Speakers Series: Sail her up the West Coast

Alasdair MacRae is a Consultant Geriatrician in Paisley (Scotland’s largest town, with a strong history of textile production and famous for THAT pattern). As well as holding the position of British Geriatrics Society (BGS) Deputy Honorary Meetings Secretary, Alasdair is Secretary of the BGS Bowel and Bladder Health Specialist Interest Group.

Despite Prof. Bernard Isaacs (a fellow Scot) naming incontinence as one of the geriatric giants in the 1960s (along with immobility, instability, and impaired intellect/memory), it was still a topic that, decades later, was not taught (at least not well enough to recollect) during my undergraduate days. Speaking to care of the elderly registrars, this is largely unchanged. It wasn’t until I started working as a registrar for (the fantastic) Vikky Morris at Musgrove Park Hospital that I gained insight to issues that those with continence problems face. Having Vikky as an enthusiastic teacher really helped pique my interest in bowel and bladder health.

In recent years, Yale University’s Dr Mary Tinetti has suggested a modernisation of the geriatric giants, with the term “5 Ms” (mind, mobility, medications, multi-complexity and matters most). Times and terms change and while it could be attributed to many of the “5 Ms”, incontinence, as a major issue in its own right, is surely being overlooked.

My niece, who is soon to be three years old, has been “toilet-trained”. Recently, she had been aware that she needed to toilet and became distressed when she was told to do it in her nappy (how many older people have felt the same way when told something similar?). To begin with, there were issues. Firstly, there was not an appropriate facility (potty) available. Mummy initially resisted change for multiple, rational reasons. Mummy purchased a potty and assisted her on the first occasion. Initially, Mummy had been resistant: toilet training was surely going to be a big inconvenience. It wasn’t true. My niece now uses the potty independently (day and night!), including emptying it, toilet flushing and hand washing. This made Mummy’s life so much easier (no longer getting up for overnight nappy changes). Empowered to toilet independently, my niece no longer felt distressed or undignified.

A comprehensive geriatric assessment, as part of a multi-disciplinary approach to patient-centred care, can provide life-enhancing benefits to those who had consigned their continence issues to being an inevitable part of getting older. Just as with my niece, education, removal of barriers, addressing issues and appropriate support provision can assist older people with continence issues, regaining dignity that was once lost.

Rather than regarding someone with continence issues as being washed up, we can all do our bit to maximise their independence and ensure that their Dignity is a dinghy that could sail through villages and towns.

For those interested in learning more about bladder and bowel health issues in older people, you can click here or, better still, join us for our Improving Continence Care in Older People Meeting (online is an option for those unable to attend in person). I, for one, will be running straight down to Leeds Central for this year’s meeting, which is being held on Friday 16 September and I hope to see you then.