Improving management of urinary incontinence in geriatric centres and nursing homes. Victorian Geriatricians Peer Review Group

Abstract

Objective: To study prevalence and management of urinary incontinence in institutes and to recommend improved strategies of managing this problem.

Method: A one-day census of ten geriatric assessment and rehabilitation services and nursing homes was undertaken to estimate the extent and management of urinary incontinence in Victoria. The definition of incontinence was extended to include patients with 'dependent continence', i.e. being dry of urine only as a result of being reminded or physically assisted.

Results: A total of 1659 patients, comprising 333 short-stay and 1326 nursing home type patients, was surveyed. The mean age was 77 and 81 years respectively. Only 43% and 23% of these patients respectively were independently continent, whilst 26% and 11% respectively of all patients were dependent continent. Incontinence occurred once or more per day in 85% of these patients and had usually been present for at least one month. There was a high association between incontinence and physical and mental infirmity. Dependent continent patients were as physically handicapped as their wet counterparts. A diverse range of management strategies, including various toileting programmes, was employed to deal with the incontinence. It is concluded that urinary incontinence is more common than reported in previous studies, largely as a result of the additional group of patients with dependent continence, a condition that often can be achieved. Proposed management protocols are outlined which aim to define different population subgroups that might respond more effectively to the various interventions available. The need for follow-up appraisal of these interventions is emphasized.