Older people are being left with long-term incontinence

bobbilly

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Interesting article in the newspaper about older people in hospital being put in nappies and leaving them incontinent.

 
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mickdl

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I think this is not only a problem in the UK… however - as long they are using pads it‚s not that bad because normaly they do no harm to the patient. I think the sub headline of the article hit the point better then the article itself: The problem are catheters. They are widely used because they reduce the care efforts needed for the patient (for a short time). How ever they cause a great number of more or less critical incidents (UTI‘s) and left the patient later also with a week bladder muscle that can not easily retrained due to the lack of personal. So they end up often a permanent drainage (SPC) or ISC what cause other problems again and needs special care.

I would guess at last 50% of the elderly immobile patience in care are functional but not physically incontinent.
 
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ltaluv

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Some hospitals in the US have created policies that sharply limit catheter and diaper use. I was hospitalized a few years ago from complications after a procedure, Because i hasn't expected to be in the visors overnight, i hasn't brought enough supplies. I asked for a diaper and was told that it was a diaper-free floor and it was against their policy to allow a diaper even on an incontinent patient. Then I asked about a Foley catheter and they said that I didn't meet the guidelines, despite the fact that I self-cath multiple times daily for urinary retention.

It made for a very unpleasant night without much sleep.
 
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SpAzpieSweeTot

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mickdl said:
I think this is not only a problem in the UK… however - as long they are using pads it‚s not that bad because normaly they do no harm to the patient. I think the sub headline of the article hit the point better then the article itself: The problem are catheters. They are widely used because they reduce the care efforts needed for the patient (for a short time). How ever they cause a great number of more or less critical incidents (UTI‘s) and left the patient later also with a week bladder muscle that can not easily retrained due to the lack of personal. So they end up often a permanent drainage (SPC) or ISC what cause other problems again and needs special care.

I would guess at last 50% of the elderly immobile patience in care are functional but not physically incontinent.
Muscle weakness is harmful. Creating new muscle weakness, where none existed before, isn't harm? In what universe?

I agree, the larger problem is catheters, at least internal ones, but diapers cause problems, too. That's why I don't wear. I'm trying to keep what I have, in spite of IC.

I'm going to use myself as an example. I have a functional component to my IC. My mobility issues get in my way, but I also have a neurogenic component. My CP makes those muscles assholes, too, not just my skeletal ones. have a stress component to it, meaning I can go, just because my body hates the way I'm moving, or my position , and a little overflow, too, they mix, and left me mine. It's not always cut and dry. Point is, they mix.

Rather done by catheter, or diaper, don't make new, real problems for parents, and don't deny solutions, thinking that'll poof old problems away.
 
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SpAzpieSweeTot

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ltaluv said:
Some hospitals in the US have created policies that sharply limit catheter and diaper use. I was hospitalized a few years ago from complications after a procedure, Because i hasn't expected to be in the visors overnight, i hasn't brought enough supplies. I asked for a diaper and was told that it was a diaper-free floor and it was against their policy to allow a diaper even on an incontinent patient. Then I asked about a Foley catheter and they said that I didn't meet the guidelines, despite the fact that I self-cath multiple times daily for urinary retention.

It made for a very unpleasant night without much sleep.
This is wrong, too, and I'm sorry you went through it. Creating new problems is bad. Ignoring pre existing problems, that may have more involved than just weak muscles, and pretending it's going to make you anything but miserable, is just as bad.
 
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sbmccue

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Having lived in London, I have to say that such an outcome is typical for the NHS. The overstretched staff are not to blame; the administrators who actually outnumber the staff are the problem. As is common in Britain, it's always easier for someone to write a report than to deal with the problem. As much as I think universal healthcare coverage is a necessity in the United States, universal care is a slippery slope. The decline of the NHS in the past 50 years is proof of the point.
 
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bobbilly

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The NHS don't just over-proscribe nappies to elderly people who are not incontinent but then end up incontinent but to people with intellectual disabilities who can have accidents but its easier to stick them in nappies and they end up incontinent too. I have seen this happen at the day centre I attend.

How fast does muscle weakness happen? Let's say a person who goes wee at the slightest urge, ow many weeks or months would muscle weakness and bladder tone happen?
 

