Rachel Read MS, OTR/L, BCG, CAPS: Knowing the facts behind it, knowing that it is very prevalent in the older adult population, it has a huge impact on functional wellness and wellness in general.
Dr. Jimmy Mckay PT, DPT: This is FOXcastOT. A podcast for clinicians made by clinicians. It’s brought to you by FOX Rehabilitation. Find out more at foxrehab.org.
Dr. Jimmy Mckay PT, DPT: Welcoming back to the show on FOXCastOT is one of my colleagues here at FOX Rehabilitation, Rachel Read. Rachel, welcome back.
Rachel Read MS, OTR/L, BCG, CAPS: Hey Jimmy thanks for having me back.
Dr. Jimmy Mckay PT, DPT: What are we talking about today what are we getting into on the program?
Rachel Read MS, OTR/L, BCG, CAPS: So one of the areas that I’m…
Rachel Read MS, OTR/L, BCG, CAPS: Knowing the facts behind it, knowing that it is very prevalent in the older adult population, it has a huge impact on functional wellness and wellness in general.
Dr. Jimmy Mckay PT, DPT: This is FOXcastOT. A podcast for clinicians made by clinicians. It’s brought to you by FOX Rehabilitation. Find out more at foxrehab.org.
Dr. Jimmy Mckay PT, DPT: Welcoming back to the show on FOXCastOT is one of my colleagues here at FOX Rehabilitation, Rachel Read. Rachel, welcome back.
Rachel Read MS, OTR/L, BCG, CAPS: Hey Jimmy thanks for having me back.
Dr. Jimmy Mckay PT, DPT: What are we talking about today what are we getting into on the program?
Rachel Read MS, OTR/L, BCG, CAPS: So one of the areas that I’m pretty passionate about is urinary incontinence and discussing it with the older adult population because a lot of people don’t talk about it.
Dr. Jimmy Mckay PT, DPT: Right. It hasn’t been brought up on the show and I’m glad you bring it up so the older adult called clinicians out there know how to be getting that conversation is probably one of the most difficult steps. How do you broach the subject?
Rachel Read MS, OTR/L, BCG, CAPS: Usually I just put it as part of my evaluation. And so when I’m having a discussion about an area that may be uncomfortable for an older adult I just usually will let them know that I’m going to ask you some questions about incontinence because it’s a common issue for the older adult population. I ask this on all my evaluations. So it’s not to make them feel like they are the exception and that it maybe is kind of the norm. I do the same with dementia. So when I’m screening for dementia sometimes I don’t want to make them feel uncomfortable. And so I say I ask everyone these questions I’m not insinuating that you have a cognitive issue and I do the same for incontinence as well.
Dr. Jimmy Mckay PT, DPT: That’s smart. Yeah make it part of standard operating procedure. So number one you get to ask those important questions to every single one of your clients. But also I bet you it gets a little easier to talk about when you talk about it so much since you made it part of your standard operating procedure.
Rachel Read MS, OTR/L, BCG, CAPS: Yeah definitely. And I think it’s an area that a lot of OTs and a lot of just therapists in general don’t assess. And my biggest thing when I’m training new clinicians is to just have that conversation and make it part of a conversation you have on all your evaluations so you get in the habit of asking that question because it is such an under assessed area for the older adults.
Dr. Jimmy Mckay PT, DPT: I love how you just you’re confident about it. I was taught in school bringing up a situation like urinary incontinence. It’s weird if you as the clinician make it weird. So as long as you don’t you’re fine.
Rachel Read MS, OTR/L, BCG, CAPS: Right.
Dr. Jimmy Mckay PT, DPT: So what’s good to some takeaway points where we want to go first?
Rachel Read MS, OTR/L, BCG, CAPS: One I talked about are ready just making it part of your standard evaluation, and then just kind of knowing the facts behind it knowing that it is very prevalent in the older adult population. It has a huge impact on functional wellness and wellness in general. Urinary incontinence can really impact a person’s physical, psychosocial, and their behaviors as well. It’s an area that again it is a sensitive subject but you need to have that conversation because it can impact them. A lot of times I find that my older adults they will not go out in the community, they don’t want to go out to church or the supermarket, because they don’t want to have that stigma of maybe I have an odor or I’m going to have an accident, and it’s embarrassing. When you eliminate that and kick out that social component you’re going to run into depression and some other issues along with it. So it really just impacts such functional areas as well.
Dr. Jimmy Mckay PT, DPT: That’s big that’s a big part of someone’s life if you take away that social function. That that would be a reason for people to possibly withdraw. So glad you address it.
Rachel Read MS, OTR/L, BCG, CAPS: Yeah. Another area that I like to discuss with the impact of incontinence is just falls. A lot of times if you have urged incontinence and you’re trying to rush in to get to the bathroom or the toilet you are more likely to fall because you’re not being careful when you’re going to the bathroom, or you’re so focused in on not having an accident that you trip or you lose your balance. Another area is just the impact that continence has on older adults as far as the medical condition. So you can have a U.T.I. You can go into acute or chronic renal failure. You know you can have skin breakdown from sitting in protective undergarments. A lot of people don’t add them all up as to how they are impacting the older adults.
