This study aimed to measure the outcome of providing specialised continence nursing advice for 12 weeks to elderly female rest home residents in improving continence, reducing the costs involved in their care, and in improving their quality of life.
Completing bladder diaries proved quite difficult in this group of elderly women, and the voiding frequency was not changed by the treatment advised. However there was a small decrease in urine loss and a reduction in the number of pads used per week, both of which were statistically significant. This reflected in improvement in quality of life assessed by the ICIQ-UI, but not for the EQ-5D. Factors influencing quality of life are probably differ from those operating in a younger population. Educating the carers in appropriate pad usage and regular toileting also provided benefit to the study participants.
Off-study, 10-20 months after completion the study, the original 68 participants were contacted to assess durability of any improvements of the main study, but without continuing supervision. 10 had died and 17 had increased frailty or did not wish to participate further, leaving 41 for consideration of the longer-term effects.
The initial improvement in pad usage during the supervised study was not maintained in the longer-term unsupervised period. Participants used a mean of 24.3 pads a week, unchanged since the start of the study. The daily volume of urine loss was variable: it improved in 8/41 participants but worsened in 22/41.
It might be conjectured that longer-term outcomes would have been better with continuing expert continence advisor input for participants and carers. Some deterioration in continence and cognitive ability might be expected with time in this age group. It highlights the difficulty of conducting research in this population with an increasing frailty and high mortality.
Can admission to resthome care of community-dwelling elderly with incontinence, be delayed by pre-emptive provision of continence care? Regrettably there are as yet, no definable numerical criteria for admission to such care.
Written by: Ted Arnold