Article:
Incontinence in people living with dementia.
Year Published: 2024
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Incontinence in people living with dementia.
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How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis article goes over the importance of using a patient centered approach in managing incontinence and promoting continence. An assessment should be done to identify possible causes of incontinence such as poly-pharmacy, mobility issues, poor choice of containment device, a low toilet which makes it harder for the patient to swat down to, forgetfulness, and other items. At PSJMC we try to use a patient centered approach to accommodate each patient. We offer the patient a bedside commode if they have trouble walking all the way to the bathroom, we regularly check on the patient to see if they need to use the toilet (at a minimum during our hourly rounding), and we assess the patient to see if an incontinence containment device is more suitable for them. If the patient does not have control of their bladder then we can use a purewick for a female patient or a primofit for a male patient, but if the patient has some bladder control then we encourage them to use the toilet regularly. What we do at PSJMC are similar to the items suggested in the article.
Discuss the limitations of the article.
A criticism of this article is that it does not have data to show the success of the patient centered approach for continence promotion and incontinence management. There was no research study mentioned in the article to support the strategies mentioned.
I forgot to include my last name in my comment. I am Bethany Sobesto.
ReplyDeleteDiscuss the research question or main problem discussed in the study?
ReplyDeleteDementia and incontinence are prevalent in the aging population, but are neither deemed "normal". While incontinence is not caused by dementia, it is common due to reduced mental, cognitive, and physical mobility experienced by persons with dementia. Incontinence is also one of the biggest factors that cause a family to move their loved-ones with dementia into a 24-hour care facility due to the increase burden it creates for caregivers. With incontinence comes the increased risk of pressure ulcers, UTIs, catheterizations, and constipation which all put a person at an additional risk for hospital admission. This article suggests assessing the cause of a person's incontinence rather than chalking it up to simply having dementia, and ensuring that caregivers are promoting dignity in continence care.
How does this research article compare to our practice, policy and/or procedure?
While the recommendation to conduct a biophsychosocial continence assessment which considers the patient with dementia as a whole rather than making an assumption about the cause of their incontinence is one that we should absolutely take into consideration during our care, it does not change our procedures on how to manage the incontinence itself in the in-patient acute care setting. The most important thing we can do as clinicians for any incontinence is to ensure that it does not cause skin breakdown. Yes, it is important to get to the root cause if this is abnormal for the patient, but we still need to address the negative physical effects that can be caused by incontinence. I do think we could all do a better job at preserving the dignity of incontinent patients - we are all so used to placing purewicks and primofits and we most likely do not take enough time to think about what that does mentally/emotionally does to a patient (even if they are not oriented x4).
Dementia doesn't automatically equal incontinence. There are many reasons to assess the patient for their normal rather than assuming they can't control their bowels and bladder. And there are reasons we should avoid automatically putting them on a purewick and primofit, such as: leakage from the containment device can cause skin breakdown, the risk of infection, and possible agitation. If a patient routinely uses a toilet at home, it is better for their physical and mental health if allowed to use the toilet at the hospital. Moreover, the authors hope that this will encourage more professionals to identify and challenge the current extrinsic barriers that exist which prevent people living with dementia and their families from accessing the right continence care and support at the right time.
Deletediscuss the research question or main problem in the study.
ReplyDeleteThe article goes into great detail how incontinence and dementia are mutually exclusive and how one does not necessarily cause the other. I appreciate the discussion of the different causes of incontinence and also age- related changes that may impact a person's continence status. Also the article emphasizes that incontinence may go underreported as there is a stigma associated with dementia and incontinence. Also poorly managed incontinence can increase caregiver burden
What are the advantages to the proposed recommendations in the article?
I think the main points of the article can be applied to admission and discharge of the patient. Almost always when there is a change in health, mobility is affected which affects continence. It s important to address the cause/source of the incontinence for discharge and home care. What supplies are needed to maintain optimal continence? what help/support is provided at home to maintain skin integrity for incontinence issues. pt/family assessment and teaching is key.
Article #5- Incontinence in people living with dementia: Promoting a person-centered approach.
ReplyDeleteQ2- What are the advantages and disadvantages to the proposed recommendations in this article?