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bobbilly said:
The NHS don't just over-proscribe nappies to elderly people who are not incontinent but then end up incontinent but to people with intellectual disabilities who can have accidents but its easier to stick them in nappies and they end up incontinent too. I have seen this happen at the day centre I attend.

How fast does muscle weakness happen? Let's say a person who goes wee at the slightest urge, ow many weeks or months would muscle weakness and bladder tone happen?
I'd think it would depend on if they were in hospital for something that left them already generally weak, or if their was already a problem with the excretory machinery, anyway. Eventually, the slightest urge, can, doesn't for everyone, but can, become no urge at all.
 

sport1

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bobbilly said:
Interesting article in the newspaper about older people in hospital being put in nappies and leaving them incontinent.

That is bad. I've been incontinent for a long time I would never let them use a catheter on me had too many uti's the diaper works fine on me my wife also says so.I'am 80+.
 
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bobbilly

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I've been wearing 24/7 for over a month now and continue to wet at the slightest urge in dribbles and gushes every 10 minutes without clenching my sphincter muscles. I can wet in any position. If I'm honest I'm quite intrigued with incontinence but deep down I know it would ruin some aspects of my life like backpacking abroad. What would happen if I continue wetting at the slightest urge without excising my bladder. I already have post void dribble when having a poo and always leave a puddle on the floor, that was left over from my last 24/7 binge. I'm scared that I'll regret if I lose my continence when the purge comes along. What do I need to look at for?
 
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NannaAnnabelle

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sbmccue said:
Having lived in London, I have to say that such an outcome is typical for the NHS. The overstretched staff are not to blame; the administrators who actually outnumber the staff are the problem. As is common in Britain, it's always easier for someone to write a report than to deal with the problem. As much as I think universal healthcare coverage is a necessity in the United States, universal care is a slippery slope. The decline of the NHS in the past 50 years is proof of the point.
"When you want something to fail it will fail" Tory rule of law #1
 
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SpAzpieSweeTot

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Post pee dribble is already not a good sign. You're already dribbling on the floor? I'd say your muscles have already changed.

I make it to the toilet, more often than I don't. That doesn't make me continent. It makes me just as IC as ever, and lucky, or possibly dehydrated and constipated enough to please everybody but myself.
 
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MaxxH

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The two opening anecdotes in the article strike me as adult children in denial about their parents' decline, perhaps fearing they will be ultimately saddled with caregiving. I've been there, done that. I didn't realize Dad had lost it until I got a very panicky phone call from him "Your sister Maxxine is now in charge of everything". He had either forgotten his computer login, or been locked out by a scammer. There was no way to pay bills or even know what they all were. Oh... in the process he lost several thousand dollars to a phone scammer offering to "clean up his computer". He had always been a very smart guy, maybe a little too impressed with his own abilities. He would ask my advice off and on about computer stuff, but apparently ignored or forgot everything I told him. My sister thinks he had a couple of mini-strokes that took out some chunks of memory. In any case, Maxxine and I had a fun few months, first teaching her how to use a computer, and then tracking down accounts and passwords so the household could keep functioning. Physical decline wasn't far behind. Dad passed within a year.

I suspect these critics of diaper use haven't spent much time up close and personal with old people needing full time supervision, whether in or out of a facility. There may be a few bright minds in deteriorating bodies, but more often than not there are mental as well as physical issues involved that put them in a facility. Wandering off, random calls to police, etc. Senility/dementia play a role. Aside from the physical challenge involved in getting to a toilet, they may occasionally forget that toilets are a thing. Wetting or messing can also be attention-getting behavior, a kind of power trip if you will. Some of these folks are more like toddlers, or even infants, than adults. Over and above staffing and training issues, diapers are a matter of practicality.

I saw the "poor little me" power trip behavior decades ago when my grandma spent her last couple years living with my parents. Now I'm seeing it with my mother. Even on the occasional good day when she remembers what a toilet is, getting her to the toilet is enough of a project that success rate isn't great. On the bad days when she doesn't want to, or forgets how to cooperate, it ain't gonna happen.

