Environmental effects on incontinence problems in Alzheimer's disease patients

Namazi, Kevan H.; Johnson, Beth DiNatale

doi:10.1177/153331759100600604

Cited by 33 publications

(25 citation statements)

References 13 publications

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“…It resulted in a very simple, corridor-free environment. The evidence for the incorporation of good visual access on the unit-level scale is not strong (Elmstahl et al, 1997;Passini et al, 2000) but the dramatic effect of making an important amenity -the toilet -easily seen provides good supporting evidence for the concept (Namazi and Johnson, 1991a). …”

Section: Total Visual Accessmentioning

confidence: 99%

Long-term care for people with dementia: environmental design guidelines

Fleming

Purandare

2010

Int. Psychogeriatr.

159

128

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Background: A large and growing number of people with dementia are being cared for in long-term care. The empirical literature on the design of environments for people with dementia contains findings that can be helpful in the design of these environments. A schema developed by Marshall in 2001 provides a means of reviewing the literature against a set of recommendations. The aims of this paper are to assess the strength of the evidence for these recommendations and to identify those recommendations that could be used as the basis for guidelines to assist in the design of long term care facilities for people with dementia.Methods: The literature was searched for articles published after 1980, evaluating an intervention utilizing the physical environment, focused on the care of people with dementia and incorporating a control group, pre-test-post-test, cross sectional or survey design. A total of 156 articles were identified as relevant and subjected to an evaluation of their methodological strength. Of these, 57 articles were identified as being sufficiently strong to be reviewed.Results: Designers may confidently use unobtrusive safety measures; vary ambience, size and shape of spaces; provide single rooms; maximize visual access; and control levels of stimulation. There is less agreement on the usefulness of signage, homelikeness, provision for engagement in ordinary activities, small size and the provision of outside space.Conclusions: There is sufficient evidence available to come to a consensus on guiding principles for the design of long term environments for people with dementia.

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Section: Total Visual Accessmentioning

confidence: 99%

Long-term care for people with dementia: environmental design guidelines

Fleming

Purandare

2010

Int. Psychogeriatr.

159

128

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“…In nursing homes, more than half of residents may be incontinent [3] [5]. The prevalence of UI in nursing homes is associated with environmental factors [7] [8] [9], immobility and medical diseases, such as diabetes mellitus, stroke and dementia [5].…”

Section: Introductionmentioning

confidence: 99%

Nursing Staff’s Experiences of Providing Toilet Assistance to Elderly Nursing Home Residents with Urinary Incontinence

Hägglund¹,

Momats²,

Mooney³

2017

OJN

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Introduction: Urinary incontinence is a common condition among elderly. It affects their daily life and quality of life. Toilet assistance may decrease urinary incontinence episodes among elderly. Many nursing home residents do not receive the available evidence-based toilet assistance they need. Aim: The aim of the present study was to describe nursing staff members' experiences of providing toilet assistance to elderly nursing home residents with urinary incontinence. Design: A descriptive design with a qualitative content analysis method was used. Method: Four nurses and seven auxiliary nurses were interviewed in three homogenous focus groups. Data were collected during spring 2015. Results: The most essential opportunity factor for good toilet assistance was the nursing staff's attitude and behavior regarding the elderly's need to visit the lavatory. This resulted in individual toilet assistance in which the elderly's integrity and needs were cared for. Functioning routines and sufficient staff availability were crucial in determining whether the elderly could visit the lavatory. Other enabling factors for good toilet assistance were information and education of staff. The main obstructing factors for good toilet assistance were the elderly's decreased cognitive ability, negative attitudes toward receiving toilet assistance and lack of communication and co-operation between professionals with regard to prescribing and fastening individual incontinence aids. Conclusion: Providing toilet assistance is a considerable nursing intervention for elderly to help them regain continence or contain incontinence, whenever possible. Person-centered incontinence care is important for developing and adjusting toilet assistance based on each older person's individual needs.

