| dc.description.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existing research on the matter is outdated and suffers from poor study designs.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. | nb_NO |