I'm getting a preview of this myself. I like long walks. Recently, they removed the porta-potties along my preferred route. Making the 5 mile loop instantly become extremely uncomfortable to impossible without a diaper. 20 years ago, not a problem. I could cover 5 miles in a half hour if I had to. Now, it's more like 2 hours as old injuries and age have caught up with me. I still have cycling, although it's mostly indoors this time of year.

Along with my decreased speed, urgency has increased. When I roll out of bed and stand up in the morning, urgency is instant. So far, I've been making it down the hall, although there usually isn't time for pants or a robe. Ultimately, these issues will result in my coming out to Mrs. Maxx about diapers. While it might have been mostly a kink years ago, now it's becoming a matter of practicality.
 
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bobbilly

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SpAzpieSweeTot said:
Post pee dribble is already not a good sign. You're already dribbling on the floor? I'd say your muscles have already changed.

I make it to the toilet, more often than I don't. That doesn't make me continent. It makes me just as IC as ever, and lucky, or possibly dehydrated and constipated enough to please everybody but myself.
I have been dribbling every time I have a poo, for some years now.
 

sport1

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SpAzpieSweeTot said:
Post pee dribble is already not a good sign. You're already dribbling on the floor? I'd say your muscles have already changed.

I make it to the toilet, more often than I don't. That doesn't make me continent. It makes me just as IC as ever, and lucky, or possibly dehydrated and constipated enough to please everybody but myself.
I agree with you make it sometimes but that doesn't make me continent far from it.
 

SpAzpieSweeTot

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MaxxH said:
The two opening anecdotes in the article strike me as adult children in denial about their parents' decline, perhaps fearing they will be ultimately saddled with caregiving. I've been there, done that. I didn't realize Dad had lost it until I got a very panicky phone call from him "Your sister Maxxine is now in charge of everything". He had either forgotten his computer login, or been locked out by a scammer. There was no way to pay bills or even know what they all were. Oh... in the process he lost several thousand dollars to a phone scammer offering to "clean up his computer". He had always been a very smart guy, maybe a little too impressed with his own abilities. He would ask my advice off and on about computer stuff, but apparently ignored or forgot everything I told him. My sister thinks he had a couple of mini-strokes that took out some chunks of memory. In any case, Maxxine and I had a fun few months, first teaching her how to use a computer, and then tracking down accounts and passwords so the household could keep functioning. Physical decline wasn't far behind. Dad passed within a year.

I suspect these critics of diaper use haven't spent much time up close and personal with old people needing full time supervision, whether in or out of a facility. There may be a few bright minds in deteriorating bodies, but more often than not there are mental as well as physical issues involved that put them in a facility. Wandering off, random calls to police, etc. Senility/dementia play a role. Aside from the physical challenge involved in getting to a toilet, they may occasionally forget that toilets are a thing. Wetting or messing can also be attention-getting behavior, a kind of power trip if you will. Some of these folks are more like toddlers, or even infants, than adults. Over and above staffing and training issues, it's a matter of practicality.

I saw the "poor little me" power trip behavior decades ago when my grandma spent her last couple years living with my parents. Now I'm seeing it with my mother. Even on the occasional good day when she remembers what a toilet is, getting her to the toilet is enough of a project that success rate isn't great. On the bad days when she doesn't want to, or forgets how to cooperate, it ain't gonna happen.

I'm getting a preview of this myself. I like long walks. Recently, they removed the porta-potties along my preferred route. Making the 5 mile loop instantly become extremely uncomfortable to impossible without a diaper. 20 years ago, not a problem. I could cover 5 miles in a half hour if I had to. Now, it's more like 2 hours as old injuries and age have caught up with me. I still have cycling, although it's mostly indoors this time of year.

Along with my decreased speed, urgency has increased. When I roll out of bed and stand up in the morning, urgency is instant. So far, I've been making it down the hall, although there usually isn't time for pants or a robe. Ultimately, these issues will result in my coming out to Mrs. Maxx about diapers. While it might have been mostly a kink years ago, now it's becoming a matter of practicality.
I have days like that. My bladder is it's most calm when I'm sleeping, or lying flat. The movement required to go from lying, to sitting on the side of my bed, and from there, to my new wheelchair, who's beautiful, and named Penny, is just, "Cuss words and pain," bad.