The authors of this article are promoting dignity in continence care and understanding the patients intrinsic and extrinsic factors and treating the patient as an individual and not one size fits everyone but rather a careful evaluation of the factors and interventions that improve outcomes. The authors have included charts and tables with useful information. Age-related changes that may impact continence are brain, bladder, muscles changes that sometimes we forget so the table is a nice review. What I thought would be very beneficial was a table labeled, “Signs that a person living with dementia may be experiencing problems with continence”. I think it would be very beneficial to make copies of this chart to give to care providers so that they have realistic expectations and can adjust the care accordingly.
Q4- Describe the method used by the author of the study.
This research article is an informative article designed to increase awareness of health-care providers to feel more confident and competent in sensitively exploring continence issues with clients and care providers to improve outcomes and design plan of care that reflects on an individual versus one-size fits everyone. The authors bring up some key points that specifically incontinence is not a normal part of dementia but that healthcare providers need to explore and determine the factors that are influencing the incontinence and interventions that could positively impact the client/ family/ care providers of these individuals. Overall, I believe the authors of this article have provided information that needed to be reinforced with health care providers.
How does this research article compare to our practice, policy and procedures?
ReplyDeleteThis article encourages patient centered care in relation to incontinence with a strong focus on assessment of patients to uncover potential reasons for incontinence. For hospitalized patients, the environment is regulated and, due to the hospitalization, the reasons for incontinence may be different than home due to acute illness and the unfamiliar environment. Treatment of incontinence in the hospital may be different then home, but some solutions such as bed side commodes and barrier creams can continue to the home setting.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital? Having a plan for incontinence for patients and families after hospitalization is important. The article does a great job of encouraging patient centered care and has great solutions. However, the reality of implementing such a plan relies on family and/or home caregivers.
Karen Caneday, RN, 6NE
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital:
ReplyDeleteThe article states that having dementia doesn't necessarily equate with being incontinent and that there are several types of incontinence: urge incontinence, stress incontinence, retention of urine, functional incontinence, and outflow obstruction. Incontinence is caused by intrinsic and extrinsic factors, such as mobility and caregivers that lack skills and knowledge about incontinence. The authors suggest that we make a thorough assessment of the patient's ability to control their bladder and bowels. What is the patient like at home, what is their normal? Do they have communication issues that can impact their ability to let their caregiver know when they need to go to the toilet? Perhaps the patient is having difficulty with mobility or taking medications that increase continence issues or cognitive impairment. Nurses should implement this assessment when admitting the patient so that we can better address any incontinence issues.
A diagnosis of dementia should not be a barrier for a person living with dementia in receiving equitable access to a person-centered continence assessment, management plan and products to meet their individual needs and the needs of those who care for them. Promoting continence should be seen as equal to, if not more important than, managing incontinence. There is a need for health and social care professionals to be more aware of the complex relationship between dementia and incontinence, and the intrinsic and extrinsic physiological, cognitive, and environmental factors that may impact on the person's ability to remain continent. By improving awareness, it is hoped that professionals will feel more confident and competent in sensitively exploring any continence issues to improve outcomes and enable more dignified person-centered care
DeleteHow does this research article compare to our practice, policy and/or procedure:
ReplyDeleteAt the hospital, we routinely put a patient on a purewick or primofit if there is any concerns for mobility issues. This is especially true of patients with dementia. One the one hand, nurses likely do this for the safety of the patient, we want to avoid falls or injury at all times. On the other hand, we may not be looking at the patient holistically. Dementia doesn't automatically equal incontinence. There are many reasons to assess the patient for their normal rather than assuming they can't control their bowels and bladder. And there are reasons we should avoid automatically putting them on a purewick and primofit, such as: leakage from the containment device can cause skin breakdown, the risk of infection, and possible agitation. If a patient routinely uses a toilet at home, it is better for their physical and mental health if allowed to use the toilet at the hospital.
1. discuss the research question or main problem in the study.
