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Solutions to Common Senior Issues

Friday December 19, 2003

Jean F. Wyman, Ph.D., RN, FAAN

12/18/03(The Pilot-Independent) - Two issues facing people as they age are tough to talk about but easy to solve with a little bit of perseverance: falling and incontinence. Each year, at least one-third of adults 65 and older will fall, and the number rises with advancing age. But there is much that seniors, their families, and friends can do to help prevent such accidents, which can lead to broken bones and a loss of independence.

Many falls are caused by balance instability, muscle weakness and gait abnormalities. The best way for people to improve their balance and strength is through exercise. Studies done at the University of Minnesota School of Nursing and elsewhere have shown that walking and practicing tai chi chuan, a Chinese martial art, can vastly improve balance, which reduces the chance of falling.

Another way to prevent falling is to modify your home environment. Remove throw rugs and other tripping hazards, use nightlights and install railings on both sides of stairwells and grab bars in the bathroom.

Improper footwear can also cause problems. Non-slip soles on slippers really can help keep someone from falling. Additionally, being on a number of medications can contribute to unsteadiness on the feet. Seniors should tell their primary care provider about all of the medications they take, including over-the-counter drugs, so clinicians can ensure patients they are on the right dosages and medications.

Another issue that many seniors, especially women, face as they age is the loss of bladder control. It’s a common problem affecting women of all ages, but the prevalence of urinary incontinence rises as women get older.

Damage to the pelvic floor muscles during vaginal childbirth is a key cause of urinary incontinence. Other causes include estrogen depletion associated with menopause and diseases such as stroke, diabetes and Parkinson’s disease.

People need to know that incontinence is not a condition they must just accept. There are many options to address incontinence, including exercises, behavioral therapies, lifestyle changes, drugs and surgery. First and foremost, incontinence is something that people need to bring up with their health care provider, even if it is an embarrassing topic. They may need to see a specialist, such as a uro-gynecologist, a urologist or a continence nurse specialist.

Providers can help patients weigh their options for treatment. Studies at the School of Nursing have shown that bladder training and doing exercises that strengthen the pelvic floor muscles can help lessen the effects of incontinence once it’s started. It’s also important to maintain a healthy weight and to quit or never start smoking.

There are several new drugs on the market for incontinence associated with an overactive bladder. It’s always better to try a behavioral therapy first; drugs only treat the symptoms, they don’t cure the problem. Finally, there are surgical options as well. However, without using exercise and other behavioral therapies to accompany the surgery, many patients end up back where they started several years later — incontinent and frustrated.

Remember, incontinence is not a problem older people just need to live with.

Jean F. Wyman is a professor of nursing and a professor of medicine in the department of family practice and community health. She holds the Cora Meidl Siehl chair in nursing research at the University of Minnesota and directs the Center for Gerontological Nursing. This column is an educational service and advice presented should not take the place of examination by a health-care professional.