People who have neurological conditions and also experience symptoms of lower urinary tract dysfunction should be offered detailed assessments, NICE has said.
The health body has issued the clinical guidance in a bid to minimise the distressing effects caused by incontinence and other urinary problems on those with conditions such as stroke, multiple sclerosis, and head or spinal cord injuries.
Under the guidance, healthcare professionals across England and Wales are advised to undertake thorough assessments of such patients, including obtaining information about their urinary tract and neurological symptoms, other health problems such as bowel or sexual problems, and their use of medication and therapies.
Factors such as mobility, hand function, cognitive function, social support and lifestyle should also be assessed, with the information gained used to inform the management of each patient’s urinary problem.
NICE says that these assessments should happen at least every three years, although individual circumstances – such as a patient’s age, diagnosis and type of management – may mean they need to be undertaken more frequently.
NICE’s director of the centre for clinical practice, Professor Mark Baker, said: “Incontinence is common in people who have conditions caused by damage to their brain, spinal cord or other parts of their nervous system. It can be particularly problematic when there is an underlying neurological condition because these people may have mobility, hand function and sight impairments and so may need extra support to manage the effects.”
He added: “Incontinence can have a huge impact on a person’s daily activities, and can increase demand on carers, such as partners and family members.”
1. Establish a culture that promotes continence, rather than just checking and changing incontinence products. This includes establishing teams of incontinence specialists, setting incident-reduction goals, raising awareness of a plan, periodically ensuring guideline compliance, benchmarking and establishing a staff competency program.
2. Develop a formal bowel and bladder programme. One of the best ways to decrease the incidence of incontinence in long-term care residents is having a clear bowel and bladder program that is in compliance with current clinical guidelines (e.g. NICE). Often suppliers of incontinence pads can supply such a programme.
3. Promote continence with broad staff education and training. Low incontinence incidents and positive survey results may lull many providers into a false sense of security, sometimes surveyors may overlook how the home is promoting continence and you might continue the same process that has contributed to higher incidents of falls, nosocomial infection or depression. Proper staff education and support on perineal care is essential to help eliminate skin breakdown or redness before it can occur as well.
4. Properly assess and identify vulnerable areas. Proper assessments include identifying the type of incontinence, and often the cause. The assessment should lead to the proper care plan and also the type of incontinence product and care that will best support the highest possible level of continence for each individual. A structured program can help identify and treat some very simple underlying causes of incontinence, such as medications, poor dexterity or mobility, anatomical defects or lack of appropriate staff.
5. Keep your eyes and ears open. It might seem simplistic, but many homes link cost with effectiveness when often a more expensive treatment or product will be more effective and reduce overall costs through such areas as reduced treatment of skincare issues or laundry bills. There are undoubtedly many treatments available for incontinence, but the best treatment is simply to pay vigilance and attention to each individual clients situation.
6. Be mindful of the total cost of incontinence. Incontinence pads represent only a fraction of care costs. Consider other metrics such as change rates, cost of laundry, nursing time, medications or ointments, falls and cost of skin injuries.
7. Understand that it’s more than just a physical problem. Preserving the dignity of the resident is paramount. Staff can help residents emotionally by making them feel confident, and by providing quality support products that reduce the incidence of embarrassing leakage.
8. Provide easily identifiable products. Make it as easy as possible for staff to identify the proper supplies, including undergarments and topical treatments, e.g. through using products where the packaging means that names can be read from across the room and also colour-coded packs and products. Staff can are often be overworked, so different products can be quickly identified can help when staff are busy.
Some Mistakes to avoid are:
- Using outdated continence management policies or guidelines.
- Assuming a good survey and few incontinence incidents mean you are managing the problem well.
- Skipping an initial assessment of vulnerable areas of the body.
Nursing homes that foster an environment in which workers feel they are valued contributors to a team of caregivers provide better care to their residents. That is the conclusion of a study out this month in the journal Health Services Research.
“We know from other fields of medicine that teamwork – the relationship between co-workers that facilitates decision making and care co-ordination – plays an important role in the quality of care,” said Helena Temkin-Greener, Ph.D., lead author of the study. “Our body of work in this area demonstrates that, while many nursing home managers may contend that they have teams in place to coordinate care, it is only when staff perceives that they are part of a cohesive unit that the quality of care is improved.”
