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What Works to Improve and Manage Fecal Incontinence in Care Home Residents Living With Dementia? A Realist Synthesis of the Evidence

Buswell, Marina; Goodman, Claire; Roe, Brenda; Russell, Bridget; Norton, Christine; Harwood, Rowan; Fader, Mandy; Harari, Danielle; Drennan, Vari M.; Malone, Jo Rycroft; Madden, Michelle; Bunn, Frances

Authors

Marina Buswell

Claire Goodman

Brenda Roe

Bridget Russell

Christine Norton

Mandy Fader

Danielle Harari

Vari M. Drennan

Jo Rycroft Malone

Michelle Madden

Frances Bunn



Abstract

The prevalence of fecal incontinence (FI) in care homes is estimated to range from 30% to 50%. There is limited evidence of what is effective in the reduction and management of FI in care homes. Using realist synthesis, 6 potential program theories of what should work were identified. These addressed clinician-led support, assessment, and review; the contribution of teaching and support for care home staff on how to reduce and manage FI; addressing the causes and prevention of constipation; how cognitive and physical capacity of the resident affects outcomes; how the potential for recovery, reduction, and management of FI is understood by those involved; and how the care of people living with dementia and FI is integral to the work patterns of the care home and its staff. Dementia was a known risk factor for fecal incontinence (FI), but how it affected uptake of different interventions or the dementia specific continence and toileting skills staff require, were not addressed in the literature. There was a lack of dementia-specific evidence on continence aids. Most care home residents with FI will be doubly incontinent; there is, therefore, limited value in focusing solely on FI or single causes, such as constipation. Medical and nursing support for continence care is an important resource, but it is unhelpful to create a distinction between what is continence care and what is personal or intimate care. Prompted toileting is an approach that may be particularly beneficial for some residents. Valuing the intimate and personal care work unqualified and junior staff provide to people living with dementia and reinforcement of good practice in ways that are meaningful to this workforce are important clinician-led activities. Providing dementia-sensitive continence care within the daily work routines of care homes is key to helping to reduce and manage FI for this population.

Journal Article Type Article
Publication Date Sep 1, 2017
Journal Journal of the American Medical Directors Association
Print ISSN 1525-8610
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 18
Issue 9
Pages 752-760.e1
APA6 Citation Buswell, M., Goodman, C., Roe, B., Russell, B., Norton, C., Harwood, R., …Bunn, F. (2017). What Works to Improve and Manage Fecal Incontinence in Care Home Residents Living With Dementia? A Realist Synthesis of the Evidence. Journal of the American Medical Directors Association, 18(9), 752-760.e1. https://doi.org/10.1016/j.jamda.2017.05.025
DOI https://doi.org/10.1016/j.jamda.2017.05.025
Keywords General Nursing; Health Policy; General Medicine
Publisher URL https://www.sciencedirect.com/science/article/pii/S1525861017303043
Additional Information The date of acceptance is estimated.

This article is maintained by: Elsevier; Article Title: What Works to Improve and Manage Fecal Incontinence in Care Home Residents Living With Dementia? A Realist Synthesis of the Evidence; Journal Title: Journal of the American Medical Directors Association; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.jamda.2017.05.025; Content Type: article; Copyright: © 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

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