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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, M; Goodman, C; Roe, B; Russell, B; Norton, C; Harwood, R; Fader, M; Harari, D; Drennan, VM; Malone, JR; et al. Buswell, M; Goodman, C; Roe, B; Russell, B; Norton, C; Harwood, R; Fader, M; Harari, D; Drennan, VM; Malone, JR; Madden, M; Bunn, F (2017) What Works to Improve and Manage Fecal Incontinence in Care Home Residents Living With Dementia? A Realist Synthesis of the Evidence. J Am Med Dir Assoc, 18 (9). 752-760.e1. ISSN 1538-9375 https://doi.org/10.1016/j.jamda.2017.05.025
SGUL Authors: Drennan, Vari MacDougal

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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.

Item Type: Article
Additional Information: © 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Keywords: Fecal incontinence, care assistants, care homes, constipation, dementia, nursing homes, older people, person-centered care, residential care, Geriatrics, 1117 Public Health And Health Services, 1103 Clinical Sciences
Journal or Publication Title: J Am Med Dir Assoc
ISSN: 1538-9375
Language: eng
Dates:
DateEvent
1 September 2017Published
30 August 2017Published Online
26 May 2017Accepted
Publisher License: Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0
PubMed ID: 28859818
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/109111
Publisher's version: https://doi.org/10.1016/j.jamda.2017.05.025

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