ReplyDeleteThe article goes into great detail explaining how dementia and incontinence are not always related to one another. I like that the various reasons of incontinence were covered, as well as how aging-related changes might affect a person's ability to maintain their continence. The article also highlights the possibility that underreporting of incontinence occurs because dementia and incontinence are stigmatized. Unmanaged incontinence might also result in a greater caregiver workload. What are the benefits of the suggestions made in this article? The article's primary ideas, in my opinion, are applicable to both patient admission and release. Mobility is almost always impacted when there is a change in health, and continence is impacted as well. Addressing the origin or cause of the incontinence is crucial.
2. What are the advantages and disadvantages to the proposed recommendations in this article?
The writers of this paper support the idea of treating patients with dignity in continence care, recognizing their internal and external influences, and treating each patient as an individual. They advocate for a thorough assessment of the interventions and circumstances that lead to better results rather than a one-size-fits-all approach. The writers have provided helpful information in charts and tables. The table provides a helpful summary of age-related changes to the brain, bladder, and muscles that may affect continence but are sometimes forgotten. I believed that a table with the title "Signs that a person living with dementia may be experiencing problems with continence" would be very helpful. Making copies of this chart and giving it to caregivers would, in my opinion, be very valuable in ensuring that they had reasonable expectations.
Luna Chowdhury
4 North
Discuss the research question or the main problem discussed in the article
ReplyDelete1. This study explores the relationship between dementia and incontenence and states that neither are an inevitable or normal part of the aging process. The article aims to improve outcomes for patients and families affected by dementia by raising awareness of some of the potential causes of incontenence vs accepting it as part of the dementia profile.
Advantages of the proposed recommendations are increased awareness of the causes of incontinence such as changes in the brain,
the muscles, changes in the bladder itself, increased risk of co
morbidities, and the possibility of medications causing incontenence.
Disadvantages: I don't see any disadvantage to assessing the etiology of incontenence, patient focused assessment and making changes if a reversible cause is identified. Although this does require a careful and thorough assessment which takes time on the part of the practitioner.
1. Discuss the research question or main problem discussed in the study?
ReplyDeleteThe main problem discussed in the study is the assumption that all patients with dementia are incontinent. The research discusses the need for accurate continence assessments and better caregiver education to improve the management of patients with dementia and incontinence. By addressing these issues, caregivers can provide more effective and individualized care, ultimately enhancing the quality of life for those affected.
2. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
Some advantages include implementing a structured toileting schedule and regular continence assessments, you can reduce the risk of skin breakdowns and pressure injuries, particularly in patients who cannot communicate their needs effectively. As well as preventing prolonged exposure to moisture to help in maintaining skin integrity, which is crucial for patients with limited mobility or cognitive impairment.
A disadvantage, allocating resources, such as time and staffing, to develop and maintain the toileting schedule may impact other areas of patient care. Another disadvantage would be an increase in falls. Encouraging patients with dementia to walk to the bathroom may increase the risk of falls, both within the hospital and at home.
1. What are the advantages and disadvantages of the proposed recommendations in the article?
ReplyDeleteThe advantage of using the proposed recommendations is that patient care would be individualized to patient specific needs. By using a patient centered approach/assessment early identification of potential complications could mean earlier treatment and more compliance with treatment.
A disadvantage of using a patient-centered assessment and individualized continence management require significant time and resources, which can be challenging in underfunded community settings. Also training staff would require additional education and time could be costly.
2. Describe the research method used by the author of the study.
This article likely used analytical, retrospective review methods to explore how incontinence impacts people living with dementia and how caregivers can implement person-centered strategies. By analyzing trends, identifying gaps in knowledge amongst healthcare professionals and making recommendations can help to promote increased continence rates in people with dementia.
(1)Describe the method used by the author of the study
ReplyDeleteThe article titled “Dementia and Incontinence: Bridging the Skills and Knowledge Gap” explores the complex interplay between dementia and incontinence, emphasizing the need for a person-centred continence assessment. The method employed in the study is largely qualitative, focusing on reviewing existing literature and expert opinions to highlight the gaps in skills and knowledge among healthcare professionals regarding the management of incontinence in people living with dementia. The study does not involve primary data collection or experimental intervention but rather provides a comprehensive overview of the current challenges and best practices. It underscores the importance of a holistic, biopsychosocial approach to continence care, which involves understanding the multifaceted nature of incontinence in dementia patients, including the physiological, cognitive, and environmental factors affecting their continence.
