by Kathleen Weissberg, OTD, OTR/L.Learning ObjectivesBy the end of this course, the participant will be able to understand the scope and cost of UI in the elderly population.By the end of this course, the participant will be able to describe normal bladder and pelvic muscle function.By the end of this course, the participant will be able to discuss assessment and management of various types of incontinence.By the end of this course, the participant will be able to identify and implement strategies for effective behavioral treatment related to continence.By the end of this course, the participant will be able to state how to establish and facilitate a Multi-disciplinary Team Continence Improvement Program.<v ->Today's presenter is Dr. Kathleen Weissberg.</v> She has presented multiple times on our site she is a great resource for us. She, in her 20 years of practice, has worked in long-term care as a researcher, educator, and has established various programs in nursing facilities including palliative care, and end of life care, incontinence management, falls management, and dementia care, and staging. She currently provides continuing education support to 6000 therapists nationwide as Director of Education for Select Rehabilitation. So happy to have you back again, thank you. <v ->Thank you so very much for that introduction</v> I appreciate it and I want to thank all of you who have joined in today. I'm just gonna adjust readjust my webcam there. We're just gonna get right into it because we've a lot to cover today in our two hours so I'm gonna go forward to the next slide and go through the objectives. We're going to start off today and talk about the cost of urinary incontinence in the elderly population. We're going to talk about normal bladder and pelvic muscle function, we will discuss the assessment and management of various types of incontinence, identify and implement strategies for effective behavioral treatment related to continence improvement, and then finally we will state how to establish and facilitate a multidisciplinary team continence improvement program, wow, that's a mouthful. You’ll see as I go through this and as Fawn mentioned the vast majority of my experience has been in long-term care so I will share I have previously worked in outpatient clinics where I've addressed urinary incontinence and also an acute care, so while I may have a bit of a long-term care bend and you'll see some stuff in here specifically related to the MDS know that all of these principles will be applicable really to any setting. And my goal for you today is not just to understand the therapy component of continence improvement but also to really understand what our piece is in the whole interdisciplinary program because the reality is if it's us or if it's Physical Therapy running this program, and it's only us it's not going to succeed. We really need to have everyone onboard including our patient and nursing and dietary and all of those folks. So that's the bend that we'll take and we'll go ahead and jump right in to talk about the scope of the problem. And again this comes from the CDC and it specifically related to long-term care and you can read it that almost one half, almost 46% of short-term nursing home residents and three quarters, a little over three-quarters of long-term nursing home residents, experience some sort of urinary incontinence. When you look at the cost of incontinence per resident we're looking at several thousand dollars per person per year. And the most recent costs are from 2014 and the CDC estimates that urinary incontinence is costing us about 19 almost 20 billion dollars and obviously that's set to increase as the population in long-term care facilities changes over the next few years. And that majority of that cost is actually attributed to the resources used for routine care. And we talk about resources that's everything from laundry detergent and incontinence products like pads and such, all the way down to the labor and the resources or the people power to address that. Now again these are based on a skilled nursing facility but I think that's where we see the vast majority of incontinence and the typical skilled nursing facility resident is incontinent seven times per day. And again if you think about the cost per episode and if you look at this slide an average 200 bed facility is spending about $10,000 per month on just supplies alone. And as we start to talk about goals a little bit later on you'll hear me say that our goal is never going to be, maybe it would be you know in a special circumstance maybe an outpatient or what have you, but for the elderly population we may not get to 100% continent. And that's okay. We even if we reduce this by 50%, 25% imagine what that would do to, not just our cost, but also to the quality of life for the individuals that we're serving. So, more of the facts, urinary incontinence is affecting about 13 million Americans and 85% of them are women. And while we see many more elderly affected than anyone else we have to recognize that it is not a normal part of the aging process. Women are more likely to develop urinary incontinence either because of pregnancy or childbirth or the hormonal changes that we see with menopause. Or maybe it's just because of weakened pelvic muscles maybe due to a surgery or something like that. Older men we see incontinence because of issues related to prostate surgery, prostate cancer, enlarged prostate, those sorts of things, but even past that things like caffeine or medications were things that are in folks diet can certainly cause urinary incontinence. Now the reality of a lot of folks have this condition and often times again it does not get addressed with their physician and in so many cases this can...