Strategies to Inform Innovations in Continence Care for People Living with Dementia in the Acute Hospital Setting: A Mixed Methods Narrative Synthesis Review

Abstract

Background: People living with dementia are at significant risk of developing urinary and/or faecal incontinence but are also at risk of functional incontinence or being labelled as being incontinent. Despite the growing population of PLWD and importance of continence care little is known about the appropriate management, organisation, and interactional, strategies for PLWD admitted to acute hospitals. This mixed methods narrative systematic review sought to identify successful strategies across all care settings that could then be used to inform innovations in continence care for PLWD in the acute hospital setting.Methods: In phase 1 a scoping search of two electronic databases (MEDLINE and PSYCinfo) and a consultation with stakeholders was undertaken. Findings from were presented to the project steering and two priority areas for phase 2 were identified which were communication and individualised care plans. In phase 2 eight databases and relevant UK government and other organisational websites were searched for English language citations from inception to August 2020. Critical appraisal was conducted using the Mixed Methods Appraisal Tool (MMA Version 11). Thematic synthesis was employed and the strength of synthesised findings for the intervention studies was assessed using the GRADE approach and the and confidence in synthesised qualitative and survey findings was assessed using the CERQual tool. Results: In phase 1, 1348 citations were found and 75 included. In phase 2, 6247 citations were found 14 research studies and 14 policy and guidance documents were included. The quality of studies varied. Material was synthesized in order to identify the facilitators and barriers around developing communication strategies and individualised management plans in response to the continence needs of PLWD.Conclusions: Recognising that PLWD are not always able to communicate their continence needs verbally is important. Incorporating interpersonal and communication skills into the context of continence care within training for those working with this patient group is crucial for continence to be maintained during an acute admission. Continence care in the acute setting should be tailored to the individual and be developed in partnership with staff and caregivers.Systematic review registration: PROSPERO: CRD42018119495