The study’s authors used data on over 45,000 residents in 162 nursing homess. They measured the quality of care by examining the incidence of incontinence and pressure ulcers, conditions that, while highly prevalent in nursing homes, can frequently be prevented from occurring. In nursing homes, the prevalence of these two conditions may be exacerbated by poor staff communication, inadequate hand-offs during shift changes , and inefficient coordination of care.
The authors surveyed 7,418 nursing home staff providing direct patient care at these facilities to measure perceived staff cohesion, defined by the extent to which staff share common goals, values, responsibility for care delivery, and group identity. Answers to survey questions were used to construct a numerical score (ranging from 1 to 5) that represented “staff cohesion” at a given nursing home.
The authors then examined the association between staff cohesion and prevalence of pressure ulcers and incontinence in that facility, adjusting for other patient characteristics. They found that less than 0.25 point improvement in a facility’s staff cohesion score was associated with a 4.5 percent decrease in the prevalence of pressure ulcers and a 7.6 percent decrease in incontinence, representing a significant improvement in both these health outcomes.
“This study empirically demonstrates that better work relationships between staff, as measured by staff cohesion, are associated with better outcomes for nursing home residents,” said Temkin-Greener. “Nursing home managers have the tools to encourage good patient care but they have to work at it and encourage practices that promote better cohesion, communication, and teamwork in their facilities. If they do this, the quality of care will improve.”
Brunel University is holding a free one day training event giving advice to health professionals on how to tackle incontinence in older people.
The training day is being held on Wednesday 13 June by TACT3, the UK’s largest collaborative research programme, focussing on older people and continence difficulties.
Eleanor van den Heuvel, principal investigator for TACT3, from the Brunel Institute for Ageing Studies, said: “We believe that care professionals working in the frontline with older people should have the opportunity to benefit from our work so we are putting on a free one day training event (refreshments and lunch included).
“The event is aimed at health and social care professionals but informal carers and people with an interest in continence research are also welcome.”
The day will include:
•The latest continence promotion workshop
•The stigma of incontinence
•Continence services as experienced by professionals and service users
•Demonstrations of prototypes of two new continence management technologies
•An exhibition with the interactive “Great British Toilet Map”
The aim of TACT3 is to reduce the impact of continence difficulties for older people by:
Improving toilet provision for older people – by investigating the problems older people have locating and using toilets when they are away from home and exploring why older people do not like or use the new automatic conveniences.
Improving understanding of continence treatment services – by exploring patient, family and professional viewpoints when people seek help for continence difficulties from the health services.
Providing assistive devices to help people with continence disability – by developing two products that have been requested by continence pad users to help older people to feel more confident and manage their condition better. The first product is a urine odour detector that will warn the continence pad user that their pad needs changing before any odour is detected by the human nose. This simple colour change device will be in the form of a small card or a piece of jewellery or other items requested by users. The other product is smart underwear that will detect a pad leak immediately and warn the wearer or carer before the leak spreads to outer clothes or furniture.
About 50 per cent of women over 40 will suffer some symptoms of urinary incontinence, with the number increasing with age; about half as many men are affected. Faecal incontinence is present in about one per cent in the general population, rising to 17 per cent in the very old and as high as 25 per cent in nursing homes.
People wanting to attend the event should call 01895 266921 or register online at www.brunel.ac.uk/bib/tact3/events, the programme for the day can be viewed at http://www.brunel.ac.uk/__data/assets/pdf_file/0007/187261/Meeting-the-Challenge-programme-Final.pdf
With summer arriving very suddenly this week, people’s thoughts suddenly turn to holidays and at Allanda we are very aware of the difficulties that can exist when travelling with those who have incontinence. Therefore when we saw some comments about how to make travel less stressful from the CareGiver Partnership we thought they were worth featuring.
Family travel can be highly rewarding, but it has the potential to be stressful as well, says Lynn Wilson, Co-Founder of The CareGiver Partnership.
