Behavioral therapy for the urinary incontinence of elderly woman
Objective: to evaluate the effectiveness of behavioral therapy applied by a nurse for micturition control and improvement in the quality of life of an elderly woman. Method: this was anexploratory study with a quantitative approach carried out between April of 2011 and June of 2012. Thirteen elderly women complaining of involuntary loss of urine without a cognitive deficit and urinary tract infection were assessed by instruments before and after the intervention. The research was approved by the Research Ethics Committee, registration No. 3021/2011, CAAE 016502280001. Results: after the behavioral therapy, 11 patients (92.30% had the micturition rhythm established, 09 elderly (75% presented absence of urinary loss, and thus, reduced the use of diapers and sanitary pads. Conclusion: the behavioral therapy administered by a nurse was effective for this group towards the re establishment of micturition control and promotion of the quality of life. Descriptors: Geriatric Nursing; Urinary Incontinence; Behavioral Therapy. RESUMO Objetivo: avaliar a efetividade da terapia comportamental aplicada pelo enfermeiro para o controle miccional e melhora da qualidade de vida da mulher idosa. Metodo: estudo exploratorio, com abordagem quantitativa, realizado entre abril de 2011 e junho de 2012. Foram 13 idosas com queixa de perda involuntaria de urina, sem deficit cognitivo e infeccao urinaria, avaliadas por instrumentos, antes e depois de uma intervencao. A pesquisa foi aprovada pelo Comite de etica em pesquisa, registro no 3021/2011, CAAE016502280001. Resultados: apos a terapia comportamental, 11 pacientes (92,30% estabeleceram um ritmo miccional, 9 idosas (75% apresentaram ausencia de perda urinaria e, com isso, reduziram gastos com fraldas e absorventes higienicos. Conclusao: terapia comportamental aplicada por enfermeiro foi efetiva para este grupo, em relacao ao re estabelecimento do controle miccional e promocao da qualidade de vida. Descritores: Enfermagem Geriatrica; Incontinencia Urinaria; Terapia Comportamental. RESUMEN Objetivo: evaluar la eficacia de la terapia comportamental aplicado por las enfermeras para el control de la vejiga y la mejora de la calidad de vida de la mujer anciana. Metodo: un estudio exploratorio con abordaje cuantitativo, realizado entre abril de 2011 y junio de 2012. Habia 13 ancianos quejandose de perdida involuntaria de orina sin deteriormente cognitivo y infeccion del tracto urinario, evaluado por los instrumentos antes y despues de una intervencion. El estudio fue aprobado por el Comite de Etica en Investigacion, numero de registro 3021/2011, CAAE 016502280001. Resultados: despues de la terapia comportamental, 11 pacientes (92,30% han establecido un ritmo urinario, 09 (75% presentaron ausencia de perdida de orina y la reduccion del gasto en panales y toallas sanitarias. Conclusion: la terapia comportamental aplicada por la enfermera fue eficaz en este grupo, para el re establecimiento de control de la orina y la promocion de la calidad de vida. Descriptores: Enfermeria Geriatrica; Incontinencia Urinaria; Terapia Conductual. RN, Clementino Fraga Filho University Hospital HUCFF, Rio de Janeiro (RJ) Brazil. PhD student in Nursing, Rio de Janeiro State University (RJ) Brazil.Email: barbaramartins.enf@gmail.com; RN, Assistant Professor at the Nursing School from the Federal University of Reconcavo da Bahia, Santo Antonio de Jesus (BA) Brazil. PhD student in Nursing, Rio de Janeiro State University (RJ) Brazil.Faperj Scholar. Email: claudiafeiolima@yahoo.com.br; RN, National Institute of Cardiology, Rio de Janeiro (RJ) Brazil. PhD in Nursing, Rio de Janeiro StateUniversity (RJ) Brazil. Email: lianacorrea@ymail.com; Nurse, Rio de Janeiro StateUniversity (RJ) Brazil. Specialist in GeriatricsandGerontology, Rio de Janeiro StateUniversity (RJ) Brazil. Email: milton.enf@gmail.com; RN, PhD, Associate Professor at the School of Nursing, Rio de Janeiro State University (RJ) Brazil. Vice Director of the unATI UERJ. Email: celpcaldas@gmail.com ORIGINAL ARTICLE Lima CFM, Caldas CP, Trotte LAC et al. Behavioral therapy for the urinary incontinence. English/Portuguese J Nurs UFPE on line. Recife, 9(8):8762 70, Aug. 2015 8763 ISSN: 1981 8963 DOI: 10.5205/reuol.7696 67533 1 SP 1.0908201501 Urinary incontinence (UI) is considered a global public health problem that is epidemiologically relevant. It isa pathology characterized by the involuntary loss of urine and can be classified into three main