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Supporting the continence of people living with dementia in hospital

NIHR-funded researchers are changing the course of continence care for people living with dementia in hospital after finding that usual care cultures are promoting incontinence.

Published: 26 July 2023

Hospital admission linked to incontinence for people living with dementia

People living with dementia are one of the largest populations within our hospitals and account for over two thirds of emergency hospital admissions. However, their admission to hospital is associated with the serious but preventable complication of hospital-acquired incontinence. Over a third will have developed urinary incontinence at discharge.  

Professor Katie Featherstone, Director of the Geller Institute of Ageing and Memory, University of West London and an NIHR-funded researcher, said: “Urinary incontinence is an avoidable harm of hospitalisation that has significant implications for people and their families. Once a person living with dementia is assessed as incontinent, then they may not be able to return home.”

Hoping to resolve the lack of research around continence care for people living with dementia, Professor Featherstone secured a £500,000 award from the NIHR Health and Social Care Delivery Research Programme. Her project aimed to identify how hospital care could be changed to improve the experiences and outcomes of people living with dementia and their families.

Continence care approaches affect independence

Over the course of a year, Professor Featherstone, Dr Andy Northcott and the team from the Geller Institute of Ageing and Memory, University of West London carried out detailed research examining the organisation and delivery of continence care for people living with dementia in acute medical units and wards across England and Wales.

Their findings, published in Health and Social Care Delivery Research, showed that continence care was dominated by ‘pad cultures’. This refers to the everyday use of single-use disposable continence pads for people living with dementia regardless of their continence status and independence.

Their work and recommendations were also discussed in an NIHR Evidence review, highlighting the need to train hospital staff to respond sensitively to their patients’ needs. It also noted how high-quality continence care may save NHS resources and avoid patients moving into care homes prematurely. 

Making continence care central to hospitals’ dementia care

Professor Featherstone collaborated with the BBC to translate the research into a powerful radio documentary, ‘The Final Indignity', and to discuss their findings in a Radio 4 interview. It quickly became top trending content on BBC News Online and resulted in a powerful and heartfelt public response.

Prior to this project, the All-Party Parliamentary Group (APPG) for Bladder and Bowel Continence Care was unaware of the need to prioritise the continence care needs of people living with dementia. In November 2022 the Group invited Professor Featherstone to contribute to their meeting and responded by announcing the ‘Misuse of incontinence pads and appliances’ as a priority area.

The team also prepared a briefing for Andrew Selous MP as the Chair of the June 2023 Westminster debate on ‘Bladder and bowel continence care’. Referring to the research, he highlighted “some very upsetting accounts of patients trying to leave the bedside to reach the toilet who were not allowed to do so.”

During the debate, the Minister of State for Health and Secondary Care, Will Quince MP, offered to meet with the APPG, NHS England and officials in the Department of Health and Social Care to discuss this issue.

As well as working with the APPG, Professor Featherstone continues to collaborate with wards and senior nursing teams within hospital trusts, using the research to improve continence care. 

“We need to increase awareness, at the hospital level, of the importance of continence care as the foundation of high-quality dignified care. It has been invisible but through our research, changes are being made to support hospitals to put it at the heart of delivering care.”

Professor Katie Featherstone, lead researcher

The study was funded by the NIHR Health and Social Care Delivery Research Programme.

More information about the study is available on the NIHR’s Funding & Awards website.

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