Rationale: Urinary incontinence (UI) is highly prevalent in residents of long-term care (LTC) facilities. LTC residents with UI are more likely than those without UI to have comorbidities, polypharmacy, and increased healthcare resource utilization. Managing UI is burdensome and costly to LTC facilities with respect to staff time, incontinence product use, and quality measures. We evaluated the impact of UI on staff, residents, care processes, and quality measures in LTC settings.
Methods: A 70-question quantitative online survey was sent to directors of nursing (DONs). DONs were eligible if they worked for ≥1 year in a facility with ≥100 beds, where ≥80% were LTC beds. Survey topics included facility characteristics and resident care, incontinence product costs and burden, quality measures, and treatment (in the context of UI). Data are reported at an aggregate facility level and are presented descriptively.
Results: A total of 71 DONs completed the survey. The mean number of residents per facility was 115; 68% of residents were female, and 62% had UI. Of residents with UI, 40% were always incontinent, 81% consistently used UI products, and only 14% were treated with medication. About half (54%) of DONs considered UI product costs to be higher than other facility supplies. DONs reported that certified nursing assistants (CNAs) spend 56% of a shift managing UI needs (eg, assistance with toileting and incontinence products), and 59% reported that UI management is a cause of high CNA turnover. Resident falls occurred at a mean of 14.3 per month per facility, with 36% of falls occurring while accessing the bathroom. LTC quality measures reported as significantly impacted by UI included urinary tract infection and falls with major injury. A total of 74.6% of DONs were unaware of any link between anticholinergics and risk of cognitive side effects.
Applicability: Management of UI in LTC settings can be burdensome to facilities and staff. Low treatment rates, low awareness of treatment-related cognitive effects, high incidence of falls due to urinary urgency, and high CNA turnover highlight the need for improved understanding of treatment and management in this population.
Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.