Doris Hägglund

A systematic literature review of incontinence care for persons with dementia : the research evidence

BACKGROUND Urinary/faecal incontinence in persons with dementia is a potentially treatable condition. However, which type of incontinence care is most appropriate for persons with dementia remains undecided. AIM The aim of this study was to perform a systematic review of literature on incontinence care in persons with dementia focusing on assessment/management and prevention. DESIGN A systematic search of the literature. METHOD The search was performed in the CINAHL, PubMed and Cochrane Library databases. RESULTS Of the 48 papers analysed, two were systematic literature reviews of management of urinary incontinence including persons with dementia. These reviews showed that the best-documented effect of toilet assistance for urinary incontinence in elderly persons with/without dementia had prompted voiding. However, prompted voiding in persons with dementia raises ethical concerns related to the persons integrity and autonomy. Timed voiding in combination with additional interventions like incontinence aids, staff training on the technique of transferring participants from bed to commode and pharmacological treatment decreased the number of urinary incontinence episodes in older persons with/without dementia. There is good scientific evidence that prevention of urinary incontinence in elders with/without dementia decreases incontinence or maintains continence. However, the evidence is insufficient to describe the state of knowledge of faecal incontinence. CONCLUSIONS Toilet assistance, including timed voiding in combination with additional interventions and prompted voiding, are the available evidence-based interventions; however, nursing incontinence care is an experience-based endeavour for persons with dementia. RELEVANCE TO CLINICAL PRACTICE There is a lack of evidence-based nursing interventions related to incontinence care for persons with dementia. More research is needed to show whether experience-based incontinence care is effective and which activities are most appropriate for persons with dementia. However, the practice of effective nursing will only be realised by using several sources of evidence, namely research, clinical experience and patient experience.

Changes in urinary incontinence and quality of life after four years : a population-based study of women aged 22-50 years

Objectives – To investigate (a) the incidence and remission rates of female urinary incontinence (UI), (b) changes in type of UI and quality of life (QoL), and (c) whether professional help had been consulted regarding UI. Design – A 4-year follow-up population-based cohort study. Setting – Surahammar, Sweden, a community of 10,500 inhabitants. Subjects – All 118 incontinent and 130 continent women aged between 22 and 50 years. Main outcome measures – Changes in type of UI were measured using the Detrusor Instability Score (DIS), which was used to distinguish between the stress incontinent and the urge incontinent women. Changes in QoL were measured using the SF-36 Health Survey. Results – The mean annual incidence and remission rates of UI were the same (4%). The majority of women (83%) reported unchanged UI after 4 years and 77% of these women had stress incontinence. At follow-up, the changes in QoL scores were significantly greater in five out of eight dimensions in the persistently incontinent group compared with the persistently continent group. QoL scores did not change significantly from baseline to the 4-year follow-up within the incidence and remission groups. Three of four women with UI had not sought professional help. Conclusions – At 4-year follow-up the type of UI is fairly stable in women below 50 years of age. The QoL decreases in five dimensions, but the clinical relevance of this might be questioned. Most women with UI had not sought professional help.

Nurse-led multidisciplinary programme for patients with COPD in primary health care: a controlled trial.

AIM To investigate the effects of a nurse-led multidisciplinary programme (NMP) of pulmonary rehabilitation in primary health care with regard to functional capacity, quality of life (QoL), and exacerbations among patients with chronic obstructive pulmonary disease (COPD). METHOD A 1-year longitudinal study with a quasi-experimental design was undertaken in patients with COPD, 49 in the intervention group and 54 in the control group. Functional capacity was assessed using the 6-minute walking test, and quality of life (QoL) was assessed using the Clinical COPD Questionnaire. Exacerbations were calculated by examination of patient records. RESULTS No significant differences were found between the groups in functional capacity and QoL after 1 year. The exacerbations decreased in the intervention group (n = -0.2) and increased in the control group (n = 0.3) during the year after NMP. The mean difference of change in exacerbation frequency between the groups was statistically significant after one year (p=0.009). CONCLUSIONS The NMP in primary care produced a significant reduction in exacerbation frequency, but functional capacity and QoL were unchanged. More and larger studies are needed to evaluate potential benefits in functional capacity and QoL.

The prevalence of urinary incontinence among women and men with chronic obstructive pulmonary disease in Sweden.