As soon as I get away from people who will judge, if I feel nauseated, I'm wearing, no f%$ks given. If I feel weak, I'm wearing, no f%$ks given. If I'm on my period, I'm not playing 'Name That Body Fluid: The Home Game," either!

On planes, trains, or long distance busses, with tiny bathrooms, that move, my crippled butt (Since it's me I'm talking of, I can say it.) ain't going near them. I could fall. Nope.

Waiting in line, too. These are all times I'd leak, or be in monsterous pain from trying not to, anyway. I don't want to give up toilet skills, and weaken my muscles, but I don't want to damage anything, just from trying to please Normies, either.
 
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ParaRomeo

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So this isn't just limited to the UK it happens in the US and going to assume other countries as well. I do think some terms might be getting lost I think when they mentioned using pads it's not incont pads and there using diapers or nappies but like the US where many in healthcare refer to them as Briefs , Depends, Attends I wonder if it's there polite version.

So the I can speak for what I know but in the US unless it's deem necessary usually a Foley is removed asap due to catheter assoc uti(cauti) & in the US if a hospital causes an infection they can be liable for the hospital bill(when they were stabilizing my spine I got a couple infections and insurance wasn't billed). But do understand why they are more opt to using for females as there is really no other options besides devices like something wick it uses suction tubing and suction and its place near their ureatha to basically suck up fluids. Where with men worse case they can use a urinal or condom cath but beside suction or a bedpan there isn't any other options for females besides absorbent products or compared to males. Like I said unless medical necessity usually caths come out before a person is transfered out of the hospital.

I will say diapers getting used even in the US usually happens more in secondary settings or after they leave the hospital and it's done for a few reasons besides lazy staff some even more so now are short staffed and often when someone is referred to say a nursing home or rehab from a hospital they have something else going on and because of staffing issues the logic is put a diaper on them Incase they can't assist the person to the bathroom so it prevents falls or potential of them more so if person has mobility issues. Over time many become diaper dependent and why I mentioned laziness though it does happen most aids/cna's are overworked & hardworking but their patient to aid ratio is usually higher than nurse to patient ratio and cna's/aids can change a diaper/nappy usually quickly it's like a pitcrew changing tires, but the laziness/convince part comes from it's quicker to change a diaper than it is to help them to the toilet wait for them then help them back to bed which can take away from them caring for others. I can say from personal experience though I am incont and paralyzed so in diapers already and usually handle my own care I have had many times more so in nursing homes and rehabs where they need to do it to because of potential skin issues, but even when I offer to help most insist on doing it won't lie they are alot quicker than me but I have had it happen in the hospital as well but in the hospital usually they will let a patient do it they actually prefer it if they can but occasionally to do skin assessments they will do random changes, and if you have a rash or anything there are times they will take over because of the liability. I don't know how it is in other countries but in the US families can sue if a person isn't changed properly or if they get a UTI but each facility is different.
 

mickdl

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sbmccue said:
Having lived in London, I have to say that such an outcome is typical for the NHS. The overstretched staff are not to blame; the administrators who actually outnumber the staff are the problem. As is common in Britain, it's always easier for someone to write a report than to deal with the problem. As much as I think universal healthcare coverage is a necessity in the United States, universal care is a slippery slope. The decline of the NHS in the past 50 years is proof of the point.

Yup… It‘s a running gag in Germany, if people saying our health system goes the Enlish way…
 

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It's all about bureaucracy and lawyers. If you call the nurse for toilet help but they're busy and you can't hold it then it's there fault. With diapers nurses can have a target change time, and asking someone to change your diaper is already uncomfortable so you're less likely to complain because if you complain you'll feel bad.
 
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ParaRomeo

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I have always wondered if there was money involved, what I mean is that when shady things are done at times money is involved in some way. Like in the US can a facility charge more because a pt needs "extra care" and the supplies needed need to be paid somehow. I think UK even though healthcare is different and like diapers are provided by govt but do wonder if a facility can also get something from the govt. No matter the country it's potentially a way to show need for more money & staffing even though most are short staff but know in the states alot of elderly storage facility and even rehabs are owned by groups or ones that have multiple facilities, even if not they must do a budget yearly
 
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