The management of continence is an important issue for residents in aged care facilities and one which needs handling effectively and discreetly in order to preserve the self respect of each individual. Incontinence can have an effect on a person's health, dignity, and independence and can also impact on the environment of the care facility. With this in mind, it is important to detect any incontinence issues because if these matters are left unaddressed then there is an increased risk of residents being exposed to skin irritations, infection and potentially a contaminated environment.

Continence assessment

Although a large majority of residents in aged care suffer from bladder and/or bowel problems, not all of them will need a comprehensive continence assessment, but those who do can be determined by an aged care nurse or carer filling in a continence screening form.  This form should be completed for all new residents, preferably within 48 hours of them being admitted and it should also be completed for existing residents whose status has suddenly changed from being continent to incontinent. Depending on whether any of the questions have been ticked with a “don't know” or a “yes” the bladder and bowel charts then need to be completed. The charts can be downloaded at http://www.bladderbowel.gov.au/assets/doc/CTRAC/ContToolEdGuide.pdf

3 Day Bladder Chart

Completing the 3 day bladder chart will give a a nurse valuable information to help her identify the time at which a resident is passing urine, the number and type of drinks being consumed, together with just how wet a resident is getting (if they are urine incontinent). In addition the chart can show the number of times a resident had pad/clothing changes as well as any particular circumstances in which the resident experienced urine incontinence.

7 Day Bowel Chart

Similar to the bladder chart, the 7 day bowel chart monitors on what day the resident had a bowel movement (whether it was on a day or night shift) and at what time. It also indicates whether the individual was faeces incontinent, the number of times they had to be changed when they were faeces incontinent, plus any specific circumstances which can be associated with the resident experienced faecal incontinence.

Filling in these charts is time consuming for aged care nurses and carers and there is a new device, the Simpad  which has recently hit the market that remotely monitors individuals for incontinence. It is likely to receive government funding for use in aged care facilities and will help give residents an improved quality of life, lower costs, and give the staff more time to attend to the other needs of their residents.

How to use the completed charts

Once the charts have been completed  the information can be used to see if any pattern is emerging. If there is a predictable pattern of voiding and of bowel movements, then a toileting programme can be tailored for that individual. If not, then put in place fixed toileting programme of say every three hours to try and pass urine and give the resident has plenty of opportunities to empty their bowels.

Some residents may require ongoing monitoring of their bowel movements to see if other medications may be needed, and for this you can use the Monthly Bowel Chart.


Encouraging all residents to take part in toileting sessions

Although it may not be possible to achieve continence for all residents, it is still important to encourage all residents to actively take part in toileting sessions so that they can remain as mobile and independent as possible. Naturally some residents may have medical conditions which render it difficult for them to know when they need the toilet and where the toilet is located. In this case, remind them on a regular basis and, if needs be, take them or point the way.

Being able to walk is vital for maintaining continence and walking to the toilet will also aid a person's mobility, especially if they sit for long periods of time. If a resident can't walk to the toilet or it is too risky or painful to allow them to do so, then you may have to look at alternatives such as absorbent pads, commodes, bedpans and urinals. Managing their clothing can also be a challenge so try and make sure they have clothing which is easy for them to undo. They may also need help getting on and off the toilet and in some cases, help with cleaning themselves afterwards. Pre-moistened wipes come in very handy.

You may have to adopt a separate continence plan for use during the night if there is a risk of them falling.

Various treatment options

The continence assessment plan also needs to include careful attention to nutrition, both food and drinks, and skin care. Finally, depending on the results of the assessment, different treatment options for incontinence can be discussed both with the resident, family, and/or with a specialist. These options include medication, bladder training, electrical stimulation, pelvic floor muscle training and referral to various health practitioners such as Geriatricians, Gynaecologists, Urologists and Continence Nurses.

Just remember that a residents continence status can change especially if their health worsens, so it is important to carry out regular reviews and update their continence care plan.

Resources: Deakin University – Continence Tools For Residential Age Care
© Department of Health and Ageing - Clinical IT in Aged Care Product Trial - Trial of a Continence Management System - Report