(2) Discuss the research question or main problem discussed in the study?
The main problem addressed in the study is the prevalent misconception that incontinence in individuals with dementia is an inevitable consequence of the disease and that nothing can be done to alleviate it. This belief often leads to inadequate assessment and management, adversely affecting the quality of life for both patients and their caregivers. The article argues that while dementia can influence continence, it is not the sole cause, and many other factors may contribute to incontinence. It advocates for a person-centred continence assessment to identify treatable causes and to develop strategies that promote continence and improve the dignity and wellbeing of people living with dementia. By addressing the skills and knowledge gaps among health and social care professionals, the study aims to improve the outcomes and care for this vulnerable population.
(1)
ReplyDeletewhat are the advantages and disadvantages to the proposed recommendations in the article?
advantages:
Person-centered approach: The article strongly advocates for a person-centered continence assessment and care plan for people living with dementia. This approach considers the individual's unique needs, circumstances, and preferences rather than making assumptions based solely on their dementia diagnosis.
Holistic assessment: The recommendations promote a comprehensive biopsychosocial assessment that considers physical, cognitive, environmental, and psychosocial factors affecting continence. This holistic view can lead to more effective interventions.
disadvantages:
Resource intensive: Implementing a comprehensive, person-centered assessment and care plan may require significant time and resources, which could be challenging in resource-constrained healthcare settings.
Complexity: The multifaceted approach recommended may be complex to implement consistently across different care settings and by various healthcare professionals.
(2)Discuss the research question or main problem discussed in the study?
The main problem discussed in this article is the complex relationship between dementia and incontinence, and the need for a person-centered approach to continence care for people living with dementia.
Specifically, the article addresses several key issues:
Prevalence: Both dementia and incontinence are prevalent in older age, but neither is an inevitable part of aging. The article notes that there are currently about 944,000 older people living with dementia in the UK, projected to increase to 1.7 million by 2040.
Misconceptions: There's a common misconception that incontinence is solely a symptom of dementia, leading to inadequate assessment and care.
This comment has been removed by the author.
ReplyDelete1. what are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
ReplyDelete- The article recommends a person-centred approach to managing incontinence in people with dementia, which tailors care to individual needs and can improve treatment effectiveness and quality of life. This method helps identify underlying causes and prevents complications while also reducing caregiver strain and addressing stigma.
However, challenges include the need for more time, training, and resources, which can be difficult in under-resourced settings. There is also a risk of missing some causes of incontinence and potential resistance to changing established practices. Overall, while this approach offers personalized benefits, it requires careful management of resources and resistance.
2. Discuss the research question or main problem discussed in the study?
- The article examines the problem of managing incontinence in people with dementia, challenging the view that it is an unavoidable symptom of the condition. It questions whether incontinence solely results from dementia or if other factors, such as physical health issues, medication side effects, and environmental conditions, also play a role. The article advocates for a person-centered approach, which involves individualized assessments to address underlying causes and improve quality of life. By moving beyond the assumption that incontinence is inevitable, it aims to enhance care practices and support for both individuals with dementia and their caregivers.
1. Discuss the research question or main problem in the study
ReplyDeleteOlder patient and dementia patient will experience incontinence. There is a skills and knowledge gap in professionals assessing and managing incontinence for people living with dementia. Patient experiencing dementia can impact their ability to remain continent. Therefore, a person continence assessment should be undertaken to promote continence and reduce the impact of incontinence for people living with dementia and those who care for them.
2. Discuss the sample size used in the study.
Currently there is an estimate of 944 000 older people living with dementia in the UK. Out of 944,000 older people; 593 200 of those people are living with advanced symptoms . The total number of people living with dementia is assume to increase significantly to approximately 1.7 million people by 2040. There is a estimation about 30–40% of people aged over 65 years experience episodes of urinary incontinence, increasing to between 60–70% in people living in care homes.
1) Discuss the research question or main problem in the study:
ReplyDeleteThe main problem in the study is the gap in assessing and managing incontinence by professionals for people with dementia. It appears that there is a misconception that incontinence is a symptom of dementia and that nothing can be done. The study highlights that it is important for healthcare to identify, assess, and manage incontinence. Poorly managed incontinence can be a significant issue with people living with dementia, their families and their caregivers.
