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OBJECTIVES: Anal incontinence (AI) is a distressing condition with grave impact on many aspects of life, including quality of life (QoL), social life and sexual activities. This study explored how AI and bowel symptoms impact QoL in a Norwegian population by (1) describing the psychosocial and sexual consequences of AI, and (2) investigating factors most often associated with AI-specific QoL. MATERIALS AND METHODS: A cross-sectional study among patients with AI referred to hospital outpatient clinics was conducted. A Norwegian version of ICIQ-B was used to measure bowel control, bowel symptoms, sexual impact, and impact on QoL. RESULTS: A total of 208 persons with AI completed the questionnaire. The results demonstrated that these patients are overall embarrassed, make plans according to the bowels, ensure the presence of a nearby toilet, and many abstain from sexual activities. After adjusting for other variables included in a multivariable model, we found that having bowel accidents on one's mind had the greatest relative impact on QoL, followed by lower bowel control, using more medications to stop bowels, having more pain/soreness around the back passage, lower age, and more straining to open the bowels. CONCLUSIONS: AI has substantial consequences for the psychosocial function and sexual activities of persons with AI. This study indicates that worrying about potential faecal accidents and the social stigma associated with this have greater impact on QoL than actual bowel leakages. Future studies should therefore focus on the emotional burden, patient coping, and health education related to bowel function and AI.
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BACKGROUND: Elder abuse in nursing homes (NH) is a widespread and complex problem. Residents' ability to share their experiences are impeded, due to a high degree of cognitive problems and frailty, and previous studies are thus mainly based on reports from staff. Therefore, we aimed to give voice to the residents by investigating their relatives' experiences with elder abuse in NH. METHODS: Qualitative individual interviews were conducted with 16 relatives of residents with experience of abuse and/or neglect in NH. Content analysis was used to analyse the data. RESULTS: Relatives perceived neglect as most pervasive and staff-to-resident psychological abuse as a key problem. Physical abuse was mostly related to resident-to-resident aggression. Relatives perceived elder abuse in NH to be related to low competence among staff, low staffing, poor NH leadership, working cultures characterized by fear and loyalty to employer or co-workers, and a lack of individualized care for the residents. Furthermore, relatives themselves experienced maltreatment from NH, which caused them to suffer stress, anxiety and distrust. Relatives also expressed a need to compensate for lack of care. CONCLUSIONS: Relatives of NH residents who had experienced abuse reported that neglect of basic care and individual rights was predominant and viewed organizational explanations as most important. Relatives perceive themselves as collaborators in care and are emotionally attached to their family member. Therefore, if relatives experience resident abuse or neglect, it inflicts a feeling of being mistreated themselves, particularly if they are not listened to or their notice of abuse on the part of the resident is ignored or trivialized. Including relatives in a committed partnership with NH in care practices is not only a valuable path to reduce the risk of abuse, but it also leads to a more sustainable healthcare with high standards of quality and safety.
Subject(s)
Elder Abuse , Nursing Homes , Aged , Family , Humans , Norway/epidemiology , Qualitative ResearchABSTRACT
AIM: To explore prevalence and associations of faecal incontinence among nursing home patients, to examine the effect of clustering of observations and to study the variation in faecal incontinence rates on both the level of nursing home units and individual patients. BACKGROUND: Faecal incontinence affects 40-55% of the patients in nursing homes and is associated with increased risk of morbidity and reduced quality of life. There is a lack of studies investigating faecal incontinence with validated instruments. More studies need to include models of analyses that allow for clustering of observations. DESIGN: Cross-sectional. METHODS: Data on 261 patients from 20 nursing home units were collected during September-October 2014. The Norwegian version of the Resident Assessment Instrument for Long-Term Care Facilities was used. Mixed effect models were conducted. RESULTS: Prevalence of faecal incontinence was 42·1% or 54% depending on the frequency labelling chosen. The effect of clustering by nursing home unit was not statistically significant. Most of the variation in faecal incontinence rates was explained by differences in patient characteristics, the most important being deficiencies in activities of daily living, cognitive impairment, diarrhoea and not participating in activities. CONCLUSION: Nursing home patients should be offered individualized assessment and continence care matching their patient characteristics. The Resident Assessment Instrument for Long-Term Care Facilities is a useful instrument because of its' combination of a comprehensive range of individual items and scales allowing for comparison of immediate or long-term change in patients status. Studies evaluating interventions targeting faecal incontinence are warranted.
Subject(s)
Fecal Incontinence/epidemiology , Long-Term Care , Nursing Homes , Quality of Life , Activities of Daily Living , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , Norway , PrevalenceABSTRACT
OBJECTIVE: Older people resident in care homes often rely on staff for support relating to their activities of daily living, including intimate care such as continence care. Managing fecal incontinence can be challenging for both residents and care staff. We conducted this review to describe the prevalence, incidence, and correlates of fecal incontinence among care home residents. DESIGN: Systematic literature review. SETTING AND PARTICIPANTS: Older care home residents (both nursing and residential care) aged 60 years and older. MEASURES: We defined double incontinence as the presence of fecal plus urinary incontinence, isolated fecal incontinence as fecal incontinence with no urinary incontinence, and all fecal incontinence as anyone with fecal incontinence (whether isolated or double). The CINAHL and MEDLINE databases were searched up to December 31, 2017, to retrieve all studies reporting the prevalence and/or incidence and correlates of fecal incontinence. RESULTS: We identified 278 citations after removing duplicates, and 23 articles met the inclusion criteria. There were 12 high-quality studies, 5 medium-quality studies, and 6 low-quality studies. The medians for prevalence (as reported by the studies) of isolated fecal incontinence, double incontinence, and all fecal incontinence were 3.5% [interquartile range (IQR) = 2.8%], 47.1% (IQR = 32.1%), and 42.8% (IQR = 21.1%), respectively. The most frequently reported correlates of fecal incontinence were cognitive impairment, limited functional capacity, urinary incontinence, reduced mobility, advanced age, and diarrhea. CONCLUSIONS/IMPLICATIONS: Fecal incontinence is prevalent among older people living in care homes. Correlates included impaired ability to undertake activities of daily living, reduced mobility, laxative use, and altered stool consistency (eg, constipation or diarrhea) which are potentially amenable to interventions to improve fecal incontinence.
