Incontinence can be an embarrassing and inconvenient health condition... but there is no reason why you should let it keep you from doing the things you enjoy.  It's also important to remember that you're not alone- an estimated 12 million Americans are living with incontinence.  Urinary incontinence can begin at many different points in life, sometimes after childbirth or menopause for women, or after prostate surgery for men.  The types and causes of incontinence vary, and your urologist may recommend different strategies or treatment options based on your particular situation.  However, WebMD has a page with great tips for managing urinary incontinence- whether you're in a social situation, at the gym, at work, or even on vacation.  For example, did you know that certain types of food (spicy or acidic) and beverages (those with caffeine or alcohol) can often worsen incontinence in some people?  While your parent or loved one may not feel comfortable discussing incontinence with anyone other than their doctor, you may be able to pass along some valuable resources to them- especially if you see that they are missing out on the things they love...

To get tips and get more information, visit the WebMD site by clicking the following link...  http://www.webmd.com/urinary-incontinence-oab/coping-08/default.htm

·   An excellent resource regarding evidence based practice for nurses in clinical and educational settings is the Harford Institute for Geriatric Nursing, New York University College of Nursing http://www.consultgerirn.org/ . This site covers geriatric topics including but not limited to overviews, definitions, background information such as incidence, prevalence, assessments, assessment tools, and nursing care strategies. In dealing with fall prevention, as an example, the information that you will have access to is a general overview of falls, definitions, along with assessment tools and educational material. One tool that is shared is the Tinetti assessment tool for the older adults who can ambulate independently. The site also provides nursing care strategies, treatment protocols and management recommendations.

·   Age related changes (such as altered visual acuity, decreased balance and muscle strength, hypotension, and changes in bladder function such as frequency and/or incontinence) increase the risk of falls. If you have a hospital based practice, you know that falls are the single largest category of incidents in an acute care setting and for people over 65 years of age, falls are responsible for one third of deaths (http://www.consultgerirn.org/).

·    In dealing with the elder population, always remember to evaluate for the risk of falls and provide fall prevention education. Another resource for educational materials is the National Institute on Aging  www.nihseniorhealth.gov .

So what exactly is in a Personal Health Record (PHR)? 

You won’t be surprised to know that the answer varies depending on who you ask.  Let’s start by looking at what My Health Care Manager includes in its PHR.

We have identified 17 dimensions to examine as part of initializing a PHR.  These are:

1. Demographic:  General demographic information including but not limited too the senior’s current living and marital status; accessibility to bathroom, bedroom, and laundry; and work/volunteer history. 
2. Family: Family members deceased and living.  Family health history and availability.
3. Social support:  The family’s/friends’ level of support, communication techniques, and the senior’s engagement in social activities.
4. Representatives/Key Contacts: Individuals that the senior has identified to have permission to health and/or financial information, including the level of information they may access and the manner in which the information can be shared.
5. Financial:  The senior’s perception of his/her financial needs and if additional assistance is required to support health or alleviate stress.
6. Spiritual:  The senior’s perception of his/her spiritual needs and level of comfort/peace with current health status.
7. Legal: Arrangements for an individual to act on the senior’s behalf including the status and copies of the senior’s advance directives, funeral, and/or burial/cremation arrangements.
8. Insurance:  Current insurance information and identified gaps or needs for continued education.
9. Support Services:  Multiple service providers and the level of communication between the providers.
10. Caregiver Support: The stress level and needs of the caregiver.
11. Physical Health:  The senior’s past medical history, treatment plans, and current health status - capturing chronic illnesses, chronic pain, incontinence, weight loss/gain, nutritional status, and sleep habits.   
12. Functional Health Status:  The senior’s perception of and satisfaction with his/her health status while assessing the senior’s physical functional status including activities of daily living, balance, ambulation, assistive devices, and sensory status.
13. Emotional/Psychological:   The cognitive, emotional, and behavior status of the senior including screens for cognitive impairment, anxiety, depressive symptoms, and substance abuse.
14. Medication History:  Medications list, multiple providers, multiple pharmacies,   allergies, polypharmacy, and medication administrative needs. 
15. Home/Residential Environmental & Safety Assessment:  Visual assessment of the senior’s environment.  Assessing fall risk, elder abuse, disaster plans, fire/burn prevention, crime/injury, injury prevention, communication system, and support network.          
16. Preventive Health Activities:  Preventative recommendations and attending health screening activities. 
17. Wellness: The senior’s understanding of activities that promote improved health status such as wellness classes, tobacco use cessation, and/or intellectual stimulation.

This information can be gathered and assessed by an individual, a caregiver, or even a Health Care Manager.  We use a 3 ring notebook to collect and organize this information so that it can easily be updated and kept current.  The binder is easily taken along on medical provider appointments and is large enough to be difficult to misplace.