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Understanding faecal incontinence in nursing home patients: Epidemiology and nurses’ management

Saga, Susan
Doctoral thesis
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URI
http://hdl.handle.net/11250/277721
Date
2014
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Abstract
Understanding faecal incontinence in nursing home patients: Epidemiology and

nurses’ management

Faecal incontinence is a common problem among nursing home patients. However, the

existing research on the matter is outdated and suffers from poor study designs. The

demographic changes in the coming decades entails an increasing number of elderly,

thus also an increasing number of nursing home patients; a growth which constitute

significant challenges for care provided in nursing homes.

The overall aim of this study was to assess the magnitude and mechanisms behind

faecal incontinence amongst nursing home patients. The methods comprise a

population-based cross-sectional study in which all nursing homes in one Norwegian

municipality were invited to participate. In addition, a qualitative focus group was

conducted in order to obtain a better understanding of the quantitative data regarding

registered nurses’ management of faecal incontinence and related bowel problems

among nursing home patients.

The response rate of the study was 90.3%. The prevalence rate for faecal incontinence

more often than once a month was 42.3%, whereas 41% of the patients had constipation

problems and 17.3% had diarrhoea or loose stool. Faecal incontinence was significantly

associated with diarrhoea, urinary incontinence, impaired cognitive function, length of

stay in nursing home between 4-5 years, dependency in feeding, dressing and mobility.

Needing some help for transfer between bed and chair was a protective factor for faecal

incontinence compared to patients who transferred independently.

The nursing home population was divided into four groups: Faecal incontinence only

(patients with urinary incontinence were excluded) (2.6%), urinary incontinence only

(patients with faecal incontinence were excluded) (31.8%), double incontinence

(patients with both faecal incontinence and urinary incontinence) (40.2%) and continent

(neither faecal incontinence nor urinary incontinence) (25.4%). Patients with faecal

incontinence only were associated with diarrhoea, less cognitive impairment and less

dependency in feeding and grooming. Patients with urinary incontinence only were

significantly associated with some dependency in activities of daily living, less diabetes

and less diarrhoea. Patients with double incontinence were significantly associated with dependency in activities of daily living, cognitive impairment, stroke, constipation,

diarrhoea, long-term care stay in nursing home and longer stay in nursing home.

Continent patients were significantly associated with higher age, less dependency in

activities of daily living, less cognitive impairment, less stroke, less Parkinson’s disease,

less constipation, less diarrhoea, short–term care stay in nursing home and short length

of stay in nursing home. A continuous variable «severity of incontinence» was

computed by frequency and amount of urinary leakage and frequency of faecal

incontinence. Severity of incontinence was associated with impaired cognitive function,

diarrhea, dependency in activities of daily living, length of stay in a nursing home and

increasing age.

Among patients with faecal incontinence, the main interventions were using

incontinence pads (88.9%) and fixed toilet schedules (38.6%). Among patients with

constipation problems, laxatives (66.2%), enemas (42%), dietary interventions (7.3%)

and manual emptying of faeces (6.3%) were used as interventions. Among patients with

diarrhea or loose stool, Loperamide (18.3%) and dietary interventions (20.1%) were

used as interventions. No interventions were carried out for 11.1% of the patients with

faecal incontinence, 20.5% of the patients with constipation and 63.4% of the patients

with diarrhoea or loose stool. The findings from the focus group interview confirmed

the quantitative findings regarding interventions used for bowel problems. In addition,

the focus group interview demonstrated that the registered nurses did not consider faecal

incontinence or diarrhea as significant problems among nursing home patients. There

was, however, a shared understanding among the interviewed registered nurses that

constipation was the patients’ main problem. Nursing management of bowel problems

were therefore mainly targeting prevention and management of constipation.
Publisher
NTNU
Series
Doctoral thesis at NTNU;2014:282

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