Continence Care For Older People Research Articles

‘We tend to get pad happy’: a qualitative study of health practitioners’ perspectives on the quality of continence care for older people in hospital

BackgroundBladder and bowel control difficulties affect 20% and 10% of the UK population, respectively, touch all age groups and are particularly prevalent in the older (65+ years) population. However, the...

Translating dignity principles into practice for continence care for older people in care homes: A study protocol.

To develop, implement, evaluate, and disseminate an evidence-based, person-centred education program to protect the dignity of care-dependent older people with dementia and continence care needs in care homes. A mixed method two-phase design underpinned by integrated knowledge translation. An education program that frames dignity as the main goal of continence care will be co-designed with a purposive sample of care home staff who provide or supervise continence care for care-dependent older people with dementia in care homes and resident relatives. The program will then be implemented and evaluated in a representative sample of care home staff to determine its clinical relevance, feasibility, acceptability, and effects on staff ratings of dignity in continence care; self-reported continence care practices and the person centeredness of the environment. Data analysis will include descriptive statistics (survey data) and thematic analysis (focus groups). Funding obtained November 2018. Ethics approval obtained May 2019. This protocol outlines a mixed methods integrated knowledge translation protocol designed to translate principles about dignity into practice to improve the care of older people who are at risk of violations to their dignity in care homes. The outcome will be a contextually appropriate, evidence-based education program that protects the dignity of care-dependent older people who have dementia and continence care needs. Based on a sound theoretical model, the education program will be contextually appropriate for use in the care homes setting and contribute to improving the overall quality and safety of care in this setting. It could also support and inform continence care for other individuals who are care dependent. Adopting an integrated knowledge translation approach to the design and delivery of the education program and piloting it will ensure the program is contextually relevant and sustainable.

A concept analysis of dignity-protective continence care for care dependent older people in long-term care settings

BackgroundAlthough codes of conduct, guidelines and standards call for healthcare practitioners to protect patients’ dignity, there are widespread concerns about a lack of attention to the dignity of older people who need assistance with toileting, incontinence or bladder or bowel care in health or social care settings that provide long-term care. Incontinence and care dependence threatens patient dignity. The aim of this research was to explore, describe and explain the concept of dignity as it relates to continence care for older people requiring long-term care.MethodsThe first four steps of Rodgers evolutionary method of concept analysis were followed. First, a comprehensive and systematic search of databases and key guidelines about continence care was undertaken to identify empirical research about dignity and continence care in older people in facilities that provide permanent residential or inpatient care of older people for day-to-day living. Data were extracted on the authors, date, sample, country of origin, and key definitions, attributes, contexts and consequences from each included record. Findings were inductively analysed and grouped according to whether they were the key attributes and antecedents of dignity in relation to continence care or the consequences of undignified continence care.ResultsOf 625 articles identified, 18 were included in the final analysis. Fifty individual attributes were identified that were categorised in 6 domains (respect, empathy, trust, privacy, autonomy and communication). A further 15 were identified that related to the environment (6 physical and 9 social). Key consequences of undignified continence care were also identified and categorised into 3 levels of impact (resident/family member, staff or organisation).ConclusionsThis research resulted in a conceptual understanding of dignity that can be used as a value or guiding principle in an ethic of care for older people who need assistance with toileting, incontinence or bladder or bowel care in long-term care settings.

The importance of addressing ageism in Swedish healthcare

Ageism is discrimination against individuals or groups based on their age. In the Swedish healthcare context, the term is uncommon, despite the fact that older people are a significant class of users. One of every five individuals in Sweden is 65 years of age or older, and the proportion of older people in the population is rising. Therefore, ageism in healthcare warrants more awareness and focus. In three recent articles that we have published relating to nutritional, depression and continence care for older people, we found indications of ageism even though we did not aim to study it. There is a need to identify the manifestations of ageism and label them, and to become alert to both the visible and invisible expressions of ageism. This will help in the development of interventions and policies to eliminate ageism in healthcare. With health inequalities growing and seemingly becoming the norm rather than the exception in Sweden and other European countries, it has become imperative to address and eliminate health inequalities through a range of initiatives and mechanisms. Fighting ageism in different settings must be a part of this larger goal.

