Many nursing homes provide continuing care and support for older people with dementia.
1
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.
2
,
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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.
Alzheimer's Society. Dementia report 2014 statistics. Available at: https://www.alzheimers.org.uk/statistics. Accessed December 23, 2016.
4
The prevalence of fecal incontinence (FI) in care homes ranges from 30% to 50%,
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,
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,
7
,
8
,
9
,
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with dementia being an independent risk factor for FI.
6
,
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,
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FI is 4 times higher in people with confirmed dementia compared with matched community
samples.
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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.To read this article in full you will need to make a payment
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Goodman C, Norton C, Buswell M, et al. Managing Faecal Incontinence in people with advanced dementia resident in Care Homes: A realist synthesis of the evidence (FINCH study). 2017 in press. https://www.journalslibrary.nihr.ac.uk/programmes/hta/137501/#/.
- What works in reducing and managing fecal incontinence in people living with dementia who are residents in care homes? A realist synthesis of evidence.J Am Med Dir Assoc. 2017; 18
- Conservative and pharmacological management of faecal incontinence in adults.in: Abrams P. Cardozo L. Khoury S. Wein A. Incontinence: 4th International Consultation on Incontinence. Health Publications Ltd, Plymouth, MN2009: 1323-1386
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NICE National Institute for Health and Care Excellence. Faecal incontinence in adults. Quality Standard 54. Available at: https://www.nice.org.uk/guidance/QS54/chapter/Quality-statement-2-Baseline-assessment. Accessed December 23, 2016.
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Article info
Publication history
Published online: July 21, 2017
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
Crown Copyright © 2017 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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- What Works to Improve and Manage Fecal Incontinence in Care Home Residents Living With Dementia? A Realist Synthesis of the EvidenceJournal of the American Medical Directors AssociationVol. 18Issue 9
- PreviewThe 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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