types: stress urinary incontinence (SUI) when involuntary loss of urine occurs during exertion or exercise; urgency incontinence (UI) characterized by complaints of involuntary urine loss immediately accompanied or preceded by urgency; and mixed urinary incontinence (MUI) when there are complains of involuntary loss of urine associated with urgency and efforts. The risk factors for UI increases with advancing age, especially in women after 70 years of age, and thus, it is important that every health professional assisting an elderly woman, regardless of their specialty, asks the following question: "do you have involuntary loss of urine?" This is because, in general, patients do not mention the issue if not questioned, often by shame or for thinking that it is a common problem of advanced age. Studies show that depending on the health conditions, type, and UI stage, the treatment may be surgical, medication, through physiotherapy or behavioral therapy, which provides healing, reduction of symptoms, or the learning of how to better deal with the problem. In Brazil, the treatment approach is, traditionally, surgical. However, this procedure involves high costs and can cause complications. Therefore, nowadays, an interest in treatments options for UI that are less invasive has risen, such as behavioral therapy. The Behavioral Therapy (BT) is a method of low risk and cost because it stimulates behavioral modifications. 3 Thus, the approach to UI represents a challenge for health professionals in search of alternatives to its treatment based in a humanized and individualized attention to women, especially encouraging self care. Selfcare is the broadest concept referring to a person's skills and performance of activities for the promotion and maintenance of health. Thus, the teaching of self care was used as a strategy to minimize the limitations established by UI and optimize the potential in self care and prevention of urological problems. To understand how the approach of UI in Brazil and the world has been conducted we performed an integrative review in the medical publication database National Library of Medicine of the United States of America (PubMed) and the following databases from the Virtual Health Library (VHL) from the Bireme Network: Base and data in Nursing (BDENF) Cochrane BVS, Latin American Literature and Caribbean Health Sciences (Lilacs) and Medical Literature Analysis and Retrieval System Online(MEDLINE) in the period between March and October of 2012 using the following descriptors: behavioral therapy; nursing; urinary incontinence; and elderly woman. A total of 25,627 articles were found related to the descriptor urinary incontinence. From these articles, 5,683 (22.1% are studies related to clinical approach and 3,095 (12% are related to incidence, prevalence, and health technology evaluation. A total of 990 articles (3.8% were found in relation to behavioral interventions (behavioral therapy) in UI, predominantly in the international literature. This shows that there are few studies related to behavioral interventions and with low cost, both for the patient and health services. We conducted a new search in July of 2014, in the same databases, and found 29,825 articles, being 14,285 (47.89% about clinical approach, 8,297 (27.81% about incidence, prevalence, and health technology evaluation, 1,003 (3.36% about BT, and 6,240 (20.91% about other UI related issues, i.e. the number of studies in the UI theme increased, however, studies about BT are still in the low numbers. Thus, the present study has the following research question: is the BT effective in the treatment of UI and improves the quality of life of elderly women? Therefore, this study aimed to evaluate the effectiveness of BT applied by the nurse for the treatment of UI and improvement in the quality of life of elderly women. This was a quantitative study for an evaluation in the same group of patients, before and after an intervention, being called a study of before and after type. Data were collected by the principal author who was trained to implement the behavioral therapy in the Uro Geriatrics outpatient clinic of a University Hospital in the city of Rio de Janeiro, between April of 2011 and June of 2012. The training occurred during team meetings and lectures of permanent education, organized by professionals from the Center of Attention to the Elderly (NAI) Elderly women, aged 60 years and enrolled in the outpatient clinic with complaints of involuntary urine loss were INTRODUCTION