Improving Continence Care for Older People

Vikky Morris is Chair of the BGS Bladder and bowels Special Interest Group. She will be speaking at the upcoming event Improving Continence Care in Older People on 21 September in Manchester.

1 in 3 women and 1 in 7 men over the age of 65 experience urinary incontinence. It is a significant problem associated with falls, fractures, social isolation, depression, urinary tract infections and moisture lesions. Faecal incontinence affects up to 10% of the population, although its prevalence is much higher in older people, nursing home residents (up to 60%), patients with cognitive impairment and neurological conditions. Numbers are also likely to be an underestimate due to the stigma attached to incontinence. Both urinary and faecal incontinence are associated with great expense, both personal and to the NHS (more than 2% of the NHS budget). In addition, in older people, incontinence is second only to dementia as a reason for admission to a residential or nursing home.

Incontinence is one of the geriatric giants but has only really become a focus for research and development of services in the last 20 years. It is still not really viewed as a potential ‘subspeciality’ interest for most geriatric SpRs, which is a shame. We have such fantastically rewarding jobs as geriatricians and it is really satisfying to help patients and their carers manage continence issues, as we really can make a difference, which is why my continence clinic is my favourite.

Many trainees do not get much exposure to continence training as there are not very many consultants with a specialist interest to teach them and there are very few training days specific to the subject. In addition, even if they have some knowledge, it is difficult to apply and prioritise this on every day hospital ward rounds with unwell patients, and it is therefore often neglected.

As geriatricians we come across lower urinary tract symptoms and/or bowel symptoms in a large number of our patients who have a variety of co-morbidities. In particular, we look after patients with Parkinson’s disease (75% of patients surveyed experience LUTS and many patients struggle with bowel symptoms), stroke, dementia, COPD, diabetes, and heart failure. Of course, we cannot forget the additive problems of polypharmacy and its impact on the bladder and bowel.

As such, geriatric SpRs, nurses working on elderly care wards or in the community with older patients, GPs and other allied health care professionals, should be advocating for better continence services for our patients. We understand the complexity of multi-morbidity, frailty and polypharmacy and therefore can consider holistically which treatments will have the biggest impact on improving symptoms and remove some of the stigma of incontinence.

At last year’s conference ‘ Improving Continence Care in Older People’, I asked the audience what they wanted from the next conference. They expressed their views and as a result we have tried to make the next conference fit your needs.

We will have sessions on faecal incontinence and bowel problems experienced by older people presented by Prof Barrett. In addition, we will learn that there are surgical options for older people with faecal incontinence, presented by Mr Mackey.

There is the opportunity for you to do a platform presentation. This is exciting as it is a chance to flesh out your CV and claim a presentation at a national conference. We have extended the deadline for presentations, so get to it and submit here!

I always feel that we as a community do not really know what is available to people in terms of urinary incontinence products, so we will be welcoming Prof Cottenden and Ms Macaulay who will be telling us all about what products are available and what might suit who! Ms Bathgate will be giving us the lowdown on bowel therapy and equipment.

Finally we have organised the option of ‘Assessing a patient in a continence clinic’ which you can take away and adapt for your clinics. You could also adapt it for ward-based assessments or to inform your local continence teams once you have made initial assessments. Sometimes giving the patient an opportunity to talk about their incontinence gives them an enormous sense of someone taking an interest, and this is the first step to helping them.

In parallel with this, we will be looking at ‘Delivering continence services to frail older people’ where there is the opportunity to explore setting up or influencing your local continence services, and who better to talk to us about this than Dr Orme, Dr Morse and Mr Robinson.

It promises to be an exciting day – so book now and I will see you in Manchester on 21st September.

Register for Improving Continence Care in Older People on 21 September in Manchester.

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