[Pathophysiology of established urinary incontinence (UI) in the elderly and an ameliorative method for disuse...

Multipathology is the physical characteristics of the elderly, and their established urinary incontinence (UI) is usually based on multiple causal diseases and types of UI. Decubitus voiding (urination and defecation) inevitably causes UI and fecal incontinence (FI). Difficulty in controlling UI and FI seen in bed-ridden elderly results in long-term use of diapers and indwelling catheters, which eventually leads to the progression of disuse syndrome and decline of ADL (activity of daily living). Most elderly UI cases have only a few major causal diseases. Arrangement of relationship between the diseases and the existing types of the UI; recognition of gender gap in urination; determination and execution of various kinds of treatment in a methodical way; and the maintenance of the proper medication dosage are the four keys to the effective and safe control of the UI. For bed-ridden elderly, passively provided suitable positions on urination and defeca-tion has become a prerequisite condition. These are not supine or Fowler (semi-reclining) positions, but normal sitting, or prone and its variation forward-tilting positions. The latter two positions, which ameliorate UI and FI in the bed-ridden elderly, have been found to improve all of the pathologies including the disuse syndrome as well. The Seikatsudai (Life rack), which provides a forward-tilting position, not only has such an effect, but also offers the possibility to make the bed-ridden elderly more independent in their lives.