盛行率與發生率 　•Campbell et al.(1985): 53% dementia with UI vs. 13% nondemented. 　•Berrios(1986): UI more prevalent in AD compared with vascular dementia 生理變化與老人排尿的相關性 　• 減少或降低 　　- 膀胱的容積 　　- 膀胱的收縮力 　　- 膀胱的遵從性 　　- 膀胱括約肌的遵從性 　　- 延遲排尿的能力 　　- 控制中樞的敏感度 　　- 尿道長度 　　- 最大的尿道關閉壓 　• 增加 　　- 排尿後的餘尿量 　　- 膀胱肌不自主的收縮 　　- 夜尿 　　- 分類 　• 壓迫性尿失禁 Stress incontinence 　• 急迫性尿失禁 Urge incontinence 　• 過渡膨脹性尿失禁 Overflow incontinence 　• 功能性尿失禁 Functional incontinence 　• 混合型尿失禁 Mixed incontinence 病因學etiology •失禁與失智症的嚴重性和沒有能力行走或移動有正相關 •在NH中失智症住民行動能力是在認知受損後失禁的最佳預測因子(Jirovec &Wells, 1990) •身體的約束(physical restrain) •精神上的問題 •部分藥物也會引起失禁 •社會與環境上 失禁的評估—病史 失禁的評估—生理 失禁的評估—檢驗   評估Assessment •evaluation and identification of incontinence •targeted physical examination 　1. rectal and pelvic examination 　2. medications review 　3. urinalysis and culture, renal function test 　4. mental status 　5. ability to respond to simple questions about voiding 　6. aspect of function: mobility, ability to transfer, manual dexterity, vision and hearing 　7. environmental factors: access to toilet, the use of restraints 　8. voiding record: frequency, timing, amount of voiding 　9. estimation of postvoid residual volume of urine 　10.examined for stress incontinence 管理Management •to identify and treat transient causes of incontinence •in cognitively impaired nursing home residents, a daily exercise program designed to improve walking •other interventions other interventions •toileting regimen ☆ •Medications •pelvic muscle exercises ☆ •environmental interventions☆ •surgery •appliance and protective pads 如廁訓練toileting regimen • behavior modification--50%改善 　1. 練習骨盆底肌肉運動（Kegal’s Exercise） 　2. 反應模式化訓練 • scheduled toileting • prompted voiding environmental interventions • visibility and access • lighting • grab bars • toilet seat height • availability of commodes and urinals • availability of mobility aids • patient’s clothing allows easy disrobing alternatives to physical restraints need to be sought

徐麗娟　 信義安養中心