2) Discuss sample size:
This article does not specify sample size but currently there is about 944,000 older people living with dementia in UK and 593,200 of those are living with advanced symptoms. It is projected that by 2040, there will be an increase of approximately 1.7 million.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThe article addressed the significant issues of incontinence among patients with Dementia. It suggests that many people think people with dementia are incontinent and as caregivers we need to identify and assess ones need. A person-centered assessment should consider what’s normal for the individual, including their usual bowel and bladder routines and any recent changes. It’s important to look at their medical history, current medications, and whether they have any communication difficulties. Also, assess whether they need support with mobility or if their environment needs adjustments, like easier-to-reach toilets or helpful aids. In the hospital setting, patient-centered assessment are done upon admission by questioning the patient and/or their caregivers.
what are the advantages and disadvantages to the proposed recommendations in the article?
Managing incontinence is about supporting the person’s dignity and autonomy. Effective management can improve their social engagement, reduce financial and emotional burdens, and enhance relationships. It’s crucial to choose products that help maintain independence, such as easy-to-use clothing and accessible toilet. However for a caregiver fatigue can develop for someone who is caring for a dementia, high fall risk and has urge incontinence. Caregiver burden can lead to reliance on adult diapers as a quick fix for managing incontinence. However, addressing the root causes and exploring comprehensive care strategies can significantly improve both the quality of care and the caregiver’s well-being. By focusing on a combination of medical, environmental, and practical solutions, caregivers can better manage both incontinence and fall risk, reducing overall fatigue and enhancing the quality of life for those they care for.
1. Discuss the research question or main problem discussed in the study?
ReplyDeleteThe article discusses the population diagnosed with dementia and the relationship with incontinence. In essence, neither is a normal part of aging. The article suggests that although there may be some link between the two, it is not accurate to suggest incontinence is simply a part of life for those with dementia. Having this belief deters caregivers, family members, and so on from providing individual based plans to help those with dementia deal with episodes of incontinence that, more likely than not, have nothing to do with their dementia diagnosis.
2. What are the advantages and disadvantages to the proposed recommendations in the article?
Speaking from an ICU perspective, I would say the advantages would be to tailor the care plan to their individual needs to promote continence. Using table 4 as a reference would help to identify some problems that may be causing the episodes of incontinence as it is not as simple as saying “she has dementia which would explain the incontinence.” The disadvantages would be having those concerns relayed to other members of the team be dismissed due to a cost vs. benefits spreadsheet. As an RN we have quite a few responsibilities that must be done and sometimes the time limit is very real on trying to figure out the best possible solution for the patient; some items on the checklist (e.g. meds, assessments, orders, etc.) must be done while others that do not contribute directly to patient care sometimes do not even get to be put on the back burner due to time and / or fatigue by the RN.
1. What are the advantages and disadvantages of implementing the recommendations on my unit ? The authors emphasize that incontinence and dementia are not a normal part of aging. They recommend a person-centered assessment to promote continence. The advantages of this is to preserve and promote a patient’s dignity. Addressing and assessing each patient may help identify issues and help improve outcomes. I feel like the nurses at PSJMC do a good job of protecting and promoting dignity. The disadvantages of implementing this recommendation is the burden on the caregiver as it is a labor and time intensive investment. The advantages of preserving dignity and psychological well-being outweigh the disadvantages.
ReplyDelete2. Discuss the research question or main problem discussed in the study.
A person-centered continence assessment should be undertaken to promote continence and reduce the impact of incontinence for people living with dementia and those who care for them. Incontinence and dementia is one of the most influential factors in deciding whether to move a person with dementia into 24 hour care. The authors highlight it should not be assumed that incontinence is a consequence of dementia as it can be the result of many other causes. They further that incontinence and dementia are not a physical or biomedical phenomenon.
1. Discuss the research question or main problem discussed in the study.
ReplyDeleteThe main problem discussed in this study is that there is a skills gap in the assessment and management of incontinence in dementia patients. The authors point out that often when a patient shows signs of incontinence, it is too easily explained away by their dementia diagnosis. While the authors acknowledge that dementia may impact continence, there may be strategies to help reduce the incidence of it happening, especially if dementia is not the sole cause.
