What kind of care is provided to patients with incontinence in residential facilities and home care?
II. Diagnostic, treatment and nursing interventions in incontinent persons
Authors:
E. Topinková 1,2; D. Jurásková 3,4; Z. Kučera 5; N. Müllerová 6
Authors‘ workplace:
Geriatrická klinika 1. LF a VFN, Praha
1; Subkatedra geriatrie Institutu postgraduálního vzdělávání ve zdravotnictví, Praha
2; Všeobecná fakultní nemocnice, Praha
3; Česká asociace sester
4; IncoForum, Česká společnost podpory zdraví, Praha
5; Odbor vzdělávání a vědy MZ ČR
6
Published in:
Čes Ger Rev 2009; 7(2): 82-89
Overview
Backgro und.
Urinary and fecal incontinence are considered as symptoms worsening significantly pati ent’s qu ality of life and accounting for high costs particularly for nursing care for incontinent in long‑term care faciliti es. We are facing repeated complaints of substandard qu ality of care and nursing practices provided to incontinent persons in these settings. In instituti ons, prevalence of incontinence raise up to 50– 70% of residents and, about a half of home care cli ents suffer from incontinence, too. In the article we present results of the project “Incontinence in the context of nursing care”. Methods. Survey in 34 nursing middle management speci alists was performed in 9 nursing homes, 5 soci al care faciliti es, 10 homes for seni ors and 10 home care agenci es focusing on the current system and qu ality of nursing care. In- depth transversal evalu ati on of di agnostic, therapeutical and nursing interventi ons in 465 incontinent pati ents of the above menti oned providers. Results. In 70% of incontinent pati ents the type has not been di agnosed. In majority of cases severe incontinence was reported (57%) often associ ated with bowel incontinence. The most frequent complicati ons were in decreasing order: dermatitis (20%), urinary tract infecti on (19%) and decubitus ulcer (12%). Urodynamic evalu ati on was performed only in 13% of pati ents, surgical treatment was provided in less than 2% and only 6% received pharmacotherapy. 12,4% of incontinent was catheterized. The most frequently used incontinent aid were bri efs with average 3– 4 daily changes in 60% of incontinent, less frequently in the remaining, followed by incontinence sheets (65%), pads (16%) and di apers (14%). Conclusi ons. Despite significant vari ability in care and nursing practices among individu al providers and types of setting, di agnostic procedures, pharmacotherapy and physi otherapy are insuffici ently offered and used in incontinent residents. Higher prevalence of complicati ons particularly skin lesi ons was reported. Continence training programs are frequently offered, however often without targeting to appropri ate residents and with inappropri ately low frequency of training. These findings reflect poor qu ality of care provided and are caused by both objective (lack of personnel, financi al limits for incontinence aids) and subjective factors (lack of specific standards, insuffici ent knowledge, and low motivati on). It is necessary to introduce health system measures to increase manpower and financi al limits for these faciliti es and, at the same time to modify current guidelines according to the specific needs of this populati on and support targeted educati onal programs for health care workers.
Keywords:
incontinence – di agnostic, medical and nursing interventi ons – qu ality of care – elderly people
Sources
1. Martan A. Močová inkontinence: operační postupy u starších žen. ČGR 2007; 5 (1): 6– 10.
2. McDowell BJ, Engberg S, Sereika S et al. Effectiveness of behavi oral therapy to tre at incontinence in homebound older adults. J Am Geri atr Soc 1999; 47 (3): 309– 318.
3. Topinková E. Inkontinence moči u seni orů stále nedostatečně di agnostikována a léčena. Ca usa subita 2009, v tisku.
4. Thűroff J, Abrams P, Andersson KE et al. Guidelines EAU pro léčbu močové inkontinence. Urologické listy 2008, 6 (1): 97– 99.
5. Jumadilova Z, Zyczynski T, Pa ul B et al. Urinary incontinence in the nursing home: resident characteristics and prevalence of drug tre atment. Am J Manag Care 2005; 11 (4 Suppl): S112– S120.
