Although most people with dementia live at home, little research has been done on whether conservative continence interventions enable them to stay there instead of moving into care homes
The majority of people with dementia live in their own homes. Difficulties with using the toilet and incontinence can lead to them moving into care homes. This report summarises a systematic review by Drennan et al (2012) that investigated the evidence for conservative interventions for the prevention or management of incontinence in people with dementia living at home.
Citation: Drennan VM (2014) Continence care for people with dementia at home. Nursing Times; 110: 9, 19.
Authors: Vari M Drennan is professor of healthcare and policy research; Nan Greenwood is senior research fellow; Laura Cole is research associate; all at the Faculty of Health, Social Care and Education, St George’s University of London and Kingston University, London.
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A round two-thirds of people with dementia live in their own home (Knapp et al, 2007). A decline in abilities and behavioural and psychological problems can lead to difficulties with using the toilet and often incontinence. These are often key factors in decisions to move to care homes (Luppa et al, 2008).
To find out about continence care for people with dementia living at home, we searched 14 electronic databases for relevant papers. We retrieved 56 studies; only three were concerned with incontinence and our population of interest. All three examined conservative interventions to address urinary incontinence (UI) and were on advising family carers.
One of these studies was an occupational therapist (OT) problem-solving intervention. Gitlin and Corcoran (1993) found that fewer than half of the suggestions made by OTs for incontinence management were tried out, with toilet schedules the least likely to be attempted.
The second study, by Engberg et al (2002), provided half the participants with eight weekly instructional visits by a nurse practitioner (NP) to assist the carer in undertaking prompted voiding, and to offer continence advice. The other half received non-continence focused visits from an NP for eight weeks then were offered the intervention. The people with dementia responded to prompts to use the toilet four out of five times and the mean number of incontinent episodes was shown to decrease with the NPs’ input. There were no statistically significant differences in the UI outcome measures for either group. Interestingly, while seven out of 15 family carers reported their caring workload had decreased, five reported it had increased.
The third study was conducted by Jirovec and Templin (2001) into the effect of offering a NP and carer-planned individualised scheme of toileting (IST) together with a booklet, continence advice, one telephone call a month for six months and bi-monthly visits. Half the participants received the IST intervention while the other half received monthly, non-continence focused phone calls. The study reported a statistically significant decrease in incontinence episodes in the invention group. However, we re-analysed the data and found a borderline rather than statistical significance.
We found insufficient evidence to recommend any of these interventions for people with dementia living at home.
There is a need for more research in general, particularly to underpin clinical guidance that is based on a consensus of expert opinion, including that of family carers.
We think it is important for clinical guidance to make the care setting clear, as recent guidance on UI in neurological conditions uses evidence gained in care homes to refer to all settings (National Institute for Health and Care Excellence, 2012).
Acknowledgments and funding
This article presents independent research funded by the National Institute for Health Research under its programme grants for applied research scheme. The views expressed here are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
Drennan VM et al (2012) Conservative interventions for incontinence in people with dementia or cognitive impairment, living at home: a systematic review. BMC Geriatrics; 12, 77.
Engberg S et al (2002) Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. Journal of Wound Ostomy and Continence Nursing; 5, 252-265.
Gitlin LN, Corcoran MA (1993) Expanding caregiver ability to use environmental solutions for problems of bathing and incontinence in the elderly with dementia. Technology and Disability; 2, 12-21.
Jirovec MM, Templin T (2001) Predicting success using individualized scheduled toileting for memory-impaired elders at home. Research in Nursing and Health; 24, 1-8.
Knapp M et al (2007) Dementia UK: the Full Report. London: King’s College London and London School of Economics and Political Science.
Luppa M et al (2008) Prediction of institutionalisation in dementia: a systematic review. Dementia and Geriatric Cognitive Disorders; 26, 65-78.
National Institute for Health and Care Excellence (2012) Urinary Incontinence in Neurological Disease. London: NICE.