Harninkontinenz bei geriatrischen Patienten: Hilfsmittel, qualifizierte Pflegekraft und Harnblasenlangzeitdrainage

Zusammenfassung

Einleitung 1/2019 wurde ein update der seit 2005 in AWMF eingestellten und fortlaufend aktualisierten Leitlinie „Harninkontinenz bei geriatrischen Patienten – Diagnostik und Therapie“ durch die interdisziplinäre Arbeitsgruppe „Harninkontinenz“ der Deutschen Gesellschaft für Geriatrie (DGG) publiziert. Aus dieser Leitlinie, die als offizielle Leitlinie DGG akkreditiert ist, stellt der vorliegende Artikel das Kapitel „Hilfsmittel, qualifizierte Pflegekraft, Harnblasenlangzeitdrainage“ dar.

Methodik In einem strukturierten Bewertungsprozess identifizierte eine Literaturrecherche zunächst die vorhandene Literatur im Kontext des „geriatrischen Patienten“, wie er als zumeist über 70jährig und multimorbid oder über 80jährig durch die Fachgesellschaften definiert ist. Primäre Berücksichtigung fanden randomisierte, doppelblinde, plazebokontrollierte Studien sowie bereits vorhandene Leitlinien zum Thema. Wo keine solchen Untersuchungen vorlagen oder aus methodischen Gründen prinzipiell nicht durchführbar sind, wurden auch Publikationen anderen Designs (nicht randomisierte Untersuchungen, Fallkontrollstudien) zur Leitlinienerstellung herangezogen. Die daraus resultierenden Leitlinienempfehlungen wurden in einem strukturierten Abstimmungsprozess unterzogen; das Ergebnis ist in Prozent der zustimmenden Gruppenmitgliedern angegeben.

Ergebnisse Eine Hilfsmittelversorgung oder Harnblasenlangzeitdrainage per Kondomurinal, transurethralem oder suprapubischen Katheter kommt passager oder als Definitiv-Maßnahme dann in Frage, wenn andere Therapieformen nicht anwendbar sind oder nicht gewünscht werden. Der Einsatz einer qualifizierten Pflegekraft ist mit nicht-pharmakologischen Interventionen wirksam und ist bei beratungsintensiven Therapieformen wie dem Toilettentraining oder einer Hilfsmittelanpassung oder der Restharnbestimmung sinnvoll.

Schlussfolgerungen Besonders in Einrichtungen, die eine Vielzahl von inkontinenten geriatrischen Patienten betreuen, ist der abgestimmte Einsatz von spezialisierten Pflegekräften sinnvoll. Unter bestimmten Bedingungen stellt auch eine Palliativversorgung einer Harninkontinenz eine Therapiemaßnahme im Kontext der geriatrischen Inkontinenzbehandlung dar.

Abstract

Introduction 1/2019 we presented an update of the AWMF guideline ‘urinary incontinence in frail elderly – diagnostics and therapy’. Since its introduction in 2015 the guideline has been under a continuous revision process by the working group ‘Incontinence’ of the German Society for Geriatrics (DGG). From this guideline which is accredited as an official guideline of the DGG we present here the chapter about continence products, specialized continence nurses and indwelling catheter.

Methods A profound literature search was done in a structured evaluation process in the context of a ‘frail elderly’. Most medical societies define a ‘frail elderly’ as someone older than 70 years and multimorbide or older than 80y. We focused on randomized, double blind, placebo controlled studies as well as already published guidelines in this field. In the case no studies were available or not feasible other publications such as not randomized studies or case reports were taken into consideration for our guideline. Recommendations resulted from a structured voting process and the results are stated as percentage of members who agreed.

Results In case of failed or not wanted incontinence treatment, options like an indwelling transurethral or suprapubic catheter or a condom catheter in men maybe the best transient or definite solution. Trained specialized continence nurses have proven to be beneficial in conservative treatment modalities, such as toilet training or measuring residual urine. They can further consult patients and carers to enhance physical environment to reduce incontinence.

Conclusion Especially in institutions caring for frail elderly a coordinated care of specialized a multidisciplinary setting of continence nurses and doctors are beneficial for those affected. Under certain conditions palliative treatment should be included in geriatric incontinence care.

Schlüsselwörter

Vorlagen - Betteinlagen - Kondomurinal - Umgebungsanpassung - suprapubischer Katheter

Keywords

pads - continence products - condom urinal - indwelling transurethral catheter - indwelling suprapubic catheter - enhancing physical environment

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