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Management of Fecal Incontinence in Older People With Dementia Resident in Care Homes: A Realist Synthesis—The FINCH Study

      Many nursing homes provide continuing care and support for older people with dementia.
      • Toot S.
      • Swinson T.
      • Devine M.
      • Challis D.
      Causes of nursing home placement for older people with dementia: A systematic review and meta-analysis.
      Care home residents may have three or more health conditions, with an estimated 80% in the United Kingdom having dementia without a confirmed or documented diagnosis, up to a third of whom may be at an advanced stage.
      • Gordon A.L.
      • Franklin M.
      • Bradshaw L.
      • et al.
      Health status of UK care home residents: A cohort study.

      Alzheimer's Society. Dementia report 2014 statistics. Available at: https://www.alzheimers.org.uk/statistics. Accessed December 23, 2016.

      In this editorial the term care home is used and includes registered homes providing nursing, social, and/or continuing aged care. Advanced dementia is variably defined but usually includes complete loss of memory and recognition, severe dependency for activities of daily living (such as bathing, dressing, toileting, and feeding), poor or absent communication, incontinence, poor mobility, difficulty swallowing, and weight loss.
      • Reisberg B.
      • Wiegel J.
      • Fransen E.
      • et al.
      Clinical features of severe dementia: Staging.
      The prevalence of fecal incontinence (FI) in care homes ranges from 30% to 50%,
      • Chassagne P.
      • Landrin I.
      • Neveu C.
      • et al.
      Fecal incontinence in the institutionalized elderly: Incidence, risk factors, and prognosis.
      • Borrie M.J.
      • Davidson H.A.
      Incontinence in institutions: Costs and contributing factors.
      • Nelson R.
      • Furner S.
      • Jesudason V.
      Fecal incontinence in Wisconsin nursing homes: Prevalence and associations.
      • Brocklehurst J.C.
      Promoting continence: Clinical audit scheme for the management of urinary and faecal incontinence.
      • Harrington C.
      • Carrillo H.
      • Dowdell M.M.
      • et al.
      Nursing facilities, staffing, residents and facility deficiencies, 2005 through 2010 by Charlene Department of Social and Behavioral Sciences.
      • Rodriguez N.A.
      • Sackley C.M.
      • Badger F.J.
      Exploring the facets of continence care: A continence survey of care homes for older people in Birmingham.
      with dementia being an independent risk factor for FI.
      • Borrie M.J.
      • Davidson H.A.
      Incontinence in institutions: Costs and contributing factors.
      • Nakanishi N.
      • Tatara K.
      • Naramura H.
      • et al.
      Urinary and fecal incontinence in a community-residing older population in Japan.
      • Johanson J.F.
      • Irizarry F.
      • Doughty A.
      Risk factors for fecal incontinence in a nursing home population.
      FI is 4 times higher in people with confirmed dementia compared with matched community samples.
      • Grant R.L.
      • Drennan V.M.
      • Rait G.
      • et al.
      First diagnosis and management of incontinence in older people with and without dementia in primary care: A cohort study using the health improvement network primary care database.
      FI has a negative impact on dignity, comfort, quality of life, and staff morale. There is a paucity of evidence on how to manage FI in older people with advanced dementia in care homes despite practice guidelines for managing FI being available.
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      Linked Article

      • What Works to Improve and Manage Fecal Incontinence in Care Home Residents Living With Dementia? A Realist Synthesis of the Evidence
        Journal of the American Medical Directors AssociationVol. 18Issue 9
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          The prevalence of fecal incontinence (FI) in care homes is estimated to range from 30% to 50%. There is limited evidence of what is effective in the reduction and management of FI in care homes. Using realist synthesis, 6 potential program theories of what should work were identified. These addressed clinician-led support, assessment, and review; the contribution of teaching and support for care home staff on how to reduce and manage FI; addressing the causes and prevention of constipation; how cognitive and physical capacity of the resident affects outcomes; how the potential for recovery, reduction, and management of FI is understood by those involved; and how the care of people living with dementia and FI is integral to the work patterns of the care home and its staff.
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