National audit of continence care: adherence to National Institute for Health and Clinical Excellence (NICE) guidance in older versus younger adults with faecal incontinence.
BACKGROUND
previous UK National Audits of Continence Care showed low rates of assessment and treatment of faecal incontinence (FI) in older people.


OBJECTIVE
the 2009 audit assessed adherence to the National Institute for Health and Clinical Excellence guidelines on management of FI and compared care in older versus younger patients.


METHODS
fifteen older (65+) and 15 younger (18-65) patients with FI were to be audited in hospital (inpatient or outpatient), primary care (PC) and care home sites.


RESULTS
data were submitted for n = 2,930 cases from 133 hospitals, n = 1,729 from 97 PC surgeries and n = 693 from 63 care homes. Bowel history was not documented in 41% older versus 24% younger patients in hospitals and 27 versus 19% in PC (both P < 0.001). In older people, there was no documented focused examination in one-third in hospitals, one-half in PC and three-quarters in care homes. Overall, <50% had documented treatment for an identified bowel-related cause of FI. FI was frequently attributed to co-morbidity. Few patients received copies of their treatment plan. Quality-of-life impact was poorly documented particularly in hospitals.


CONCLUSIONS
this national audit shows deficits in documented assessment, diagnosis and treatment for adults with FI despite availability of clinical guidance. Overall care is significantly poorer for older people. Clinicians, including geriatricians, need to lead on improving care in older people including comprehensive assessment where needed. Improvement in some indicators in older people with successive audits suggests that ongoing national audit with linked information resources can be useful as both monitor and agent for change.
Guy's and St Thomas' NHS Foundation Trust-Ageing and Health, St Thomas' Hospital, 9th Floor, North Wing Westminster Bridge Road, London SE1 7EH, UK Division of Health and Social Care Research, King's College London, London, UK Clinical Effectiveness and Evaluation Unit (CEEU), Royal College of Physicians, London, UK.
Danielle
D
Harari
Clinical Effectiveness and Evaluation Unit (CEEU), Royal College of Physicians, London, UK.
Janet
J
Husk
Clinical Effectiveness and Evaluation Unit (CEEU), Royal College of Physicians, London, UK.
Derek
D
Lowe
Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada.
Adrian
A
Wagg
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003142:Communication; D019091:Critical Pathways / Q000592:standards; D005242:Fecal Incontinence / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D063886:Patient Discharge Summaries / Q000592:standards; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards; D011788:Quality of Life; D012307:Risk Factors; D012944:Social Support; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
NICE; audit; constipation; faecal incontinence; older adults; older people