The Management of Urinary Incontinence in Residential and Nursing Homes for Older People

Abstract

We assessed the management of urinary incontinence amongst older people in residential and nursing homes and examined strategies for continence care in the homes. A random sample of local authority and private residential and nursing homes was drawn from an earlier census of long-term care. Strategies for continence care, the standard of care provided and the need for more help were determined by means of a structured questionnaire and the observations of a continence adviser. A random selection of residents in each of the homes was assessed for the presence, severity and symptoms of urinary incontinence, for symptom control and physical dependency. Eighty-seven per cent of the homes used pads and 83% daytime toileting to promote continence care but only 52% practised night-time toileting and 49% the use of clear toilet signs. A greater emphasis was placed on incontinence management rather than continence promotion, the latter being "good' in only 32% of homes. Although the majority of homes reported having adequate access to aids and appliances, 39% of residents had severe symptoms of urinary incontinence resulting in bed-wetting and wetting of clothing. Substantial social and psychological effects were found; 87% of residents needed changes in their management of the condition and incontinence management was "good' in only 47% of homes. Although 73% of homes were optimistic about offering good continence care, they were infrequently supported by continence nurses (30% of homes) or specialist continence doctors (9% of homes). Consequently 57% requested more help from the specialist services. The high prevalence of severe and uncontrolled symptoms of urinary incontinence combined with the lack of support received by the homes for the management of these residents indicated the urgent need for a greater input from the specialist continence service.

Absorbent products for urinary/faecal incontinence: a comparative evaluation of key product designs

“…52 Although there are four main designs of body-worn pads available in disposable and washable variants (inserts, diapers, T-shaped diapers and pull-ups) ( Table 51), disposable products dominate and washables are more seldom used in homes. Insert pads are the simplest, cheapest (on a per product basis) and most commonly used of the disposable designs in the UK, although diaper designs are also frequently used.…”

“…There are also indications that designs vary in how long they take to apply and remove; however, this has not been demonstrated clinically. 51 Several studies have shown that incontinence is a costly aspect of care in nursing homes, 52 including laundry, disposal and staff changing costs in addition to the purchase price of the products. The choice of containment method is likely to affect significantly the overall expenditure, 53 but it is not known which designs of product are most cost-effective.…”

Healthcare personnel’s attitudes towards patients with urinary incontinence INFORMATION POINT: Regression analysis

“…Incontinence training programmes are documented to be effective in reducing urinary incontinence (Schnelle et al ., 1990; Yu et al ., 1990; Colling et al ., 1992; Long, 1985), but nursing home staff show low compliance with the programmes (Schnelle et al ., 1990; Campbell et al ., 1991; Cheater, 1993; Lekan‐Rutledge, 1998). Studies have shown not only that education is crucial for implementation, but also that staff communication and support is important (Schnelle et al ., 1995; Peet et al ., 1996; Lekan‐Rutledge, 1998). Urinary incontinence is under‐reported and frequently overlooked by health professionals (Cheater, 1993; Grealish, 1998): some long‐term care providers seem to passively accept urinary incontinence in older people and fail to actively intervene (Freundl & Dugan, 1992).…”

Older people in care homes and the primary care nursing contribution: a review of relevant research

“…For example, two separate surveys by Peet et al (1995) (n = 6079) and Roe and Shiels (2000) (n = 652) found that around a third of residents from residential homes had a continence problem. Eighty seven per cent of homes in the Peet et al (1996) survey reported using aids and appliances. Both studies claimed that in only two-thirds of the homes was promotion or management of continence adequate.…”