Registered nurse's experiences of continence care for older people: A qualitative descriptive study.

This study aimed to illuminate nurses' experience of continence care for older people receiving home care, either in their own home or in an assisted living facility. Registered Nurses (RNs) have a major role to play in identifying and establishing appropriate actions regarding continence care for older people. However, the crucial nursing care pathway for continence care is commonly described as poor. Interviews were conducted with 11 RNs providing home care, and the transcribed texts were analysed using inductive content analysis. The impressions of RNs were categorised according to four themes: perceptions of continence care, an open approach to continence care, the need for personalised aid fittings and the importance of teamwork in continence care. Key findings were the importance of teamwork; the need for nurses to embrace leadership at the point of care and be more visible in terms of the provision of direct care; substantiation that evidence-based interventions, such as scheduled toileting and prompted voiding, should constitute the norm in continence care within the context of home care; and the need for nurses to support the right of older persons to receive an assessment of their continence problems, deemed to be the minimum standard of quality care. The provision of continence care that is based on key nursing standards, such as evidence-based and person-centred care, as well as individualised continence care that is based on evidenced-based guidelines, would ensure an improvement in the continence care that is presently on offer to older people. Nurses need to embrace leadership at the point of care and to be more visible with the provision of direct care in order to improve continence care for older people receiving home care.

What can nurses do to manage incontinence challenges in end-of-life care?

What can nurses do to manage incontinence challenges in end-of-life care?

Incontinence-associated dermatitis in older people: prevention and management

British Journal of Community NursingVol. 23, No. 5 Care of the Older PersonIncontinence-associated dermatitis in older people: prevention and managementAnn YatesAnn YatesSearch for more papers by this authorAnn YatesPublished Online:30 Apr 2018https://doi.org/10.12968/bjcn.2018.23.5.218AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References All Wales Tissue Viability Nurse Forum and All Wales Continence Forum. All Wales best practice statement on the prevention and management of moisture lesions. 2014. https://tinyurl.com/h5z7equ (accessed 18 April 2018) Google ScholarBale S, Tebble N, Jones V, Price P. The benefits of implementing a new skin care protocol in nursing homes. J Tissue Viability. 2004; 14(2):44–50 https://doi.org/https://doi.org/10.1016/S0965-206X(04)42001-4 Crossref, Medline, Google ScholarBardsley A. 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Br J Nurs 27 (3) 2-3 https://doi.org/https://doi.org/10.12968/bjon.2018.27.2.76 Google Scholar FiguresReferencesRelatedDetailsCited byAssessment and documentation of incontinence-associated dermatitis after implementation of a standardised instrument: a comparative studyMary Montague, Matthew Karafa, Nancy M. Albert11 September 2019 | Journal of Wound Care, Vol. 28, No. Sup9 2 May 2018Volume 23Issue 5ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 30 April 2018 Published in print 2 May 2018 Information© MA Healthcare LimitedPDF download

Urinary continence care for older people in the acute setting.

Urinary continence care for older people in the acute setting.

The importance of good continence care for older people

Despite its taboos, high-quality continence management is an integral part of looking after older people in the residential home. Ann Yates describes this important aspect of care, from its causes in the home to assessment and management

Do self-reported 'integrated' continence services provide high-quality continence care?

systematic collection of clinical outcome data remains the most difficult task in the measurement of clinical effectiveness. However, the examination of the relationship between organisational and clinical process of care may provide a surrogate measure of quality in care. data from the 2006 National Audit of Continence Care for Older People were used to examine whether there was an association between organisational structure and standard of continence care for older people. 'Quality' scores were produced and the relationship between scores was examined. there were statistically significant correlations between organisational and process scores for continence care. Primary care scored higher than hospitals or care homes in regard to service organisation [median (IQR): 57 (45-68) vs 48 (36-65) vs 50 (38-55), P = 0.001]. Differences were less with clinical process scores for urinary incontinence (UI) [median (IQR): 42 (32-52) vs 40 (29-49) vs 43 (34-52), P = 0.06] and for faecal incontinence (FI) [median: 42 (34-53) vs 45 (36-55) vs 47 (41-53), P = 0.12]. those with an integrated service provide higher quality care to older people. The provision of high-quality care for continence appears to be dependent upon well-organised services with personnel who have the appropriate training and skills to deliver the care.

