From the Editor: Pop pops, Pee, and Quality of Life

I view aging through the eyes of my 85-year-old dad. He lives completely independently and is in relatively good health.   He has type 2 diabetes (not surprising, owing to his penchant for carbs and disinclination to exercise), high blood pressure, and high cholesterol (all fairly well controlled); a history positive for prostate cancer (irradiated into remission); a nonsymptomatic benign pituitary adenoma discovered inadvertently and checked every 2 years; and some gait issues for which he receives physical therapy. He has a lovely lady friend he met after my mom died. He is an active participant in all family events (and there are a lot of them, with 5 great-grandchildren). In short, he has a wonderful quality of life he and all of us who love him are eager to preserve.

Not long ago, he confided in me he had been having some “accidents,” mostly because his body gives him short warning on the urge to urinate but doesn’t give him the speed, strength, and balance necessary to promptly answer the call. What did I think about his using something like Depends? He assured me he didn’t intend to rely on any products for anything other than Just In Case. I told him I admired his willingness to address the problem, just as I applauded him when he (on his own) gave up driving when he lost his confidence in his ability to handle his car. My concern that maybe he would get a little remiss about potty breaks has proven unfounded, and his having this little bit of extra assistance has allowed him to continue his neighborhood walks and family visits without fear of embarrassment.

 Although a great deal of the literature and some fairly recent F Tags (2006) discourage the use of incontinence protection in continent adults, I’m here to encourage caregivers and policymakers to consider the whole picture when sculpting and implementing protocols. What is more conducive to maintaining patient dignity: 1) providing adult continence products or 2) setting up a scenario in which a person, whose mobility and neurological or cognitive issues thwart the agility to make it to a bathroom in a timely manner, needs to curtail activity or worse, fester in his/her urine or feces?

F Tag language addresses assessment, implementing an appropriate individualized intervention, monitoring the intervention for effectiveness, and modifying the intervention as needed. Nowhere does it mention “laziness,” either on the part of the provider or the patient, or age, or, come to think of it, the patient’s wants and needs. Adult diapers or Texas (external) catheters should only be viewed as the easy way out when an able patient is not helped to maintain continence, not when they are used as continence aids to alleviate the stress of worrying, Will I get to the toilet in time? Such worry affects fluid intake (my dad often comments he is afraid to drink too much because it just makes him have to go more) and fall risk (trying to move too quickly on unsteady legs).

The key part of the F Tag (now in practice for 8 years; feedback desired) is “individualized” intervention. Clinicians should remember to qualify “individualized” with patient input. My dad’s primary care physician (his most regular health care contact, the professional he most respects, and incidentally, a “Top Doc” in our city) should have initiated a conversation, listened to my dad’s concerns, and provided the option of protective continence gear; such advice from his doctor (particularly, because his generation tends to revere their physicians) would have eased his mind and perhaps avoided a somewhat off-putting (his) chat with his daughter.

I accept the fact that continence is not the same caliber issue as a physician being aware of a patient’s driving incompetence but not notifying the state department of transportation (as is the mandate in Pennsylvania and other states) about pulling the person’s license. In many cases, physicians leave it to family members to be the bad guys and take away car keys to keep loved ones and the rest of the driving public safe (that’s a father-in-law tale for another day). But similarly, when the clinician did not take action, it became our family’s responsibility to protect my father’s dignity and safety (lest in his urgency, he’d fall and possibly break a hip). Thankfully in my dad’s case (my dad being my dad), we were the good guys, praising him for being proactive about his intimate habits, giving him the response he was reluctant but relieved (no pun intended) to hear. He sometimes makes offhand remarks about being like his diapered great-grandchildren, but we sidestep his dismay about the problems of getting older by putting a baby in his lap to remind of the joys he has lived to see.

The point is while incontinence is said not to be (but in practice frequently is) an age-related issue, providers should be prepared and willing to have the conversation and champion use of any device or product that maintains and/or improves quality of life. Bifocals, hearing aids, canes, and continence aids should not be promoted as signs of the limitations and challenges of aging. They are badges of honor, extending human potential and pleasure for as long as possible.

This article was not subject to the Ostomy Wound Management peer-review process.