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“…It is the personalisation of the person's continence care and their environment and interpretation of behaviour from the person's viewpoint that takes precedence (Table 17). There were only two studies that designed dementia-specific continence interventions 158,159 and these were conducted in the early 1990s in an Alzheimer's disease unit. Another study, 160 from 1989, considered how the signs and symptoms of dementia affected nursing home residents' ability to engage with interventions to reduce and manage UI.…”

mentioning

confidence: 99%

“…We found two research papers on this topic, both from 1991. 158,159 In one small study 158 (14 participants, random allocation, crossover design and 9-day intervention) removing the visual barrier to the toilet in patients' rooms (taking away screens and visual barriers so that toilets were constantly visible) resulted in an eightfold increase in toilet use, but this may have also had the unintended consequence of causing potentially pathological frequency (every 9.8 minutes on average). Researchers placed tape on toilet seats and used detached tape to indicate toilet use.…”

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confidence: 99%

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Managing Faecal INcontinence in people with advanced dementia resident in Care Homes (FINCH) study: a realist synthesis of the evidence

Goodman

Norton

Buswell

et al. 2017

Health Technol Assess

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BackgroundEighty per cent of care home residents in the UK are living with dementia. The prevalence of faecal 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.ObjectiveTo provide a theory-driven explanation of the effectiveness of programmes that aim to improve FI in people with advanced dementia in care homes.DesignA realist synthesis. This was an iterative approach that involved scoping of the literature and consultation with five stakeholder groups, a systematic search and analysis of published and unpublished evidence, and a validation of programme theories with relevant stakeholders.Data sourcesThe databases searched included PubMed, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, Scopus, SocAbs, Applied Social Sciences Index and Abstracts, BiblioMap, Sirius, OpenGrey, Social Care Online and the National Research Register.ResultsThe scoping identified six programme theories with related context–mechanism–outcome configurations for testing. These addressed (1) clinician-led support, assessment and review, (2) the contribution of teaching and support for care home staff on how to reduce and manage FI, (3) the causes and prevention of constipation, (4) how the cognitive and physical capacity of the resident affect outcomes, (5) how the potential for recovery, reduction and management of FI is understood by those involved and (6) how the care of people living with dementia and FI is integral to the work patterns of the care home and its staff. Data extraction was completed on 62 core papers with iterative searches of linked literature. Dementia was a known risk factor for FI, but its affect on the uptake of different interventions and the dementia-specific continence and toileting skills staff required was not addressed. Most care home residents with FI will be doubly incontinent and, therefore, there is limited value in focusing solely on FI or on single causes of FI such as constipation. Clinical assessment, knowledge of the causes of FI and strategies that recognise the individuals’ preferences are necessary contextual factors. Valuing the intimate and personal care work that care home staff provide to people living with dementia and addressing the dementia-related challenges when providing continence care within the daily work routines are key to helping to reduce and manage FI in this population.LimitationsThe synthesis was constrained by limited evidence specific to FI and people with dementia in care homes and by the lack of dementia-specific evidence on continence aids.ConclusionsThis realist synthesis provides a theory-driven understanding of the conditions under which improvement in care for care home residents living with dementia and FI is likely to be successful.Future workFuture multicomponent interventions need to take account of how the presence of dementia affects the behaviours and choices of those delivering and receiving continence care within a care home environment.Study registrationThis study is registered as PROSPERO CRD42014009902.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Environmental effects on incontinence problems in Alzheimer's disease patients

Cited by 33 publications

References 13 publications

Long-term care for people with dementia: environmental design guidelines

Long-term care for people with dementia: environmental design guidelines

Nursing Staff’s Experiences of Providing Toilet Assistance to Elderly Nursing Home Residents with Urinary Incontinence

Managing Faecal INcontinence in people with advanced dementia resident in Care Homes (FINCH) study: a realist synthesis of the evidence

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