Overcoming the barriers to optimum continence care: the need for an expanded approach to implementation

In spite of a growing body of evidence to show that urinary incontinence is treatable or symptoms can be significantly improved in the majority of older people significant shortfalls in the quality of continence care are highlighted consistently in the international literature. The key barriers to providing optimal continence care for older people points to a need to address change not only from an individual practitioner perspective but also at the levels of the multidisciplinary team and organization. Examples of some emerging implementation frameworks that incorporate the broader context in which change occurs in 'real world' practice are introduced which may serve as useful guides. It is argued that if national and international standards of good practice for continence care are to be achieved, implementation methods have to take account of the complex interplay of patient, practitioner, social and organizational factors that mediate change.

Continence Care for Older People in England and Wales

A number of policy documents have identified deficiencies in continence services in England and Wales, and have called for the development of integrated services. A national audit was conducted to assess the quality of continence care for older people and whether these requirements have been met. The audit studied incontinent individuals aged 65 years and older. Each site returned data on organizational structure and the process of 20 patient's care. Data were submitted via the Internet, all were anonymous. The national audit was conducted across England, Wales, and Northern Ireland. Data on the care of patients/residents with bladder problems were returned by 141 of 326 (43%) Primary Care Trusts, 159 of 196 (81%) secondary/acute care trusts (198 hospitals), and 29 of 309 (9%) invited care homes. Fifty-eight percent of Primary Care Trusts, 48% of hospitals, and 74% of care homes reported that integrated continence services existed in their area. While basic provision of care appeared to be in place, the audit identified deficiencies in the organization of services and in the assessment and management of urinary incontinence in the elderly. The requirement for integrated continence services has not yet been met. Assessment and care by professionals directly looking after the older person were often lacking. There is an urgent need to reestablish the fundamentals of continence care into the practice of medical and nursing staff, and action needs to be taken with regard to the establishment of truly integrated quality services in this neglected area of practice.

Promoting effective continence care for older people: a literature review

Recent United Kingdom guidelines have identified the need for integrated continence services within health regions. While there is evidence of improvements in community services there is little evidence that the quality of nursing care offered for older people with urinary incontinence in care settings has improved. This literature review identifies some of the underpinning issues that impact on continence promotion for older people. Despite evidence that older people suffer physical, social and psychological distress as a result of mismanaged urinary incontinence, costs of promoting continence are higher in financial terms than containing incontinence. The extent of the problem is difficult to identify in terms of how many older people are affected by different types of urinary incontinence. Nurses' attitudes are found to affect the quality of continence care delivered, and there continues to be a lack of evidence around sustainable strategies for continence promotion in care settings.

National audit of continence care for older people: management of urinary incontinence

the Department of Health report 'Good practice in continence services' highlights the need for proper assessment and management of urinary incontinence. The National Service Framework for Older People required service providers to establish integrated continence services by April 2004. A national audit was conducted to assess the quality of continence care for older people and whether these requirements have been met. the audit studied incontinent individuals of 65 years and over. Each site returned data on organisational structure and the process of 20 patients' care. Data were submitted via the internet, and all were anonymous. the national audit was conducted across England, Wales and Northern Ireland. Data on the care of patients/residents with bladder problems were returned by 141/326 (43%) of primary care trusts (PCT), by 159/196 (81%) of secondary care trusts (involving 198 hospitals) and by 29/309 (9%) of invited care homes. In all 58% of PCT, 48% of hospitals and 74% of care homes reported that integrated continence services existed in their area. Whilst basic provision of care appeared to be in place, the audit identified deficiencies in the organisation of services, and in the assessment and management of urinary incontinence in the elderly. the results of this audit indicate that the requirement for integrated continence services has not yet been met. Assessment and care by professionals directly looking after the older person were often lacking. There is an urgent need to re-establish the fundamentals of continence care into the practice of medical and nursing staff and action needs to be taken with regard to the establishment of truly integrated, quality services in this neglected area of practice.