AIM The aims of the present study were to investigate the prevalence, characteristics and status of urinary incontinence among women and men with chronic obstructive pulmonary disease in primary health care. BACKGROUND Information on the prevalence of urinary incontinence in women and men with chronic obstructive pulmonary disease is scant. Such knowledge may be important to the development of care for patients with chronic obstructive pulmonary disease. DESIGN A questionnaire survey. METHOD The study included 391 women and 337 men, aged 50-75 years, with chronic obstructive pulmonary disease. A self-administered, evidence-based questionnaire for incontinence was used. A response rate of 66% was obtained, of which 89·3% had spirometry-confirmed chronic obstructive pulmonary disease, and most patients had been diagnosed with moderate (Stage II) chronic obstructive pulmonary disease. RESULTS The prevalence of urinary incontinence in women and men with chronic obstructive pulmonary disease was 49·6 and 30·3%, respectively. Women and men with urinary incontinence had a significantly higher body mass index than did women and men without urinary incontinence. The most common type of incontinence in women was stress incontinence (52·4%) and in men postmicturition dribbling (66·3%). Women with urinary incontinence had a higher presence of a symptomatic cough than did women without urinary incontinence (p < 0·001). On the whole, incontinence affected women more than men concerning experienced bothersomeness of incontinence (p < 0·001). More women than men with urinary incontinence refrained from activities (p < 0·021) and had sought help for incontinence (p < 0·012). CONCLUSION The present results indicate that urinary incontinence content should be included in care plans for patients living with chronic obstructive pulmonary disease. In addition, the results imply that nurses and physicians working in primary health care should ask patients with chronic obstructive pulmonary disease about urinary incontinence and then offer appropriate assessment and management of it. RELEVANCE TO CLINICAL PRACTICE In the context of primary health care, assessing and managing urinary incontinence should be included in care plans for patients living with chronic obstructive pulmonary disease.

Impact of cough and urinary incontinence on quality of life in women and men with chronic obstructive pulmonary disease

AIMS AND OBJECTIVES The aim of this study was to investigate the impact of cough and urinary incontinence on quality of life in women and men with chronic obstructive pulmonary disease in primary health care. BACKGROUND Existing information on the impact of cough and urinary incontinence on quality of life in patients with chronic obstructive pulmonary disease is scant. DESIGN A questionnaire survey. METHOD The study included 391 women and 337 men, aged 50-75 years, with chronic obstructive pulmonary disease. A self-administered questionnaire consisted of CCQ and SF-12 questionnaires. A response rate of 66% was obtained. Most patients had been diagnosed with moderate (Stage II) chronic obstructive pulmonary disease. RESULTS Women and men with urinary incontinence showed a significantly higher presence of symptomatic cough and phlegm production than did women and men without incontinence. Women with incontinence had a significantly higher burden of CCQ symptoms, functional and mental state than did women without incontinence. Concerning quality-of-life scores, women with incontinence had lower physical state scores (37·6 ± 10·4 vs. 41·4 ± 9·9; p < 0·001) and mental state scores (44·3 ± 10·2 vs. 47·1 ± 10·5; p < 0·007) than did women without incontinence. Men with incontinence had a significantly higher burden of CCQ symptoms and mental state than did men without incontinence. When examining the quality-of-life scores, men with incontinence had lower mental state scores than did men without incontinence (46·0 ± 9·7 vs. 49·8 ± 9·7; p < 0·001). CONCLUSION The present results indicate that cough and urinary incontinence lead to poor quality of life in women and men with chronic obstructive pulmonary disease. RELEVANCE TO CLINICAL PRACTICE In the context of primary health care, appropriate questions concerning urinary incontinence and quality of life should be included in care plans for women and men living with chronic obstructive pulmonary disease.

Effekten av tranbärsjuice och personalutbildning i vårdhygien för att förebygga urinvägsinfektioner inom särskilt boende

Cranberry juice is often given to elderly persons in nursing homes to prevent urinary tract infections; still there is little evidence to support its use. Basic hygiene routines are important for preventing urinary tract infections. The aim of this study was to investigate whether cranberry juice and staff education in hygiene care can prevent symptomatic urinary tract infections among elderly persons living in nursing homes. A quasi-experimental study with three intervention groups and one control group was conducted involving 257 elderly women and men. A total of 48 symptomatic urinary tract infections were documented over the six months of the study: 21 (43.7%) in the cranberry group, 11 (22.9%) in the control group, 9 (18.7%) in the cranberry/hygiene care group and 7 (14.5%) in the hygiene care group. These between-group differences were not statistic significant. Hence, our study showed no preventive effect from cranberry juice, alone or in combination with staff education in hygiene care, on the incidence of symptomatic urinary tract infections. However, more and better research with larger randomised trials or cranberry capsules is needed to study its potential use to prevent urinary tract infections in elderly persons.