Incontinence is a Prevalent Health Problem Among Nursing Home Patients that Must be Addressed

Incontinence is a serious health problem that can affect both men and women at any stage of life.  Although the likelihood of experiencing incontinence increases with age, incontinence is not a normal age-related health issue. Not only does incontinence pose critical psychological and social constraints, it also significantly diminishes an older adult’s quality of life and increases the need for nursing home care. Incontinence is defined as the uncontrollable loss of urine or feces or a combination of both.  Urinary incontinence (UI) is described as “any involuntary loss of urine.”   Staff in nursing home facilities are responsible for providing direct care to their residents.  Thus, nurses are critically responsible for treating and caring for patients with incontinence.

The prevalence rates of urinary incontinence are high in nursing homes worldwide.  According to research published in the Journal of Advanced Nursing, UI prevalence rates in nursing home facilities are as high as 60%. The prevalence rates for UI in European countries, Japan and the United States are estimated between 43-65%.  High incontinence rates of prevalence result in many negative consequences that include anxiety, diminished overall health in nursing home patients, greater workload for nursing staff, and higher expenses for the health system.  Moreover, studies have shown that incontinence is a risk factor for decreased ability to perform activities of daily living in nursing home patients.

According to evidence-based literature, the most widely known risk factors for urinary incontinence are age, gender, and dementia.  Furthermore, the risk of incontinence can be exacerbated by other factors such as diabetes and stroke, and can be associated with impaired mobility and decreased ability to eat and drink.  Substantial evidence indicates that applying structural indicators, such as “keeping voiding records or food and fluid diaries” can assist in improving the effectiveness of incontinence care.  In regards to care processes, international literature encourage nursing interventions that include supervision of diet, bowel tendencies or toilet training, and the modification and implementation of incontinence-inducing medication.

A recent study that analyzed the prevalence and quality of incontinence care in nursing home facilities across the United States found that the most common deficiencies in nursing homes were structural indicators such as the limited availability of brochures that provided information regarding incontinence risk factors and care.  On a care process level, body worn pads or underlay pads that protect beds or chairs were heavily relied upon and training interventions that aimed to improve incontinence in patients were rarely provided. The study also found that the prevalence of double incontinence—meaning, having both urinary incontinence and fecal incontinence—was significantly high (69.2%) among the nursing home patients.

The study’s findings indicate that due to the high level of patients with double incontinence issues and the significantly low rate of training interventions regarding this type of incontinence, nursing home facilities such that those in Fremont and Hayward, California, should strive to improve the quality of incontinence care provided to their residents in order to maintain their quality of life and independence, as well as their psychological and physical well being.