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

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 However, the existing research on the matter is outdated and suffers from poor study designs.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