2. What are the advantages and disadvantages to the proposed recommendations in the article?
The advantage to the authors’ recommendations is that they are taking a “person-centered” approach. This helps the person doing the assessment understand any other contributing factors to the incontinence like diet, visual impairments, mobility issues, etc. A disadvantage to this person-centered approach is that the patient involved may not be the best historian due to their dementia. They may require a lot of external report to help with their incontinence and may not be able to follow through with the interventions on their own. For example, if the patient is having issues because they are visually impaired and can’t get to bathroom on their own, they need to be able to find their glasses consistently and put them on. If they have dementia, they may have issues with losing their glasses or lack the dexterity needed to put them on themselves.
1. Discuss the research question or main problem discussed in the study.
ReplyDeleteThis study highlights on some of the issues that are important for health and social care professionals to explore and identify, assess and manage incontinence to improve outcomes for families affected by Dementia. Dementia and incontinence are both prevalent in the older age, it is either inevitable or normal part of ageing. Most of the time we made assumptions that incontinence is a symptom of Dementia. While Dementia may impact on person's ability to remain continent, it may not be a sole cause, and there may be treatments and strategies that can the incidence of incontinence.
2. How does this research article compare to our practice, policy and/or procedure.
At Providence Saint Joseph Medical Center, we take care of patient that has a diagnosis and history of Dementia. Dementia is a diagnosis that describe a group of symptoms including memory impairment, mood disturbance, issues with communication, reduced cognition and social functioning, behavioral and personality changes which are caused by progressive neurodegenerative disorders. As the Dementia progresses to advance stage, patient are likely to experience increase cognitive and physical impairment, resulting in symptoms such as reduced mobility and limited ability to verbally communicate. Deteriorating function also increases the incidence or urinary and fecal incontinence.
As a bedside nurse, it is in our policy to assess and used a person centered continence assessment and manage a plan for a person living with Dementia. It should also be a part on our patient assessment to check on patients baseline, such as what is normal for this person? What is the usual bowel and bladder routine. Most of the time people living with Dementia are labeled as incontinent, and the primary focus on trying to contain urinary and fecal matter by using incontinence product rather than identifying and treating underlying causes of incontinence. Based on our knowledge and assessment, we address factors that might be causing incontinence for patient with Dementia, such as if patient able to verbally communicate their needs? Is the patient taking any medications that can cause them to urinate often such as diuretics. Is there any changes to patients diet that may cause them to have constipation or diarrhea. These factors are part of our assessment as a nurse.
1. Discuss the research question or main problem discussed in the study?
ReplyDeleteThe main problem discussed in this study is the topic of dementia and incontinence which as healthcare providers we see on the day to day basis. The article concentrates on managing incontinence in patients who are suffering from dementia. Some of the detailed points discussed includes the impact incontinence can have in the quality of life of patients with dementia. The inability to control bowel or bladder causes a distress in patients which hand in hand impact the cognitive and emotional difficulties the patients face. Secondly, it discusses some of the challenges the healthcare team faces in managing incontinence due to the cognitive impairment. However, it is important to understand that incontinence is not caused by dementia. People with dementia are likely to experience functional incontinence which occurs from the physical and environmental challenges. However, some of the other causes of incontinence can be due to stress, overflow, and outflow incontinence.
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
One of the limitations of this article is the fact that it does not specify the sample size of the study. Although the article discusses the importance of promoting patient dignity, it fails to discuss in successful methods that can be used as part of the healthcare to promote and encourage better person to person continence evaluation plan. If the study used a method of evaluation such as when using the Braden scale for evaluating skin, it would help nurses identify better how continence can be evaluated as a part of their assessment.
Describe the method used by the author of the study
ReplyDelete- this article used an analytical approach to analyze patients with dementia and the assumption that all experience incontinence.
Discuss the research question or main problem discussed in the study?
