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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Wagg
Adrian
A
Geriatric Medicine, University College Hospital, 25 Grafton Way, London WC1E 6AU, UK. a.wagg@ucl.ac.uk
Potter
Jonathan
J
Peel
Penny
P
Irwin
Penny
P
Lowe
Derek
D
Pearson
Michael
M
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D054869:Clinical Audit; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration / Q000592:standards*; D004739:England; D005260:Female; D049691:History, Medieval; D006707:Homes for the Aged / Q000458:organization & administration / Q000592:standards; D006760:Hospitalization; D006801:Humans; D016496:Incontinence Pads / Q000592:standards; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland; D009730:Nursing Assessment / Q000592:standards; D009735:Nursing Homes / Q000458:organization & administration / Q000592:standards; D010347:Patient Care Planning / Q000592:standards; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards; D011785:Quality Assurance, Health Care / Q000458:organization & administration / Q000592:standards*; D013222:State Medicine; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000453:epidemiology / Q000628:therapy*; D014852:Wales