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High-quality, personalised continence care for people with dementia must be a key priority, NIHR review finds

Senior woman sad in hospital stock photo iStock 481029605

Published: 21 June 2022

High-quality, personalised continence care for people living with dementia is essential for a good quality of life, the latest NIHR Evidence review shows. 

The review is part of a series that brings together NIHR research to provide actionable insights for practice, and shows  that:

  • Many people living with dementia at home, in care homes and in hospitals frequently do not receive adequate continence care. 
  • Continence care needs to be prioritised and improved including early continence assessment, better support for carers to manage continence problems. 
  • Professionals need training, and research is needed to provide them with more evidence-based interventions to call upon. 

Pad culture

One of the studies highlighted in the review, describes how continence care affects people in UK acute hospital wards who are living with dementia. 

This group of people make up 25% of all acute admissions, and numbers are increasing because of the UK’s ageing population.

The research is published in Health and Social Care Delivery Research and led by Professor Katie Featherstone, Professor of Sociology and Medicine, and Director of the Geller Institute of Ageing and Memory at the University of West London. It found evidence of ‘pad cultures’, the routine use of incontinence pads in the care of patients with dementia during a hospital admission, regardless of whether they were continent.

The study concludes there needs to be more investment in research to help improve training and education and to support hospitals deliver evidence-based, high-quality care. 

Professor Katie Featherstone, Chief Investigator for the study, said: “Continence care is an important but poorly understood feature of everyday care for people living with dementia. Identifying, assessing, and effectively supporting a person's continence can enable people living with dementia to maintain their dignity and improve their health. Our research found these ‘pad cultures’ had significant impacts on people living with dementia.”


The NIHR Evidence review also brought together NIHR evidence on improving continence care for people living with dementia at home or in residential care homes. The review’s recommendations included routine audit and assessment of the quality of continence care, including the use of pads, in all care settings and audits should be carried out in collaboration with specialist dementia care and continence teams. 

Professor Jill Manthorpe, Associate Director of the NIHR School for Social Care Research said: “People living with dementia have a right to live well and with dignity. This must be at the heart of caring for them. The findings from Professor Featherstone’s research demonstrates that assessing and managing continence problems can help many more people living with dementia to maintain their wellbeing and preserve their dignity. The NIHR  Evidence review shows high quality continence care may be able to save resources, avoiding costly hospital admissions and premature transitions to residential care.” 

The NIHR is supporting studies across the UK to help tackle dementia challenges including continence problems. Through research, the NIHR will be better able to help develop effective treatments and improve care. The NIHR has funded and supported 416 dementia research projects in the last five years, at a cost of £53,913,263. 148 projects are currently active.

Read our Themed Review

Listen to our podcast on continence care for people living with dementia

Read more about Professor Katie Featherstone's report in Health and Social Care Delivery Research

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