Understanding incontinence in the older person in community settings

Problems of the bladder, bowel or both are common in the community setting and are challenging issues for affected individuals, carers and healthcare staff to manage. Within the UK, an estimated 14 million individuals have urinary incontinence (NHS England, 2018), and over 6.5 million adults have bowel control problems (Yates, 2017; NHS England, 2018), with 1 in 10 affected by faecal incontinence. Nearly two thirds of people with faecal incontinence also have urinary incontinence, a condition known as ‘double incontinence’ (NICE, 2015b). Faecal incontinence is closely associated with age, and it is more prevalent in residential or nursing homes, with 1 in 3 individuals in residential homes and 2 in 3 individuals in nursing homes affected (NICE, 2015b; NHS England, 2018). However, these statistics are probably an underestimation given the stigma associated with the condition and its consequent under reporting (Bedoya-Ronga and Currie, 2014). Although the incidence of incontinence is known to increase with age, it is not an inevitable part of the ageing process (Day et al, 2014). Older people may be more prone to continence issues for a number of reasons, for example, multiple morbidies such as stroke and dementia, mobility problems, or polypharmacy, which can affect both bowel or bladder function. Additionally, the muscles of the bladder age and begin to malfunction, the prostate enlarges in men and weak pelvic floor muscles result in proplapse. These can have negative effects on an individual's physical and emotional wellbeing and can contribute to anxiety, depression and loss of personal relationships (Yates, 2017); increase susceptibility to urinary infections and falls; and can cause incontinence-associated dermatitis. There is certainly scope to address and improve or manage some of these issues more appropriately. This article looks at these points in depth.