National audit of continence care for older people: management of faecal incontinence

Faecal incontinence in older people is associated with considerable morbidity but is amenable to successful management. Quality standards in this area were previously subject to a pilot audit in primary, secondary care and care homes to allow providers to compare the care delivered by their service to others and to monitor the development of integrated continence services as set out in the National Service Framework for Older People. This study reports the results of the national audit. Data were returned by 141 primary care sites, 159 secondary care trusts (involving 198 hospitals) and 29 care homes. Data on the care of 3,059 patients/residents with bowel problems were analysed. Fifty-eight per cent of Primary Care Trusts (PCTs), 48% of hospitals and 74% of care homes reported that integrated continence services existed in their areas. Whilst basic provision of care appeared to be in place, the audit identified deficiencies in the organisation of services and in the assessment and management of faecal incontinence. The results of this audit indicate that the requirement for integrated continence services contained within the National Service Framework for Older People has not yet been met. Basic assessment and care by the professionals directly looking after older persons is often lacking. There is an urgent need to re-establish the fundamentals of continence care into the daily practice of medical and nursing staff, and undoubtedly, action needs to be taken with regard to the establishment of truly integrated, quality services in this neglected area of practice.

Audit shows no improvement in continence care

The largest audit of continence care for older people in primary and secondary care, mental health trusts and care homes across the UK, makes disappointing reading. The data, published by the Royal College of Physicians (RCP), show little improvement on this time last year

National audit of continence care for older people: results of a pilot study*

Bladder and bowel problems are common in the elderly and are associated with a considerable morbidity and impact on quality of life. Inequalities in service provision and access to services have been recognized but there has been no systematic approach to measuring the quality of continence care for older people. This study aimed to develop quality standards, to assess the reliability and utility of the resulting audit package and to report on the standards of care provided in primary care, secondary care and care home setting. Fifteen sites in secondary care, primary care and in long-term care settings were randomly selected to pilot the audit package. Data collectors completed audit questionnaires relating to the structure [organization] of care, the outcomes of care, and the process of care for 20 subjects with urinary incontinence and 10 subjects with faecal or double incontinence. The audit tool was reliable (median kappa score of 0.7). Access to integrated continence services, as defined by Good Practice in Continence Services was inadequate. Eighty-five per cent of hospitals had no written policy for continence care. There were deficiencies in obtaining information, in carrying out basic and specialist examinations and investigations and in determining the cause of incontinence. There was a high prevalence of catheter use in secondary care settings. The pilot has indicated significant inadequacies in continence care and demonstrates that in many sites the National Service Framework milestone for integrated continence services has not been met. A national audit of continence care is required to determine the extent of inadequate continence care.

Continence Care for Older People

Surveys of incontinence among the elderly in Japan have shown that about 10% of Japanese men and 40–50% of Japanese women have some degree of incontinence. Unfortunately many of those with incontinence seem to think that there is nothing that can be done about it. They give up because they think incontinence is a part of aging. Incontinence is not simply a part of aging, continence can be regained. However, an assessment to find the causes of an individual's incontinence and his/her possibility of improvement must first be accomplished. Causes of incontinence include bladder functional disorder, intelligence disorder, mobility and dexterity problems, and environment problems. Incontinence is categorized into several types, based upon the particular cause of the incontinence. Bladder functional disorder has been identified as the cause of three types of incontinence: urge incontinence, stress incontinence, and overflow incontinence. Urge incontinence is recognized as the involuntary loss of urine associated with an abrupt and strong desire to void. Urge incontinence often is associated with urinary frequency and is a symptom of bladder muscle irritability. Both urge incontinence and urinary frequency can be controlled by medication that relaxes the bladder muscle. Stress incontinence has been defined as the involuntary loss of urine secondary to increased abdominal pressure. The most common cause of stress incontinence is a weak pelvic floor muscle. Therefore, pelvic floor muscle exercises are useful for the prevention and improvement of stress incontinence. Overflow incontinence has been recognized as the involuntary loss of urine due to over‐distension of the bladder. In order to control overflow incontinence, it is necessary to determine whether the bladder distention is due to enlargement of the prostate gland or is a side‐effect of medication. Functional incontinence has been shown often to be secondary to an intelligence disorder, or to mobility and/or dexterity problems. Regardless of the cause of the incontinence, an appropriate environment is needed in which to treat the incontinence. Treatment and care for the incontinent individual needs to be done by a multidisciplinary team in accordance with the type of incontinence being experienced.