Care indicators - Incontinence

Incontinence

Focus on Incontinence

Incontinence is frequently experienced by the elderly (Vinsnes et al., 2012). Incontinence can be subdivided into urinary, faecal and double incontinence. Urinary incontinence is an involuntary form of urine loss and can occur in various forms (Abrams et al., 2013). Faecal incontinence refers to involuntary loss of faeces. Persons suffering from double incontinence lose both urine and faeces involuntarily (National Collaborating Centre for Acute Care, 2007)

Prevalence

According to the LPZ study from 2013 the prevalence of urinary incontinence and faecal incontinence in general hospitals is 9.3% and 13.3% respectively. In special housing, care and welfare facilities the prevalence is no less than 46.5% for urinary incontinence and 30.1% for faecal incontinence (Halfens et al., 2013).

Incontinence is thus one of the most widespread health problems that often leads to a reduction in people’s quality of life. Practical and hygienic problems caused by incontinence are often associated with problems such as shame, stigmatisation, depression, limitations to daily life, limitations to sexual activity and reduced self-reliance. Incontinence also has significant economic consequences. The estimated costs of urinary incontinence are estimated to be 256 million euros in the Netherlands (Ministry of Health, Welfare and Sport), 333 million euros in Sweden and 1.2 billion euros in Germany (Schoberer 2009).

The following graph indicates that the prevalence of incontinency injuries has risen again slightly in special housing, care and welfare facilities (yellow) in 2014.

Prevalentie Incontinentie 2004-2013 (%)
Figure 1. Development of incontinence injuries from 2004-2014 according to the LPZ measurement (Halfens et al. 2014)

Incontinence injuries

Incontinence can lead to incontinency injury. In particular long-term skin contact with urine is frequently associated with skin injury. Incontinence injuries can be recognised by both the form and the colour of the injury. The corrosive effect of urine softens and macerates the skin. This leads to damage of the uppermost skin layers. Other characteristics include purple colour, oedematous/swollen skin and dampness of the skin. The location of the injury is also important. Incontinence injuries also occur where bony prominences do not form pressure points.

Pressure sores and incontinence injuries are often confused. It is important to distinguish between a pressure-related injury and an incontinence injury. An incontinence injury, also known as associated dermatitis, is a moisture injury that is often hard to distinguish from a pressure injury.

References

  • Abrams P, Cardozo L, Khoury S & Wein A eds. (2013).’Incontinence: 5th International Consultation on Incontinence, Publisher: International Consultation on Urological Diseases- European Association of Urology.
  • Beeckman D, Schoonhoven L, Verhaege S, Heyneman A & DeFloor T (2009).' Prevention and treatment of incontinence-associated dermatitis: a literature review', Journal of Advanced Nursing, vol. 65, no. 6, pp. 1141-1154.
  • Gray M (2010).'Optimal Management of Incontinence-Associated Dermatitis in the Elderly', American Journal of Clinical Dermatology, vol. 11, no. 3, pp.201-210.
  • Halfens RJG, van Nie NC, Meijers JMM, Meesterberends E, Neyens JCL, Rondas AALM, Rijcken S, Wolters SMP en Schols JMGA (2013). Rapportage Resultaten Landelijke Prevalentiemeting Zorgproblemen 2013. Maastricht: Maastricht University, oktober 2013.
  • National Collaborating Centre for Acute Car 2007. ‘The Management of Faecal Incontinence in Adults’. NICE Clinical Guidelines, No. 49.
  • Schoberer D (2009). Prävalenz und Management der Inkontinenz in österreichischen Krankenhäusern und Pflegeheimen - Ein Tabu wird thematisiert, Masterabschlussarbeit, Institut für Pflegewissenschaft Medizinische Universität Graz.
  • Vinsnes AG, Helbostad JL, Nyrønning S, Harkless GE, Granbo R Seim A (2012). 'Effect of physical training on urinary incontinence: a randomized parallel group trial in nursing homes’, Journal of clinical Interventions in Aging, vol. 7, pp. 45-50.
  • Zorgvoorbeter.nl: onderscheid tussen decubitus en incontinentie dermatitis. Retrieved 19 November 2015

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