“If you’re traveling with a loved one who needs special care due to issues such as a disability, heart condition or incontinence, the key to success is in planning,” says Wilson. “Consider the following summer travel tips, and increase the odds that your vacation truly will be a pleasure trip.”
- If a budget allows, professional assistance, such as from a specialized travel agent or skilled respite worker who travels with a family, can make planning and vacationing easier and more enjoyable.
- Medical clearance from a doctor, along with extra medication and copies of medical records, can offer peace of mind. Patients and caregivers should ask about medication side effects, such as when combined with sun or certain types of foods.
- Most airlines offer priority check-in and boarding and on-board wheelchair availability for passengers with special needs. It’s helpful to allow for longer connection times between flights and arrange wheelchair or cart transportation between terminals or gates.
- When driving with someone who’s elderly or disabled, allowing time for frequent stops for eating, stretching and using a restroom makes a trip more enjoyable.
- Hotels can accommodate needs through first-floor rooms, adjoining rooms, rooms close to elevators, or special accommodations for wheelchairs.
- Support stockings are a simple, inexpensive way to manage leg pain or numbness, which is common when a senior sits for prolonged periods. Frequent walking breaks also can help keep blood moving in legs and feet.
- Keeping a slower pace on a vacation, including designated rest periods, can help reduce stress for everyone.
- It’s easy to become constipated on vacation, sometimes due to sitting for longer periods or eating unhealthy foods. Drinking plenty of water and nutrition shakes, eating healthfully and stretching can help prevent constipation. Travellers who frequently get constipated might consider packing laxatives.
“If you are traveling and an elderly loved one is staying home, make sure a family member or other caregiver has emergency medical contact information, is stocked up on needed health care supplies, and knows his or her daily schedule,” says Wilson.
Allanda have now added a selection of Disposable Bibs to our existing Bib Range to give our customers more choice than ever.
These handy, disposable serviette bibs come with integral front pockets and back ties for dignified and hygienic protection at meal times. The two cellulose layers absorb fluid, and the intermediate plastic film acts as a barrier to protect clothing. The front pocket collects any spills while the integral back ties secure the serviette in place, close to the user neck. Following meals, the reverse side of the cellulose tissue can be used as a napkin.
We also offer two types of washable bibs, our standard washable bib is a tartan coated fabric, designed for easy cleaning.
An article recently in the Daily Mail highlighted the importance of seeing your GP to discuss health concerns and to look beyond the obvious when treating incontinence and dementia.
When Carole Smith started tripping over more often, she started to worry. ‘ ‘I’d often bruise myself quite badly, but I never mentioned it to anyone. My walking had become more laboured and slower, too.’
There was another problem as well in that often she couldn’t reach the toilet in time.
‘It started ten years ago. I was so embarrassed and upset. I didn’t tell anyone — not even my GP.’
Then in 2006, when she was 67, Carole tripped on a kerb while carrying some shopping home and broke her ribs. She was taken to hospital, badly bruised and after that, a team of six physios came to my house for a week. She realised while they were there that the assumption was that dementia was setting in.
‘They were quite patronising and started trying to tell me things like how to cross roads safely and how to step up kerbs, as though I’d forgotten how to do it. But as far I was concerned, I still had all my marbles and was perfectly able to navigate around my house.’
Three months after the physio, Carole went to her GP to seek an explanation who asked to see her walk across the room. ‘She commented on the fact that my gait was wide and I was unable to keep my knees near each other and said she wanted to refer me to a neurologist for further tests.’
Her GP told Carole she thought the problem was hydrocephalus and said the incontinence and the way Carole was walking and falling were classic signs.
Hydrocephalus is an abnormal increase of cerebrospinal fluid in the brain.
When this fluid builds up it starts to affect the brain’s function, causing symptoms such as gait disturbance (a wide, slow, shuffling gait with unsteadiness, particularly when turning); cognitive impairment such as memory loss, confusion and urinary incontinence.
‘The result was instantaneous. ‘I was in (hospital) for three days having the fluid drained off through a small tube in my back,’ said Carole, who was diagnosed with normal pressure hydrocephalus.
