Chapter 18: Elimination

A large portion of the geriatric population experiences common issues such as constipation, which is defined by hard, dry stools and often stems from inadequate dietary fiber or fluid intake, reduced mobility, underlying neurological conditions, or the use of specific medications like narcotics and diuretics. Unrelieved constipation can progress to fecal impaction, sometimes identifiable by the leakage of liquid stool around the hardened mass. Similarly, diarrhea poses a serious threat due to the high risk of rapid dehydration and subsequent electrolyte imbalances in older individuals. The text also meticulously details urinary incontinence (UI), clarifying that while prevalent, UI is not a normal sign of aging. It differentiates between types such as stress UI (leakage with exertion like coughing), urge UI (sudden involuntary bladder contractions), overflow UI (leakage from a perpetually full bladder, common in men with prostatic enlargement), reflex UI, and functional UI (incontinence resulting from external physical or cognitive barriers to reaching the restroom). Effective nursing interventions for all elimination issues center on careful assessment, maximizing fluid and dietary bulk, promoting physical activity, implementing scheduled toileting routines, addressing environmental barriers, and utilizing behavioral strategies, such as Kegel exercises, to strengthen sphincter muscle tone. The chapter underscores the necessity of staff responsiveness and patient education to prevent complications, including falls and skin breakdown, which are often associated with elimination problems.