Association Between Constipation and Fecal Incontinence in Community-Dwelling Older Adults in Japan.

Review Question/Objective What tools are the most appropriate for the assessment of faecal incontinence in older adults living in the community? Inclusion Criteria Types of Participants This review will consider patients over the age of 65 years who live in the community (i.e., they do not live in a residential aged care facility). Types of Interventions/phenomena of interest Interventions of interest are current tools being used to assess faecal incontinence in community-dwelling older adults. Types of Outcomes Outcome measures of interest include measures of reliability (e.g., inter-rater reliability, test-retest reliability, internal consistency) and validity (discriminant and convergent validity, consistency of factor structure) for tools designed to assess faecal incontinence symptom severity and faecal incontinence quality of life. Measures of sensitivity (proportion of people who really have the condition who are detected as such by the test) and specificity (the proportion of people without the condition who are detected as such by the test) of tools will also be included.

Most older adults live in the community either alone or in a family arrangement. Community-living older adults are diverse, and the health status of some is characterized by complexity related to having multiple morbidities and possibly frailty. Assessment and management of fecal incontinence in frail community-dwelling older adults with health-related complexity may be enhanced using a complexity framework that accounts for social, environmental, and political contextual factors as well as health/medical concerns. This chapter will explain common problems that contribute to fecal incontinence in these older adults such as impaction with overflow, constipation, diarrhea, and mild to moderate cognitive impairment. It will address special considerations that the advanced practice nurse must take into account including hearing and vision impairment, physical limitations, the physical environment and toilet access in the home, diet and hydration, and the role of the caregiver. The chapter will then discuss appropriate management interventions. Interventions highlight the importance of a holistic approach, client and caregiver engagement and education, and referral to other healthcare professionals and community services.

Urinary and faecal incontinence in older adults

This Month in Gastroenterology

Prevalence of Fecal Incontinence in Older Adults: A Systematic Review and Meta-Analysis.

Prevalence and Burden of Fecal Incontinence: A Population-Based Study in Women

Of all the health challenges frail elderly face, fecal incontinence is one of the most dreaded. Lack of knowledge within the field of fecal incontinence is evident. With life expectancy lengthening, the percentage of people who will require care in a nursing home will increase in the years to come. Nursing home patients are the most fragile of the older patients. Among this group, there are often problems connected with defecation, such as constipation, diarrhea, and fecal incontinence. Fecal incontinence is a complex problem. It is therefore necessary to have a broad approach to fecal incontinence, and it is important that nurses have high knowledge and advanced skills when it comes to meeting patients’ needs for assessment, care, and treatment. Fecal incontinence can lead to feelings of shame and embarrassment and to a downward spiral of psychological distress, dependency, and poor health. Loose stool, as well as hard stool, can be related to fecal incontinence. Urgency associated with bowel movements is also an important factor. The most important risk factors are functional incapacity, reduced cognitive function, diarrhea, constipation/impaction, stroke, some neurological diseases, diabetes, and comorbidity in general. The level of knowledge among health personnel on the value of good bowel care seems limited. There is at present a relatively limited evidence base from high-quality experimental trials of fecal incontinence, and it remains challenging to provide strong evidence for most interventions. Frail older people require a different care approach addressing the potential role of comorbid disease and current medications, in addition to the functional and cognitive impairment, and should take into account the degree of bother to the person. When appropriate, patient education is important to promote self-management and other coping mechanisms. An environment with physical or social obstacles may impair the ability to maintain continence. This is particularly relevant to individuals who have physical or mental disorders. Good care quality encompasses care personnel to acknowledge the problem of fecal incontinence compassionately. Healthcare personnel should be trained in identification and management of fecal incontinence in nursing home patients.

Privacy during defecation is important to individuals and society at large and it has not been studied in older people with fecal incontinence. One hundred twenty adults aged 65 years and with fecal incontinence who were either living in their own homes or in a nursing home or receiving care in an acute or rehabilitation elderly care ward were surveyed with a questionnaire that included questions on privacy during defecation. Privacy while defecating was often least achieved in the patients with fecal incontinence living in nursing homes (NH) (n=7, 23%) but usually was achieved in those living at home (H) (n=28, 93%) and by some being cared for in rehabilitation wards (R) (n=16, 53%) or in acute wards (AC) (n=15, 50%; P<.001). Very few participants with fecal incontinence were aware of leakage (NH: n=3, 10%; R: n=9, 30%; AC: n=9, 30%; H: n=15, 50%), able to clean themselves (NH: n=0, 0%; R: n=2, 7%; AC: n=5, 17%; H: n=24, 80%) or had access to patient information leaflets about fecal incontinence (NH: n=3, 10%; R: n=4, 13%; AC: n=1, 3%; H: n=16, 53%). Older people, especially those who are dependent, lack privacy during bowel movements. They are usually unaware of being incontinent of stool and are unable to clean themselves afterwards. Access to information about fecal incontinence is poor.

What can community nurses do for older adults who experience faecal incontinence?

