urinary incontinence and fall risk

The Facts

Up to 60 percent of hospital patients and nursing home residents experience urinary incontinence.
Incontinence is associated with increased the risk of patient falls (in other words, up to 50 percent of falls are elimination-related).
Urinary incontinence is an important risk factor for recurrent falls and hip fracture.

Urinary incontinence can contribute to fall risk in several ways:

Incontinence episodes may lead to slips on wet floor surfaces.
Urge incontinence (involuntary leakage accompanied by or immediately preceded by urgency) may increase risk when a patient hurries to the toilet to avoid wetting themselves.
Incontinence can lead to episodes of dizziness (micturition syncope, for example).
Episodes of incontinence may be transitory (transient incontinence is present in up to 50 percent of patients) and often related to acute illness, such as urinary tract infections that can cause incontinence, delirium, drowsiness and hypotension.
Medications used to treat incontinence, such as anticholinergics or alpha blockers, can cause postural hypotension. z
Nocturia (waking at night to void) can result in poor sleep, which is associated with increased fall risk.

Reduced mobility and balance -- impaired ambulation and balance make it difficult to reach the toilet and thereby increase the risk.
Reduced dexterity (in manipulating undergarments, etc.)
Need for toileting assistance and impaired cognition (in other words, performing a secondary task, such as walking and concentrating on getting to the toilet, may be difficult).
Need to use a walker -- urinary incontinence is a significant risk factor for those who can't stand without support.
Increased episodes of nighttime incontinence.
Urinary frequency and toileting - the combination of urinary frequency and the need for frequent assistance with toileting is much more of a fall risk factor than incontinence by itself.

Identify and treat the cause of incontinence, including medication side effects. Patients may have more than one type of urinary incontinence. The goal of treating urinary incontinence is to improve the continence status of the patient by modifying those factors causing incontinence.
Identify and address co-morbid fall risk factors (gait and balance, transfer ability, reduced dexterity, etc.) which can have an impact upon toileting.
Respond to toileting requests promptly, especially if the patient requires assistance to get to the toilet. Ensure that patients with impaired mobility can reach/use the nurse call bell; if not, consider the use of a fall alarm to warn staff of unassisted transfers and the use of hip protectors for patients at risk of hip fracture.
Locate patient near to the toilet if possible. Consider a bedside commode or urinal if the toilet is not close by.
Implement a toilet assistance program that best matches the patient's needs and pattern of voiding.
Ensure that patient is wearing suitable clothes that can be easily removed or undone by self or staff and that patient wears footwear to reduce slipping in urine.
Consider a non-slip mat on the floor beside the bed for patients who experience incontinence when transferring from bed.
Keep the pathway to the toilet obstacle free and leave a nightlight on in the bedroom/bathroom at night.

March 2007