Care For Incontinent Older People Still Poor, Survey Shows

The results of the second survey of continence care for older people carried out by the Royal College of Physicians show little improvement since this time last year. There have been minor improvements in some areas, but integrated services are still a dream rather than a reality.

Urinary incontinence affects some 24% of older people and 30-60% of people in institutional care. Faecal incontinence occurs in approximately 1-4% of adults and up to 25% of people in institutional care. Both cause much distress and loss of dignity for the older person.

This year more sites have a written policy for continence care, but this has not led to better patient care – assessment and management of continence is still poor across primary care, secondary care and mental health sites, the latter included in the audit for the first time.

Some services have even been reduced, and there is a huge reliance on pads and other incontinence products instead of finding and treating the root cause of the problem. Because using pads and catheters is expensive, three-quarters of primary care settings and care homes ration their use, leaving many patients to fund their own supplies.

Only 30% of services have a person with leadership responsibility for continence. The re-audit shows that:

• Where a continence problem is identified, assessment or management of that problem is still not guaranteed.
• Whilst most of the structures required to provide continence services exist, provision of true integrated services is incomplete.
• Documentation of continence assessment and management is inadequate.
• Management consists predominantly of containment rather than active treatment of the problem.

Dr Adrian Wagg, Director of the Continence Project at the Royal College of Physicians, said: “Continence is an unglamorous area with few people fighting its corner. Services can be seen as an easy target for cuts in times of financial hardship.

“The amalgamation of primary care trusts around the country and other changes within the NHS have served to fragment, rather than bring together the disparate providers, needed for truly integrated services. Although there are scattered examples of improvement, care remains, at best, mediocre.”

Dr Jonathan Boyce, Head of Audits at the Healthcare Commission, said: “Many of the issues surrounding continence can be overlooked due to people’s reluctance to discuss it. But continence is a real and serious issue that affects the lives of many older people and Trusts should be looking to review and improve their services. This is about providing quality care for older people and supporting them to live with dignity.”

Dr Judith Wardle, Director of the Continence Foundation, said: “The Continence Foundation is saddened but not surprised by the low level of improvement shown by the repeat continence audit. Unfortunately, even that small improvement may be lost: information is now coming into our office about primary care continence services that are being cut completely or suffering major cuts.”