Fecal Incontinence in Older Adults

Review question/objective: The objective is to identify the effectiveness of educational interventions on knowledge of continence management and number of continence episodes in older adults. More specifically, the objectives are to identify: 1) What is the effect of educational interventions directed at healthcare staff, carers or clients on their knowledge of urinary and faecal incontinence in older adults? 2) What is the effect of educational interventions directed at healthcare staff, carers or clients on the frequency of incontinent episodes in older adults? 3) What is the effect of educational interventions directed at healthcare staff/carers/clients on number of hours spent on the management of incontinence? Inclusion criteria: Types of participants: This component of the review will consider studies that include clients from all settings with urinary and/or faecal incontinence aged 65 years and older, and the carers and healthcare staff who care for them. In agreement with the accepted definitions of incontinence a participant will be defined as incontinent if there is a complaint of any involuntary leakage of urine and/or the involuntary loss of flatus, liquid or solid stool. Types of intervention(s)/phenomena of interest: This review will consider any study that teaches the client/carer/healthcare staff strategy(ies) for the prevention or management of urinary and/or faecal incontinence or attempts to increase the knowledge of continence management. These strategy(ies) include but are not limited to educational strategies that teach: 1) treatment of transitional causes of incontinence for example urinary tract infection, constipation, diabetes control, medication modification, pain management, and depression 2) fluid control 3) toilet technique and correct posture on the toilet 4) bladder training 5) bowel management 6) pelvic floor muscle exercises 7) biofeedback 8) Electricial stimulation 9) Urethral massage for men 10) Knowledge of pharmacotherapy eg oestrogen, cranberry, anticholinergics, antispasmodics 11) Knowledge of medication modification 12) Enviromental modification 13) Containment aids and continence products We will also consider any study that presents information about urinary or faecal incontinence to the participants. Types of outcomes: This review will consider any study that measures any of the following four outcomes: 1) Changes in client/carer/healthcare staff knowledge of continence and/or incontinence and its management. TRUNCATED AT 350 WORDS

Faecal incontinence significantly affects a patient's quality of life, and limited research has been conducted into effective interventions that are specific to residential aged care. Australian and New Zealand prevalence data indicate a general faecal incontinence rate of 12-13% in older adults and up to 50% inresidential aged care. The objective of this article is to describe the suggested initial investigation and management of faecal incontinence in older adults residing in residential aged care. Discussion of invasive management strategies is outside the&nbsp;scope of this article. Faecal incontinence is difficult to treat and there is limited evidence to support any treatment beyond three to six months. However, recognition remains the major barrier to treatment with non-invasive interventions that are available to reduce episode frequency and prevent complications. A combination of exercise programs and integrated continence care in residential aged&nbsp;care may provide significant benefit<br /> if there are sufficient staffing resources available. <div class="hor-line">&nbsp;</div>.

Fecal incontinence is an important health issue that has devastating psychological, social and economic consequences for the aging population. However, it is under-reported and under-treated, often because of mistaken assumptions that incontinence is a normal part of aging and that little can be done about it. There are effective treatments that can be easily implemented in the primary-care setting, which can greatly improve an older person’s quality of life and potentially avert premature referral to a nursing home. Therefore, it is important that clinicians screen for the problem and are comfortable with its evaluation and treatment. This article reviews the epidemiology of fecal incontinence, approaches to improving identification and quality of care, as well as the assessment and treatment of the most common etiologies of fecal incontinence.

A Feasibility Study of Transcutaneous Posterior Tibial Nerve Stimulation for Bladder and Bowel Dysfunction in Elderly Adults in Residential Care

Background: Falls in older adults are a major barrier to healthy longevity. Recent studies suggest that muscle quality is associated with fall risk. This study aimed to determine whether a functional muscle quality index (MQI) using the 5-repetition sit-to-stand test (5R-STS) reflects fall risk in community-dwelling older adults. Methods: This cross-sectional study included 137 community-dwelling older adults (≥65 years) in Japan. Lower limb skeletal muscle mass (SMM) was measured using the BIA method, and muscle function was assessed using the 5R-STS. The MQI was calculated as "(5R-STS (s)/SMM (kg)) × 10". Fall history was collected using a self-administered questionnaire, and binary logistic regression analysis including gait speed and physical frailty was performed. Results: Participants were divided into fallers (n = 36; age = 78.2 ± 5.6) and non-fallers (n = 101; age = 76.9 ± 5.3). Significant differences were found between the groups in gait speed (p = 0.01), TUG (p < 0.01), 5R-STS (p < 0.01), and MQI (p < 0.01). Binary logistic regression identified MQI (OR = 1.28; p < 0.01) and gait speed (OR = 0.14; p = 0.02) as explanatory variables for fall history. The results of the evaluation using the receiver operating characteristic (ROC) curve showed that the cutoff value for MQI to distinguish fall history was 8.04 s/kg, and the cutoff value for gait speed was 1.21 s. Conclusions: The MQI using the 5R-STS shows promise as an indicator of fall risk in older adults. Further longitudinal studies are needed to clarify the causal relationship.