Subject(s)
Fecal Incontinence/epidemiology , Homes for the Aged , Nursing Homes , Aged , Aged, 80 and over , Humans , Incidence , PrevalenceABSTRACT
Introduction. Constipation is a common, bothersome, and potentially dangerous condition among nursing home (NH) patients. Between 50 and 74% of NH patients use laxatives. Objective. To study prevalence and associations of laxative use and constipation using the comprehensive Norwegian version of the Resident Assessment Instrument for Long-Term Care Facilities. Methods. Cross-sectional study. Patients from 20 NH units were included. Logistic regression was used to analyze the results. Data collected in NHs might be clustered. Consequently, the multivariable models were tested against a mixed effects regression model to investigate variance both on the level of patients and on the level of NH units. Results. In all, 261 patients were included. The prevalence of constipation was 23.4%, and 67.1% used laxatives regularly. Balance problems, urinary incontinence, hypothyroidism, and Parkinson's disease were associated with constipation. Reduced ability to communicate and number of drugs were associated with laxative use. Antidementia-drugs and being involved in activities 1/3 to 2/3 of daytime were protective factors for laxative use. Mixed effects analyses identified variance on the level of NH units as nonsignificant. Conclusion. Constipation and laxative use are common. Variance is mainly explained by different patient characteristics/health deficiencies. Hence, patients might benefit from individualized care to compensate for deficiencies.
ABSTRACT
BACKGROUND: Fecal incontinence has a high prevalence in the nursing home population which cannot be explained by co-morbidity or anatomic and physiological changes of aging alone. Our hypothesis is that fecal incontinence can be prevented, cured, or ameliorated by offering care staff knowledge of best practice. However, it is not clear which educational model is most effective. To assess the effect of two educational programs for care staff, we planned a three armed cluster-randomized controlled trial. There is a lack of research reporting effects of interventions targeting improved continence care processes in older patients. Thus, to improve the quality of the planned trial, we decided to carry out a pilot study to investigate the feasibility of the planned design, the interventions (educational programs) and the outcome measures, and to enable a power calculation. This paper reports the results from the pilot study. METHODS: Three nursing homes, representing each arm of the planned trial, were recruited. Criteria for assessing success of feasibility were pre-specified. Methods, outcome measures, acceptability, and adherence of the components of the intervention were evaluated by descriptive statistical analyses and qualitative content analysis of one focus group interview (n = 7) and four individual interviews. RESULTS: The main study is feasible with one major and some minor modifications. Due to challenges with recruitment and indications supporting the assumption that a single intervention with one workshop is not sufficient as an implementation strategy, the main study will be reduced to two arms: a multifaceted education intervention and control. The components of the multifaceted intervention seemed to work well together and need only minor modification. Important barriers to consider were sub-optimal use of skill-mix, problems of communicating important assessments and care plans, and isolated nurses with an indistinct nurse identity. CONCLUSIONS: Overall, the main study is feasible. The pedagogical approach needs to consider the identified barriers. Thus, it is essential to empower nurses in their professional role, to facilitate clinical reasoning and critical thinking among care staff, and to facilitate processes to enable care staff to find, report, and utilize information in the electronic patient record. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01939821.
Subject(s)
Fecal Incontinence/prevention & control , Fecal Incontinence/therapy , Homes for the Aged/organization & administration , Inservice Training/organization & administration , Nursing Homes/organization & administration , Nursing Staff/education , Adult , Female , Humans , Middle Aged , Norway , Pilot Projects , Practice Guidelines as Topic , Research DesignABSTRACT
BACKGROUND: Fecal incontinence has a high prevalence in the older population, which cannot be explained by comorbidity or the anatomical or psychological changes of aging alone. Fecal incontinence leads to a high economic burden to the healthcare system and is an important cause of institutionalization. In addition, fecal incontinence is associated with shame, social isolation and reduced quality of life. The importance of identifying treatable causes in the frail elderly is strongly emphasized. It is recommended that an assessment of fecal incontinence should be implemented as part of an evaluation of older patients. Although there is a substantial evidence base to guide choice of implementation activities targeting healthcare professionals, little implementation research has focused on the care of older people nor involved care processes or care personnel. This study is based on the assumption that fecal incontinence among nursing home patients can be prevented, cured or ameliorated by offering care staff knowledge of best practice through a multifaceted educational program. The primary objective is to test the hypothesis that a multifaceted educational program for nursing home care staff on assessment and treatment of fecal incontinence reduces patients' frequency of fecal incontinence. METHODS/DESIGN: The study is a two-armed, parallel cluster-randomized controlled trial. Primary outcome is the frequency of fecal incontinence among patients. Sample size calculations resulted in a need for a total sample of 240 patients. Twenty nursing home units in one city in Norway will be recruited and allocated to intervention or control by an independent statistician using computer-generated tables. The intervention is a multifaceted educational program. Units in the control arm will provide care as usual. The intervention period is 3 months. Data will be collected at baseline, 3, and 6 months. Data will be analyzed using mixed effect models with the cluster treated as a random effect. DISCUSSION: This study is the first randomized controlled trial specifically focusing on this neglected area. The result of the study will give evidence for best practice for continence care in nursing homes, and organizational advice concerning implementation strategies. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02183740 , registered June 2014.