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Assessment of functional incontinence in disabled living centres.

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Function of disabled living centres Anyone can visit a disabled living centre and visitors come from every part of the community. Some people visit to try out equipment and to be given advice before they purchase something for themselves. Others come with a health or social services professional to find suitable equipment before it is provided through a local authority or NHS loan store or disabled facilities grant.

Abstract

VOL: 101, ISSUE: 02, PAGE NO: 65

Viv Chadwick, DipCOT, DMS, Dip Rehabilitation Studies, was formerly research occupational therapist at PromoCon, Disabled Living, Manchester; she is now occupational therapist, Hilton Special School, Suva, Fiji

Function of disabled living centres Anyone can visit a disabled living centre and visitors come from every part of the community. Some people visit to try out equipment and to be given advice before they purchase something for themselves. Others come with a health or social services professional to find suitable equipment before it is provided through a local authority or NHS loan store or disabled facilities grant.

 

 

Some disabled living centres provide training for health care professionals and carers in, for example, equipment safety and moving and handling.

 

 

Centres vary in size and in their funding and resources. Some are part of the statutory services, others are supported by the local authority or by a health trust. Some are wholly or partly in the voluntary sector.

 

 

Forty-six of the disabled living centres in Britain are members of the Disabled Living Centres Council (Box 1).

 

 

Continence assessment for visitors to disabled living centres
According to Good Practice in Continence Services (Department of Health, 2000), up to 10 per cent of older visitors to disabled living centres and around five per cent of younger women visitors will have continence problems.

 

 

Sometimes visitors will mention continence problems during an assessment; for example, when a visitor is looking at bathing aids, going up stairs or using public transport.

 

 

However, staff at the centres do not always feel able to pursue the subject, beyond including it as a factor when considering the suitability of equipment.

 

 

This means that some centres miss an opportunity to help visitors who may not have discussed this issue with anyone else.

 

 

Reasons for not seeking help - Visitors to disabled living centres are often highly motivated people who want to continue with their lives and are looking for appropriate support, but who may not be vulnerable enough to be involved with the statutory services.

 

 

They may need help to manage while they are on a waiting list to be seen by the continence or occupational therapy service or they may just regard ‘accidents’ as being a normal part of the ageing process.

 

 

Disabled living centres are rarely appropriate places to offer a full continence care service. They usually do not have suitable accommodation for a clinic, and staff usually do not have appropriate skills. However, they could help with the functional assessment of continence problems because equipment displays include toileting aids (Fig 1).

 

 

It could be appropriate for disabled living centre staff to assess people for functional incontinence and provide a signposting service to other services; for example, the local continence adviser.

 

 

Functional incontinence has been defined as: ‘Urinary leakage due to a functional deficit (impaired physical mobility, dexterity, or cognition), rather than to organic dysfunction of the urinary system’ (Rook et al, 2000). Faecal incontinence may also be due to a functional deficit. If urinary or faecal incontinence do not respond to treatment, appropriate use of equipment, adaptations and aids may help people to manage.

 

 

Disabled living centres and functional continence assessment
In 2003, PromoCon carried out some research looking at the assessment of functional continence problems and whether there is a role for disabled living centres to offer a functional assessment service.

 

 

The research project started with a literature search looking at functional aspects of continence care, the effects of incontinence and the role of occupational therapists in continence care. The definition of incontinence used was: ‘The involuntary or inappropriate passing of urine and/or faeces that has an impact on social functioning or hygiene. It also includes nocturnal enuresis’ (DoH, 2000).

 

 

The literature showed that continence care was an important part of health care (Modernisation Agency, 2003) and that government policy had recognised the importance of looking at a user’s abilities, the environment and equipment (DoH, 2000).

 

 

Research has demonstrated that incontinence can severely restrict a person’s ability to take part in the community and can cause depression. Kelleher et al (1997) showed that women with urinary incontinence are so worried about having an accident that they restrict their social life and their work. Furthermore, their incontinence can damage family relationships. There is also evidence that people do not seek treatment for urinary or faecal incontinence. Ashworth and Hagan (1993) identified that professionals who provide continence services see only a fraction of the people who have a continence problem.

 

 

Users’ views - Interviews with users of continence services who agreed to help with the research showed that there are difficulties accessing help for continence problems. Sometimes this is owing to poor availability of resources, but it may also be because of the embarrassment that people feel about disclosing that they have continence problems.

 

 

Staff views - Qualitative interviews were carried out with staff at disabled living centres to identify the level of functional continence care they felt able to provide. They were also asked what level of support they would require to provide a service. An analysis of the research showed that these centres have a role to play in functional continence care but that the staffing, skills and resources in the different centres should determine the level of continence care that could be offered.

 

 

Training package - PromoCon has developed a training package of support for disabled living centres. The package (Box 2) is being used in some of the centres that took part in the research and is being offered to all the disabled living centres in Britain that are affiliated to the Disabled Living Centres Council.

 

 

A training session for staff looks briefly at normal bladder and bowel function, functional assessment for continence care, and how centres can be more proactive in their functional continence care. It identifies the conditions and disabilities that can cause difficulties, and provides suggestions for approaching the problem of continence care. In addition, it identifies the skills that are required to enable a visitor to feel supported.

 

 

The package also covers some of the ways of enabling people to manage their toileting when their difficulties are functional, such as adapted clothing, urinals and other useful equipment.

 

 

The training is not intended to be comprehensive but provides an introduction to functional continence problems and their solutions.

 

 

Conclusion
A training package for staff in disabled living centres was developed after research revealed that these centres could have a role in functional continence care. The package will be available for interested organisations such as support groups, community equipment services and voluntary organisations.

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