What Works to Improve and Manage Fecal Incontinence in Care Home Residents Living With Dementia? A Realist Synthesis of the Evidence

Abstract

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. Dementia was a known risk factor for fecal incontinence (FI), but how it affected uptake of different interventions or the dementia specific continence and toileting skills staff require, were not addressed in the literature. There was a lack of dementia-specific evidence on continence aids. Most care home residents with FI will be doubly incontinent; there is, therefore, limited value in focusing solely on FI or single causes, such as constipation. Medical and nursing support for continence care is an important resource, but it is unhelpful to create a distinction between what is continence care and what is personal or intimate care. Prompted toileting is an approach that may be particularly beneficial for some residents. Valuing the intimate and personal care work unqualified and junior staff provide to people living with dementia and reinforcement of good practice in ways that are meaningful to this workforce are important clinician-led activities. Providing dementia-sensitive continence care within the daily work routines of care homes is key to helping to reduce and manage FI for this population.

A concept analysis of dignity-protective continence care for care dependent older people in long-term care settings

“…After title and abstract screening, and removal of duplicates, 55 articles were reviewed at full-text level. From these, 18 articles [21,23,30,32,33,[68][69][70][71][72][73][74][75][76][77][78][79][80] (see Fig. 1 for the PRISMA flow chart) were included.…”

“…Among the eligible articles were three studies that were reported in two or more papers. Specifically, the 'FINCH' study was reported in three papers [69,70,77]. Similarly, Ostaszkiewicz reported on different aspects of the same Grounded theory study about providing continence care in Australian residential aged care homes (RACH) in three papers [32,72,73].…”

“…Seven of the included studies offered evidence about dignity from the perspectives of older people with continence care needs. Among these were a review of literature about residents' quality of life related to UI, their perspectives about being incontinent and care preferences [74], and a realist review to investigate care recipients' and other stakeholders' perspectives of what interventions work to reduce and manage FI in care homes in the UK [69,70,77]. In addition, we found two qualitative explorative descriptive studies: one of which examined the continence care preferences of people receiving palliative care [78] and the other explored how family relatives of older people in long-term residential aged care understand quality continence care [75].…”

The Prevalence, Incidence, and Correlates of Fecal Incontinence Among Older People Residing in Care Homes: A Systematic Review

“…Previous reviews on the prevalence of fecal incontinence (FI) have concentrated on community dwellers. 1,2 To facilitate planning and provision of quality continence care in care homes 3 (a collective term for nursing or residential care settings, or aged care, or skilled nursing facilities), there is a need to understand the prevalence, incidence, and correlates of FI within care homes.…”

“…15 An estimated 50% of older people living in care homes experience FI, compared with 18% of the general population. 19,22 FI may result in low self-esteem, stigmatization, 3 and feeling of social isolation, 23 and in some cases it predicts mortality. 24,25 Generally, people are embarrassed to discuss their experience of FI with health care professionals or even with friends and family, as it can be seen as a "taboo within stigma" 26 ; this is also the case in care homes.…”