Continence care for older people in England and Wales: data from a national audit.
BACKGROUND
A number of policy documents have identified deficiencies in continence services in England and Wales, and have called for the development of integrated services. 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 aged 65 years and older. Each site returned data on organizational structure and the process of 20 patient's care. Data were submitted via the Internet, 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 of 326 (43%) Primary Care Trusts, 159 of 196 (81%) secondary/acute care trusts (198 hospitals), and 29 of 309 (9%) invited care homes. Fifty-eight percent of Primary Care Trusts, 48% of hospitals, and 74% of care homes reported that integrated continence services existed in their area. While basic provision of care appeared to be in place, the audit identified deficiencies in the organization of services and in the assessment and management of urinary incontinence in the elderly.


CONCLUSIONS
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 reestablish 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
A
A
Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, London, United Kingdom. a.wagg@ucl.ac.uk
Lowe
D
D
Peel
P
P
Potter
J
J
D000368:Aged; D003430:Cross-Sectional Studies; D004739:England; D005242:Fecal Incontinence / Q000175:diagnosis / Q000628:therapy*; D015577:Geriatric Assessment; D019983:Guideline Adherence / Q000592:standards; D006302:Health Services Research; D006299:Health Services for the Aged / Q000592:standards*; D006801:Humans; D008485:Medical Audit; D009660:Northern Ireland; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies; D013222:State Medicine / Q000592:standards*; D014549:Urinary Incontinence / Q000175:diagnosis / Q000628:therapy*; D014852:Wales