Urinary and Fecal Incontinence in Nursing Home Residents

Abstract

Urinary and fecal incontinence (UI, FI) are co-morbid conditions affecting over 50% of nursing home residents. Both forms of incontinence are risk factors for elderly persons to be placed in the nursing home, and such institutionalization itself is a risk factor for developing incontinence. Management should focus on identifying and treating underlying causes, such as detrusor instability, urinary tract infections, diet-or medication-induced diarrhea, constipation and fecal impaction. Despite appropriate management, residents may remain incontinent because of dementia and health or restraint-related immobility. Nursing homes lack the staff and financial resources to provide residents with sufficiently frequent toileting assistance (including prompted voiding). Use of special undergarments and absorbent pads is the usual practice. The article reviews the results of studies that have documented how prompted voiding programs can significantly reduce UI and FI, particularly if the intervention includes dietary and exercise components. Recent systematic anorectal testing of nursing home residents with FI has documented impaired sphincter function (risk factor for FI), decreased rectal sensation and sphincter dyssynergia (risk factor for constipation and impaction). The data suggest that the use of laxatives and stool softeners for prophylaxis against constipation and impaction related to underlying dyssynergia may have produced sufficient fluidity in the stool to predispose the residents with impaired sphincter function to manifest FI. Documentation of noninvasive and efficacious interventions by RCT and the labor costs of implementing these measures can lead to changes in how nursing home care is provided and funded.

Urinary incontinence in institutionalized elderly: prevalence and impact on quality of life

“…This corroborates the fact that only a minority of institutionalized elderly in Brazil received any type of UI therapy, and the most frequent practice is limited to the use of sanitary napkins and diapers (23,30).…”

Managing Faecal INcontinence in people with advanced dementia resident in Care Homes (FINCH) study: a realist synthesis of the evidence

“…Essentially, there is a body of continence research in US nursing homes (some of which is focused on FI) by Ouslander et al, 45,93,94 Leung et al, 95,96 Levy-Storms et al, 97 Rahman et al 98,99 and Schnelle et al, [100][101][102][103][104][105][106] but there is little consideration of the impact of dementia on continence or implementing the interventions (based around PV). There is also a body of literature on the non-pharmacological approaches to the reduction and management of behavioural and psychological symptoms of dementia (BPSD) in UK care homes by Ballard et al, 107 Fossey et al, 108,109 Lawrence et al 110,111 and Whitaker et al 112,113 We theorised parallels between the experience of FI and BPSD and the use of 'containment' as the predominant but not ideal approach to management:…”

Antibiotic Resistance in Nursing Homes

“…2004;Eriksen HM & Al, 2007;Ricci G & Al, 2010). Fecal incontinence is also associated with an higher risk of urinary infection (Topinkovà E & Al, 1997;) and both urinary and fecal incontinence may contribute to extensive environmental contamination with pathogens and antimicrobial agent-resistant bacteria (Schnelle JF & Al, 1997;Leung FW & Schnelle JF, 2008;Pagliari P & Al, 2011).…”