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

Grant, Robert; Drennan, Vari; Rait, Greta; Petersen, Irene; Iliffe, Steve

doi:10.1371/journal.pmed.1001505

Cited by 71 publications

(56 citation statements)

References 32 publications

(30 reference statements)

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“…In a UK General Practitioner database, when compared with those without a dementia diagnosis, dementia was associated with approximately three times the rate of diagnosis of UI. The incidence rates of first diagnosis per 1000 person-years at risk for UI in the dementia cohort, among men and women, respectively, were 42.3 [95 % confidence interval (CI) 40.9-43.8] and 33.5 (95 % CI 32.6-34.5) [24]. When assessed urodynamically, the majority of incontinence associated with dementia appears to be related to detrusor overactivity, resulting in urgency incontinence [25,26].…”

Section: Dementia and Incontinencementioning

confidence: 99%

Managing Urinary Incontinence in Patients with Dementia: Pharmacological Treatment Options and Considerations

et al. 2015

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Urinary incontinence and lower urinary tract symptoms are highly prevalent in late life and are strongly associated with dementia and frailty. Incontinence is extremely common among those living in long-term care and is most commonly due to urgency incontinence. Although national and international guidelines for continence care exist, they often fail to consider the complex comorbidity found in patients with dementia and are often not followed; continence practices in long-term care may promote rather than prevent incontinence. The majority of those with dementia living in the community can be managed successfully with standard treatments, both pharmacological and non-pharmacological; the expectations and aims of treatment of both the patient and their caregivers should be considered. A dementia diagnosis does not preclude management of incontinence, but treatment options may be more limited in those with advanced dementia who are unable to retain information and modify behaviors. High-quality data to guide the choice of pharmacological agent in those with dementia are lacking. Oxybutynin has been shown to have significant adverse cognitive effects, but data to support the use of trospium, solifenacin, darifenacin, and fesoterodine are limited. No data are available for mirabegron. Neither age, frailty, nor dementia should be considered a barrier to pharmacological management, but consideration should be given to the total anticholinergic load. Evidence to guide the treatment of incontinence in this vulnerable patient group is scarce, and available guidelines adapted for each individual's situation should be applied.

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Section: Dementia and Incontinencementioning

confidence: 99%

Managing Urinary Incontinence in Patients with Dementia: Pharmacological Treatment Options and Considerations

et al. 2015

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“…Faecal incontinence is likely to be more prevalent among CH residents living with dementia than in the general population. In a study of primary care patients, the rate of FI diagnosis was four times higher for people with dementia than in a matched group without a diagnosis of dementia, (Grant et al 2013) but these figures don't differentiate between FI and toileting difficulties. However, FI alone is relatively uncommon.…”

Section: Box 2 -Issues To Consider or Address For People Living With mentioning

confidence: 97%

Supporting people living with dementia and faecal incontinence

Russell

Buswell

Norton

et al. 2017

Br J Community Nurs

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“…The focus on avoiding or treating constipation may be exacerbating FI, and careful thought 13,14 Epidemiological studies have identified dementia as an independent risk factor for FI, [15][16][17] and a study of primary care patients found FI to be four times higher in people with dementia than in a matched community-dwelling sample with FI but without a diagnosis of dementia. 18 Studies suggest that the prevalence of FI in care homes is between 30% and 50%. 15,[19][20][21][22][23] The level of variation is believed to reflect differences in care and the way in which continence is defined (by frequency, amount and detection method) as well as the individual characteristics of older people.…”

Section: Conclusion and Implications For Health Carementioning

confidence: 99%

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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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

Cited by 71 publications

References 32 publications

Managing Urinary Incontinence in Patients with Dementia: Pharmacological Treatment Options and Considerations

Managing Urinary Incontinence in Patients with Dementia: Pharmacological Treatment Options and Considerations

Supporting people living with dementia and faecal 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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