‘Of these three symptoms, the gait disturbance is the one that always appears,’ says Richard Edwards, consultant neurosurgeon at Frenchay Hospital, Bristol. ‘The cognitive problems and incontinence usually accompany it, but not always.’
Carole was diagnosed with normal pressure hydrocephalus (NPH), where the cause of the build-up is unknown.
Acquired hydrocephalus is caused by damage to the brain after a head injury or after conditions such as stroke, brain haemorrhage, brain tumour or meningitis. The condition is most common in people aged 60 or older and its trio of symptoms are also classic signs of other conditions, such as Alzheimer’s or Parkinson’s disease, so it often goes misdiagnosed.
Incredibly, it’s estimated that 2 per cent of all people over 60 who’ve been diagnosed with dementia actually have normal pressure hydrocephalus, which equates to about 10,000 people in the UK.
‘One study showed that NPH affects about five people per 100,000,’ says Mr Edwards, ‘which means we should be treating about 3,000 new cases a year. Instead, we’re treating about 300.’ He stresses the need for better awareness and testing, so fewer people are misdiagnosed. With a proper diagnosis, the symptoms of this kind of hydrocephalus can be alleviated.
For GPs and the public alike, there can be other indications to watch out for. ‘For example, if a person has been diagnosed with Parkinson’s, but they’re not responding to medication, then hydrocephalus should be considered,’ says Mr Edwards. Carole is thankful her GP spotted the signs so quickly.
The full article can be found at: http://www.dailymail.co.uk/health/article-2097376/How-dementia-beaten-drain-brain.html#ixzz1lnHYT7nL
A Canadian website has provided some useful guidance for people who believe their ageing parents may be experiencing adult incontinence.
According to an article on Canoe.ca, urinary incontinence should not be a barrier to an active life, as it can be “easily and effectively managed” with the aid of absorbent products, such as Tena Comfort Plus, and lifestyle changes.
It can be caused by a number of conditions, such as stroke, Alzheimer’s disease, diabetes, arthritis or urinary tract infections, or by certain medications.
The website advises people to discuss any concerns about their parents with their healthcare professional, who can advise them on treatment options for adult incontinence.
It points out: “There is a wide range of treatments available to manage incontinence, including absorbent products (which absorb urine and odour), exercises, lifestyle changes, medical devices, medications and surgery.
“Finding the right treatment can help your parents stay active and enjoy life.”
Wales’ older people’s commissioner has expressed concerns about the treatment received by elderly people, including those with adult incontinence, when staying in NHS hospitals.
Ruth Marks published a damning report earlier this year, entitled ‘Dignified Care?, which found many older patients were receiving “shamefully inadequate” care in Welsh hospitals.
Ms Marks has now told the Western Mail that she remains unconvinced that patients are being treated with dignity.
She said that health boards and the Welsh government had responded to the report, but that “more does need to be done”.
“There is good and even excellent work in some areas, but there are inconsistencies and some absolute basics are still not there,” she revealed.
Earlier this year, Welsh ministers announced that the watchdog Healthcare Inspectorate Wales would be asked to carry out spot checks to ensure elderly patients are receiving a good standard of care in hospital.
These checks are likely to look at a number of issues, including dementia and the treatment of people with adult incontinence.
The charity Age UK has teamed up with the NHS Confederation and Local Government Group (LG Group) to set up a new commission focusing on dignity in care provided to older people in hospitals and care homes, many of whom are reliant on incontinence pads and pants.
The move follows recent reports on patient complaints from the Health Ombudsman and the inquiry into circumstances at Mid Staffordshire NHS Foundation Trust.
Experts will research what people expect in terms of dignity in care and establish ways to improve the situation across health and social care services.
Age UK chair Dianne Jeffrey explained: “This commission aims to build understanding of why and how older people’s essential care is going wrong and to set out practical solutions for getting it right in the future.”
Cllr David Rogers, chairman of the LG Group’s community wellbeing board, observed that public concern about the experiences of some patients and care home residents was “widespread and legitimate”.
He added: “The LG Group is very keen to play our part in finding practical ways in which we can raise standards and eliminate bad practice.”