Incontinence: assessment, diagnosis, and management in two rehabilitation units for older people.
BACKGROUND
Incontinence of both bladder and bowel is a major health care problem and adversely affects the lives of many people living at home or in health service facilities. The prevalence and severity of incontinence is a global concern that has, in recent years, prompted investigation across several countries. Current approaches to continence care indicate an emphasis on safety and reduction of risk, rather than on detailed individualised assessment and management.


OBJECTIVE
To show approaches to assessment, diagnosis, and management of urinary and faecal incontinence in two rehabilitation settings for older people in Ireland. The study forms part of a larger 2-year case study to identify the determinants of practice "context" that enable or hinder proactive approaches to promoting continence and the treatment of incontinence in rehabilitation settings for older people.


METHODS
The Royal College of Physicians Audit Scheme was used to record the assessment and management of urinary and faecal incontinence. This scheme also includes questions regarding resources available to enable effective continence management. Over 6 months, 220 patients who suffered from incontinence participated in two study sites: a 78-bed rehabilitation unit in Northern Ireland and an 80-bed rehabilitation unit in Southern Ireland.


RESULTS
Findings indicated that 60% of incontinent patients had urinary incontinence, 3% faecal incontinence, and 37% mixed urinary and faecal incontinence; however, a specific continence assessment and specific rationale for treatment decisions or continuation of care were lacking. The focus was on continence containment rather than on proactive management. The examination of resources available for continence promotion and management showed that even though guidelines for continence management were available to staff in one unit, there was a dearth of appropriate education or support for staff in continence care.


CONCLUSIONS
Because incontinence remains an issue for older people and the clinical implications of sustained incontinence are multifaceted, strategies should focus on the development of practice towards evidence-based multidisciplinary approaches to continence promotion and management.
Coffey
Alice
A
School of Nursing and Midwifery, University College Cork, Republic of Ireland. a.coffey@ucc.ie
McCarthy
Geraldine
G
McCormack
Brendan
B
Wright
Jayne
J
Slater
Paul
P
D000368:Aged; D000369:Aged, 80 and over; D019317:Evidence-Based Medicine; D005242:Fecal Incontinence / Q000175:diagnosis / Q000453:epidemiology / Q000451:nursing / Q000628:therapy*; D005260:Female; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D009730:Nursing Assessment; D019982:Organizational Case Studies; D015995:Prevalence; D012047:Rehabilitation Centers; D014549:Urinary Incontinence / Q000175:diagnosis / Q000453:epidemiology / Q000451:nursing / Q000628:therapy*