Continence Care and Containment Strategies in Older Women

Containment strategies (pads, appliances, catheters) are not treatments but tools to maintain dignity and safety when incontinence persists.
Pads are the most common strategy but pose risks including moisture-trapping, skin breakdown, and increased infection risk.
Pad selection must be based on: leakage volume, mobility/dexterity, skin integrity, and environment.
In Australia, the Continence AIDS Payment Scheme (CAPS) provides financial assistance for products.
Pad weight testing provides an objective estimate of severity by calculating the difference between dry and used pad weights.

Indwelling urinary catheters are associated with significant harms: delirium, infection, reduced mobility, and urethral trauma.
Long-term urethral catheters can cause urethral erosion; suprapubic catheters are generally preferred for long-term use.
Catheters should be used as a harm minimization strategy for severe cases, not for clinician convenience.
Management options include: - Valve systems: Only for patients with adequate cognition and dexterity under specialist guidance. - Free drainage: Mandatory overnight or during a urinary tract infection.

ISC is the preferred method for managing urinary retention compared to indwelling catheters.
Benefits include lower infection risk and better preservation of bladder function.
Use in older patients may be limited by visual/cognitive impairment, reduced dexterity, or mobility.
Clinician-led education is essential to prevent unnecessary long-term indwelling catheter placement.

Asymptomatic bacteriuria is nearly universal in long-term catheter users and should not be treated.
For symptomatic infections, urine specimens must be collected from the catheter sampling port, never the drainage bag.
The catheter should be changed during the course of antibiotic treatment for a diagnosed infection.