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Facilities who have implemented the BladderScan® as part of a comprehensive incontinence management program have found that it profoundly improves quality of life for both residents and staff. |
Bladder disfunction and incontinence are common occurrences in elderly patients. Residual urine in elderly patients can be seen to be of major significance in its association with voiding disfunction, incontinence and the aetiology of urinary tract infection. Through the use of BladderScan® diagnostic catheterisation is not necessary and so the patient can avoid the physical and emotional trauma associated with urethral catheterisation. BladderScan® is a key tool for allowing users to evaluate bladder function without invasive and repeated catheterisations. BladderScan® will improve the quality of life for patients in the elderly care setting and provides a beneficial, inexpensive, non-invasive method for diagnosing urinary incontinence in elderly patients.
Indications for the use of the BladderScan® within Geriatrics are:
Benefits for the user of BaldderScan® include:
Bladder Dysfunction in The Elderly
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The sample size of this study was 16 patients from either Geriatric rehabilitation or acute rehabilitation units. It shows that 8 patients were catheterised and 8 patients received BladderScan® assessments. (5 of which were unable to void naturally). BladderScan® facilitated bladder retraining by allowing the nurses to evaluate bladder function without invasive and repeated catherisations. In addition, 8 out of 16 patients had UTI's at the time of admission. However at the time of discharge, only 2 patients were still being treated for UTI.
This paper uses a sample of 948 Geriatric patients with urinary incontinence. It shows that of the 948 patients, 56.4% suffered with urge incontinence. 29.9% had bladder instability 18.6% had outlet obstruction. 14% suffered with stress incontinence. The conclusion to the study demonstrates that by using a portable ultrasound scanner on every ward will certainly improve the quality of life for the patient and provides a beneficial, inexpensive, non-invasive method for diagnosing urinary incontinence in elderly patients.
Results: The ultrasound demonstrated excellent test-retest and interrater reliability. For low PVRs, the device was highly sensitive (.90 for PVR<50 ml and .95 for PVR<100 ml). For PVRs of more than 200 ml. (n = 26), the ultrasound had a sensitivity of .69 and a specificity of .99. Conclusion. The portable ultrasound we used was reliable and reasonable accurate for assessing PVR in a representative sample of incontinent NH residents. Discussion: Ultrasonic measurement of PVR volume is being used increasingly in the office practice of urology, inpatient rehabilitation units, and in acute hospitals.
A study of 33 patients showed that 10 were admitted with urinary retention. Determination of bladder volume was performed with a BladderScan® BVI 3000 portable ultrasonographic device. Retention was resolved for 7 of these patients by the time they were discharged. The portable ultrasonographic device is a simple and non-invasive tool, useful for diagnosis, follow up and therapy guidance of urinary retention after stroke.
The BladderScan® provides conservative and reliable estimates of PVR prevalent among 10% of frail elderly persons. Intermittent catheterisation and alpha blocking medication may quickly resolve UR in almost 70% of affected patients.
Urinary incontinence (UI) is a prevalent and costly problem in nursing homes. Staff education remains an ongoing issue, as caregivers must be aware of attitudes and beliefs about the aging process and its impact on the genitourinary system in order to provide effective care. Under the Prospective Payment System, nursing homes need to change business as usual and remain abreast of new innovations and research in different behavioral interventions and continence technology.
Urinary and fecal incontinence are prevalent, disruptive and expensive health problems in the nursing home population. Nursing home residents who are incontinent of urine shoud have a basis diagnostic assessment including a determination of postvoid residual urine volume done by catherization or ultrasonography.
Incontinence is considered a negative outcome, and the Omnibus Budger Reconciliation Act of 1987 (OBRA '87) states that the maintenance of as much normal function as possible is the responsibility of the nursing home. Nursing homes are now required to demonstrate that any deterioration in a resident's activities of daily living, such as toileting, are clinically unavoidable. Therefore, activitites to promote and protect continence, interventions to effectively treat incontinence, and documentation of these activities and interventions have assumed even greater prominence.
Of the 309 patients, 244 (79%) had readings of post-void residual volume taken on admission: 90/244 (37%) had retention pre-operatively, 122/216 (56% post-operatively and 40/183 (22%) in the recovery phase. One year after operation 305 patients were traced and median follow-up was 2 years. Older age, cognitive impairment, polypharmacy, impaired mobility and urinary retention on admission and during recovery were associated with a higher fatality in the first post-operative year. Pre-operative urinary retention is common among older women with proximal femoral fracture and affects over half post-operatively. Retention is one of several factors associated with higher fatality.
Incontinence in the elderly population ranges from 8% to 51% overall and from 15% to 30% for community-dwelling persons. Tests that assist in delineating urinary incontinence include postvoid residual (PVR) volume by catherization or pelvic volume by catheterisation of pelvic ultrasonography and stress testing. Bladder ultrasonography can noninvasively detect urine volumes of greater than 100 ml with a sensitivity of 77% to 90% and a specificity of 81%.2. It can be a valuable adjunct to the basic screening methods already mentioned. The potential advantages of bladder ultrasonography over catheterisation are (1) little practice is needed for correct operation, (2) calculations are not required, (3) it is a noninvasive technique, eliminating risk of infection, and (4) the patient is not subjected to an uncomfortable procedure.
Prevalence of incontinence was 73% (n=133). 5% (n=10) used catheterisation. 22% (n=40) was continent. 133 patients had PRUV >50 ml (mean 99ml, max 638 ml). The prevalence of PRUV was high to patients with LUTS, but no significance was shown.
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