Continence Coach: Our Collective Responsibility to an Aging Society

     Increasing longevity is exerting a major impact on every sector of our economic and social structure, including healthcare. Modern technology and advanced pharmaceuticals render Americans less vulnerable to mortality from infections and other forms of disease that in earlier decades led to imminent death.¹ As a consequence, half of all Americans today are living with one or more chronic condition or illness such as heart disease, osteoarthritis, and chronic pulmonary conditions.²

     This puts an enormous financial strain on health services in the US; increasingly higher numbers of patients with multiple, often complex, chronic illnesses require care. More than 75% of healthcare spending now is devoted to medical costs to treat chronic illness across numerous healthcare delivery settings.^3,4 Although the recent increase in the incidence of diabetes, obesity, and hypertension could dampen or reverse the trend toward increased life expectancy,⁵ the US Census Bureau6 still projects that, barring any unforeseen breakthrough in science and technology to lengthen life, by 2050 people will live into their mid-80s (up from 77.85 years in 2006) and not long after into their early-90s.

     In near panic effort to “fix” Medicare to contain healthcare spending for persons 65 years and older, we as a nation have yet to adequately address one of the fundamental, underlying needs — namely, educating all healthcare providers who care for the elderly. I concur with Rosanne M. Leipzig, MD,⁷ a professor at Mount Sinai School of Medicine, who maintains that “basic geriatric knowledge is preventive medicine.” She openly advocates that nurses, social workers, pharmacists, and other healthcare professionals working with physicians should have [the knowledge] to improve care for older people.

     What are the implications of this assertion — ie, what is basic geriatric knowledge? Claire Fagin, PhD, former Dean of the School of Nursing at the University of Pennsylvania and Scholar in Residence at the Institute of Medicine, National Academy of Sciences, asserts, “No matter what area you decide to specialize in, geriatric nursing is bound to be part of your professional future. Older adults are the core business of healthcare in this country today, representing the majority of primary healthcare visits, hospital admissions, and long term care residents.”

     How many nurses — already highly skilled in caring for chronic wounds, fragile skin, and ostomies — have secured professional training and advanced education in primary care of older adults? How many know that confusion in octogenarians can be due to bladder infections as easily as to heart attacks or allergy medication?⁸ How many think about continence care as primary care or at least about the primary care components of continence care?

     If you have experienced such gaps in your own knowledge base or fear gaps exist in the educational bank of others in the geriatric work environment, become a loud and resounding voice for relevant instruction, required certification with licensing, and continuing education. Until all clinicians receive this basic training, we can’t deliver the safe, dependable, comprehensive care 75-year-olds need and deserve. Plus, without knowledge, we will never break the soaring spiral of healthcare costs, regardless of whether life spans reach 80, 85, or 95 years and beyond. What you don’t know can hurt you… and the health of your elderly patients.

The National Association For Continence is a national, private, non-profit organization dedicated to improving the quality of life of people with incontinence. The NAFC’s purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence.

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

1. Partnership for Solutions. Chronic conditions: public perceptions about health care access and services. Available at: www.partnershipforsolutions.org/DMC/files/polling_final.pdf. Accessed August 4, 2009.

2. Wu S, Green A. Projection of chronic illness prevalence and cost inflation. Prepared for Partnership for Solutions by the Rand Corporation. Baltimore, MD: The Johns Hopkins University;2000.

3. Anderson G, Horvath J. The growing burden of chronic disease in America. Public Health Reports of the Bloomberg School of Public Health at The Johns Hopkins University. 2004;119:263–269.

4. Berenson RA, Horvath J. Confronting the barriers to chronic care management in Medicare. Health Affairs Web Exclusive. Available at: www.content. healthaffairs.org/cgi/content/full/hlthaff.w3.37vl/DC1.

5. Manton KG, Stallard E, Tolley HD. Limits to human life expectancy: evidence, prospects, and implications. Population Develop Rev. 1991;17(4):603–637.

6. US Census Bureau. Facts for Features: Special Edition – Oldest Baby Boomers Turn 60! Available at: www.census.gov/Press-Release/www/releases/archives/fact_for_features_special_editions/006105.html. Accessed January 31, 2009.

7. Leipzig RM. The patients doctors don’t know. The New York Times. Available at: www.nytimes.com/2009/07/02/opinion/02leipzig.html. Accessed July 2, 2009.

8. Fagin C, Franklin P. Geriatric nursing. Available at: www.nsna.org/pubs/imprint/septoct05/sept-oct-05_geriatric_fagin.pdf. Accessed July 14, 2009.