The Candid Caregiver often receives questions from readers wondering about incontinence issues. Among them: How to console their older adult who is facing incontinence; how to convince their elder that wearing protection is far better than smelling of urine; or how to pay for the products once they are in use. Feeling the need for an expert in this area, I contacted Mica Phillips, director of urology for the durable medical equipment provider AeroFlow. Our email conversation has been lightly edited for length and flow.
The Candid Caregiver: Mica, could you tell us about the most common conditions that cause incontinence in older adults?
Mica Phillips: The three most common types of incontinence affecting older adults include:
Urge incontinence — the most common type. This involves the involuntary loss of urine after a sudden, urgent need to urinate strikes. Common causes include injuries, strokes, nerve damage, Parkinson’s, dementia, or Alzheimer’s. Contributing conditions also include constipation, prostate enlargement (in men), and pelvic floor atrophy in women.
Stress incontinence occurs when increased abdominal pressure overpowers the bladder, leading to involuntary leakage. As the bladder muscles weaken with age, activities such as laughing, lifting a heavy object, or even getting out of bed or a chair can cause leaks. This is more common in women due to childbirth and decreased estrogen levels after menopause. In men, prostate conditions such as enlargement, surgery, or cancer treatments may contribute.
Functional incontinence occurs when a patient feels the need to urinate, but can’t make it to the bathroom in time due to a mental or physical disability. Contributing factors involve conditions such as arthritis that make it difficult to unzip their pants in time or hip injuries that reduce mobility. Other causes include Alzheimer’s, multiple sclerosis, and neurological disorders.
TCC: Do you see more reluctance to talk about the issue with men or women or does gender not matter — everyone is embarrassed?
MP: Incontinence is much more common in women, so it’s understandable to think that they’re more reluctant to talk about it than men. However, incontinence can be much more shocking and embarrassing for men just because it is less common. Childbirth and menopause can cause stress incontinence in women, so women most likely already know about bladder pads and other discrete products. Men often don’t know where to start, and the stress and embarrassment brought on due to the sensitive nature of this condition can be overwhelming.
TCC: As an eldercare columnist, I hear from caregivers about the reluctance of older adults to face up to their problem and actually accept wearing protection. Can your staff counsel caregivers on how to convince a parent or spouse that it’s more dignified to wear protection than to smell like urine?
MP: If people discuss the topic of possible incontinence issues happening with age, and do so openly, it helps to normalize incontinence. This can break down barriers, allowing parents to feel comfortable asking their adult children for help.
Protection basically comes down to the need for comfort and sanitation. Sitting in wet undergarments can lead to embarrassing odor, dermatitis, and other skin integrity issues and breakdowns. By not managing incontinence, the situation could get much worse, leading to hospital readmissions and other complications.
If the caregiver tells the older adult about new moisture-wicking products, such as adult briefs and protective underwear, and how they can help the people stay clean and dry, the idea that others needn’t know about their condition can sink in. Stress that incontinence products have also been greatly improved with newer materials. Patients no longer have to wear loud, bulky undergarments. Now, there are adult pull-ups that look like regular underwear to help discreetly manage the condition.
TCC: You state that AeroFlow helps people understand how to go about finding insurance coverage for their products so that this expense isn’t crippling their monthly income. How is this done?
MP: Insurance can be incredibly confusing to navigate and those with incontinence already have enough on their plate. That’s why we do the work for them by determining their coverage options. Medicare does not cover incontinence products, and most private insurance companies do not cover them either, but many lower-income seniors have Medicaid as a secondary plan. Medicaid will often cover up to 200 incontinence supplies a month. This allows patients on a fixed income to, hopefully, eliminate the expense of incontinence products from their monthly spending, while maintaining their dignity and quality of life. We can help them set up their coverage.