6. Topinková E. Geri atri e pro praxi. Praha: Galen 2005.
7. Narayanan S, Cerulli A, Kahler KH et al. Is drug therapy for urinary incontinence used optimally in long‑term care faciliti es? J Am Med Dir Assoc 2007; 8 (2): 98– 104.
8. Department of He alth and Human Services Centers for Medicare and Medicaid Services. Interpretive Guidelines for Long‑Term Care Faciliti es. Urinary Incontinence. Medicare State Operati ons Manu al Appendix PP – Guidance to Surveyors for Long Term Care Faciliti es. §483.25(d), F 315. [http:/ / cms.hhs.gov/ manu als/ Downlo ads/ som107ap_pp_guidelines_ltcf.pdf]. Přístup z 15. 3. 2009.
9. Horčička L. Kvalita života žen s močovo u inkontinencí. ČGR 2009; 7 (1): 22– 25.
10. Holroyd- Leduc JM, Lyder CH, Tannenba um C. Practical management of urinary incontinence in the long‑term care setting. Ann Long Term Care: Clin Care Aging 2006; 14 (2): 30– 37.
11. Ostaszki ewicz J, Johnston L, Roe B. Timed vo iding for the management of urinary incontinence in adults. Cochrane Database Syst Rev 2004; 1: CD002802.
12. Ouslander JG, Griffiths PC, McConnell E et al. Functi onal Incidental Training: a randomized, controlled, crossover tri al in Veterans Affairs nursing homes. J Am Geri atr Soc 2005; 53 (7): 1091– 1100.
13. Topinková E. Farmakologická léčba urgentní inkontinence a hyperaktivního měchýře u seni orů. Ca usa subita 2008; 11 (1): 6– 10.
14. Shih YC, Hartzema AG, Tolleson- Rinehart S. Labor costs associ ated with incontinence in long‑term care faciliti es. Urology 2003; 62 (3): 442– 446.
15. Topinková E, Jurásková D, Kučera Z. Jako u péči poskytujeme paci entům s inkontinencí v rezidenčních zařízeních a v domácí péči? I. Názory a postoje zdravotnických profesi onálů. ČGR 2009; 7 (1): 14– 21.
16. van Ho uten P, Achterberg W, Ribbe M. Urinary incontinence in disabled elderly women: a randomized clinical tri al on the effect of training mobility and to ileting skills to achi eve independent to ileting. Gerontology 2007; 53 (4): 205– 210.
17. Landi F, Cesari M, Russo A et al. Potenti ally reversible risk factors and urinary incontinence in frail elderly pe ople living in community. Age Ageing 2003; 32 (2): 194– 199.
18. Zmrhal J, Topinková E. Inkontinence moči u žen vyššího věku, di agnostika a léčebné možnosti. Postgrad Med 2004; 6 (3): 47– 56.
19. Fink HA, Taylor BC, Tacklind JW et al. Tre atment interventi ons in nursing home residents with urinary incontinence: a systematic revi ew of randomized tri als. Mayo Clin Proc 2008; 83 (12): 1332– 1343.
20. Department of He alth. Go od practice in continence services. London 2006. [www.doh.gov.uk/ continenceservices.htm]. Přístup z 29. 12. 2008.
21. Eustice S, Roe B, Paterson J. Prompted vo iding for the management of urinary incontinence in adults. Cochrane Database Syst Rev 2000; 2: CD002113.
22. Schnelle JF, Alessi CA, Simmons SF et al. Translating clinical rese arch into practice: a randomized controlled tri al of exercise and incontinence care with nursing home residents. J Am Geri atr Soc 2002; 50 (9): 1476– 1483.
23. Hanuš T. Epidemi ologi e inkontinence moči. Urolog listy 2004; 2 (1): 14– 18.
24. Zmrhal J, Zmrhalová B, Záhumenský J. Inkontinence u žen nejen ve vyšším věku. Postgrad Med 2008; 10 (7): 753– 759.
25. Kučera Z, Topinková E, Jurásková D et al. Inkontinence v ošetřovatelském kontextu. Sestra 2009; v tisku.
Labels
Geriatrics General practitioner for adultsArticle was published in
Czech Geriatric Review
2009 Issue 2
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