Incontinence management
::
::
::
::
::
::
::
::
::
::
::
::
::
::
|
|
BETTER INCONTINENCE CARE NEEDED IN NURSING HOMES
Incontinent nursing home residents are among the frailest of the frail. Most have physical impairments that restrict their mobility and many suffer from dementia. Given the profound functional and cognitive losses they've experienced, you might think these residents would be poor candidates for prompted voiding programs that improve continence. Not so. A significant proportion of these severely impaired residents are motivated to stay dry. And that fact, perhaps more so than any other, dramatically demonstrates how important this personal care area is to nursing home residents. It restores a shred of dignity to lives that increasingly are insulted by loss.
Nursing home staff, on the other hand, view incontinence care as one of the most "onerous and difficult" aspects of their job, for reasons all of us can too easily imagine (1). It is also, they say, inordinately time consuming if done properly, which goes a long way-but not all the way-toward explaining why most nursing homes do it poorly.
Consider the facts:
- More than 50% of nursing home residents suffer from urinary incontinence, and most of them have both physical and cognitive problems that prevent them from independently using the toilet (2).
- The vast majority of these residents, 80%-90%, use diapers and some form of staff toileting assistance to manage incontinence (3).
- Incontinent residents need toileting assistance three to four times within a 12-hour period to stay dry (4-6).
- Studies show, however, that they are rarely toileted and are not changed after every wet episode (5,7). Staff normally change residents an average of 1.34 times per 12 hours and provide toileting assistance an average of .5 times, and very rarely more than twice a day.
Lack of staff time partly explains the latter findings, but lack of staff knowledge is another, often un-credited culprit. To make matters worse, this overlooked second problem can exacerbate the first.
(prev | next)
|
|
|
