You are taking care of an older female adult with severe cognitive impairments. She is unable to tell you when she needs to urinate and, as a result, is often incontinent. What do you realize she is experiencing?

Choice A reason: A shortened warning time between the desire to void and actual micturition is a common sign of urinary incontinence in older adults. It is caused by the decreased bladder capacity, increased bladder irritability, and reduced urethral resistance that occur with aging.

Choice B reason: The first urge to void occurs at the midbladder volume (250-350 mL) is not a correct answer, as this is the normal bladder sensation for adults of all ages. It does not indicate urinary incontinence.

Choice C reason: Diarrhea is the most common gastrointestinal complaint made to the health care provider is not a correct answer, as it is not related to urinary incontinence. It is a separate condition that affects the bowel movements.

Choice D reason: Constipation as a symptom of altered bladder functions is not a correct answer, as it is not a direct cause or effect of urinary incontinence. However, constipation can worsen urinary incontinence by increasing the pressure on the bladder and pelvic floor muscles.

Choice E reason: None of the above is not a correct answer, as there is one choice that is true for urinary incontinence in older adults.

Choice A reason: Over-the-counter NSAIDs are generally harmless is not a true statement, as NSAIDs can cause serious adverse effects in older adults, such as gastrointestinal bleeding, renal impairment, hypertension, and heart failure. NSAIDs should be used with caution and under medical supervision in older adults.

Choice B reason: Stool softeners and laxatives should be used with opioids is a true statement, as opioids can cause constipation in older adults, which can lead to discomfort, abdominal pain, fecal impaction, and bowel obstruction. Stool softeners and laxatives can help prevent and treat constipation and promote regular bowel movements.

Choice C reason: Opioids are less effective in older clients than in younger clients is not a true statement, as opioids can have the same or even greater analgesic effect in older adults, depending on the dose, route, and duration of administration. However, opioids can also cause more side effects in older adults, such as sedation, confusion, respiratory depression, and falls. Opioids should be used with caution and under medical supervision in older adults.

Choice D reason: The dose limit for acetaminophen is difficult to reach for older adults is not a true statement, as older adults may be more susceptible to acetaminophen toxicity, especially if they have liver disease, malnutrition, or chronic alcohol use. The dose limit for acetaminophen is 4 grams per day for adults, but it may be lower for older adults or those with risk factors. Acetaminophen should be used with caution and under medical supervision in older adults.