Dr. Jimmy Mckay PT, DPT: Glad you bring that up again you know this is a part of someone’s function and you’re paying attention to the entire individual, the entire human being. And this matters. These things these types of things matter. And that’s where I see therapists come in as we’re able to have these conversations that maybe others avoid because because of how big of a deal it is.
Rachel Read MS, OTR/L, BCG, CAPS: What can an OT do? So there are a lot of behavior interventions. And really the medical guidelines advise that you use behavior interventions before pharmacological interventions or surgical interventions and before you’re using you know protective undergarments or pads to prevent them. Just because of the infection risk that are associated with them. And so behavioral interventions can be really quite simple interventions to use, such as: issuing a toileting schedule or avoiding, assessing what they’re eating and what they’re drinking. What are their behaviors and habits what are they doing during the day? Other ones could be just you know working on their ADL’s, addressing physical limitations such as you know they just don’t have the strength to be able to squat and get onto and off of the toilet. So maybe they’re not going to the bathroom and they’re having accidents because they just can’t transfer on and off the toilet or get to the bathroom. So a lot of those are just behavioral interventions that we can address and as OTs are within our scope of practice as well to address. I think a lot of OTs kind of get not so confident in their skills for addressing incontinence because they think maybe I have to do some internal exams or maybe I have to do some weights some internal weights and that is just not what you really need to do in the older population. Most of the time it’s functional incontinence. It’s not a medical reason for their incontinence. It’s just that they maybe can’t take off their pants or they have dementia and they just can’t find the bathroom so they’re just kind of wandering and then having accidents. So it really is kind of again you have to look at them holistically and determine what it is. Because like I said a lot of times it’s functional incontinence and not you know a medical diagnosis of the stress or urge or mixed incontinence.
Dr. Jimmy Mckay PT, DPT: Yeah I love how you go with least invasive to then progressing and really just searching for that why. Because there are as you listed many reasons why this would be taking place and you’re looking for that why for that individual that client sitting right across from you and when you dress that why, the issue goes away. Anything else you want to add about urinary incontinence.
Rachel Read MS, OTR/L, BCG, CAPS: I guess my final thought is just making it part of your plan of care and your evaluation once you start getting comfortable with having that conversation it’s going to become second nature to you and it’s going to be just like your assessing name on any other. You know if you’re doing a balance screen or you’re doing a strenth screen you know recommend making it part of your evaluation. Getting comfortable with it. There’s a tons of resources that you can find interventions the effectiveness of the interventions on various platforms. Medbridge has a lot of educational components and C.U. courses on incontinence that I have taken all of those courses and actually have had discussions with Cindy Nebel who is the person who created the ones on Medbridge. So I would say just find your resources and if you’re not comfortable talk to somebody.
Dr. Jimmy Mckay PT, DPT: Love that. Every episode we have FOXtail Rachel you’re familiar with this because you bauma show before.
Rachel Read MS, OTR/L, BCG, CAPS: Yeah.
Dr. Jimmy Mckay PT, DPT: Can you think back to a situation where you actually brought up the issue of your U.I. and had some real success out of it in changing an individual’s life?
Rachel Read MS, OTR/L, BCG, CAPS: Yeah absolutely. Within like the first two years of me being an OT at FOX I was working in a senior living community and we were noticing me and the lead therapist there was an OT as well, and incontinence was really kind of impacting everybody on the memory care unit and the staff was stressed out. The clients were really falling, having functional declines, and we kind of correlated it all back to functional incontinence that they were having because they were just you know memory care unit in a lot of people had a diagnosis of dementia and we actually piloted a program within the memory care unit screened people send out referrals, requests for orders to the physicians to say hey you know incontinence is an issue. It’s causing this business for your clients. We would like to see them for OT services to see what we can do. And we made such a huge impact on that memory care unit and they started instituting voiding LODs and toileting schedule for the clients and we did tons of caregiver education, and it was a huge success and it kind of was what brought me to being so passionate about this area because I lived through this and it was a program that we kind of developed. It’s where all of my understanding of this passion for it came from.
Dr. Jimmy Mckay PT, DPT: Love that. Rachel Reid occupational therapist here with us at FOX Rehabilitation. Appreciate your time talking about an area that we need to talk about more, urinary incontinence here on the program.
Rachel Read MS, OTR/L, BCG, CAPS: Thank you.
Dr. Jimmy Mckay PT, DPT: Thanks for listening to FOXcastOT, a clinically excellent podcast. It is brought to you by FOX Rehabilitation.
Dr. Jimmy Mckay PT, DPT: FOX clinicians work hard, love their work, and get the respect they deserve. Sound good? Then you’ll love the autonomy to work in your own style and the support you get to achieve excellence plus freedom and flexibility to have a personal life, whether it’s your first day or you’ve been around for a while. Your contribution is acknowledged and rewarded. That’s what makes FOX a success. Happy, well-trained clinicians make great health care. Are you a fit for FOX? Find out now at foxrehab.org.