- It has been recognised that there is a skills and knowledge gap in professionals assessing and managing incontinence for people living with dementia. All too often, assumptions are made that incontinence is a symptom of dementia and that nothing can be done if a person living with dementia experiences episodes of incontinence. While dementia may impact on a person's ability to remain continent, it may not be the sole cause, and there may be treatments and strategies that can reduce the incidence in those affected
Describe the method used by the author of the study
Delete- this article used an analytical approach to analyze patients with dementia and the assumption that all experience incontinence. In the study they are emphasizing the need for a person-centred continence assessment. The study also focuses on comprehensive literature and not focused on a certain study group
1. What are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteManaging incontinence effectively is essential for maintaining a person’s dignity and autonomy, and it can have several positive outcomes which included improved social engagement, reduced financial and emotional burdens, the enhancement of relationships. Choosing appropriate products to support their independence will help tremendously. Addressing caregiver fatigue will help them from just relying on adult diapers as a quick fix rather than addressing and identifying the underlying issue. Instead of relying solely on absorbent products, exploring various care strategies can improve not only the quality of care the person receives, but it can help reduce the above mentioned caregiver fatigue. A few care strategies can include consulting healthcare professionals for appropriate medical treatments/interventions, modifying their living environment to make it safer and more accessible, as well as implementing strategies and products that support both the person’s independence and the caregiver’s well-being, as well as any associated fall risk.
2. Discuss the research question or main problem in the study
The main problem addressed in the study is the gap in assessing and managing incontinence for individuals with dementia. There are a few identifiable issues: misconception of incontinence as a dementia symptom, the need for comprehensive assessment and management. Poor management can exacerbate discomfort, reduce the quality of life, and negatively impact the daily functioning of an individual with dementia. Ineffective management can also lead to increased stress, burden, and challenges in caregiving, affecting both the emotional and practical aspects of the caregiver’s role. By improving assessment and management practices, healthcare providers can help mitigate the negative effects of incontinence on people with dementia, their families, and caregivers. This approach fosters better care outcomes and supports overall well-being for all involved.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis research article compares to our practice & policy as Saint Joseph's is a hospital that strives to provide their patients with as much dignity as possible to ease a patient in their healing journey. By nurses recognizing and understanding that being diagnosed with dementia does not always equal an incontinent patient, they are able to investigate what each patient's strengths and weaknesses in order build on those strengths to help these patients regain some of their independence and dignity when it comes to issues of continence. This also opens the door of discussion between the patient and their caregiver/family members in order to identify the dementia patient's needs at home, whether they be physical, psychosocial, or cognitive, as well as any additional needs that the caregiver or family member may need to help assist this patient.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
The advantages of implementing the articles recommendations are that patients with dementia will receive person-centered care that adhere to each individuals specific needs. This would allow bedside nurses to not assume dementia patients will be incontinent, which in turn allows patients to feel more dignity as they're able to discuss their issues and needs with their nurse & caregiver.
The disadvantages of implementing these recommendations is that more individualized care is a bit more time consuming. Unfortunately, most hospitals are understaffed and have more patients than nurses to care for, which limits the amount of time caregivers are able to spend with their patients to provide them specific individualized care.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe research question or main problem discussed in this study examines the assumption that incontinence is a symptom of dementia and the assumption that there is nothing to do to prevent it or address it. The assumption that incontinence cannot be avoided in patients with dementia can result in a passive approach in managing the problem . Which it can lead to inappropriate interventions
2.)
ReplyDeletewhat are the advantages and disadvantages to the proposed recommendations in the article?
This article focuses on teaching the importance of understanding the process of dementia among the elderly. Identifying and managing the continence needs of patients with dementia plays a huge advantage in preventing skin damage due to fecal/urinary incontinence. One disadvantage is very unfortunate that many clinical settings work under staff and makes it difficult to comply with the necessary steps to prevent skin breakdown
1. Discuss the research question or main problem discussed in the study?
ReplyDeleteThe study addresses the issue of the incorrect assumption that all patients with dementia are incontinent. It highlights the importance of conducting accurate continence assessments and improving caregiver education to better manage both dementia and incontinence. By tackling these concerns, caregivers can offer more effective and personalized care, thereby improving the overall quality of life for those affected.
2. what are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
The article advocates for a person-centered approach to managing incontinence in individuals with dementia, emphasizing that tailored care can enhance treatment effectiveness and quality of life. This approach aids in identifying underlying causes of incontinence, preventing complications, reducing caregiver stress, and addressing stigma. However, implementing this method presents challenges, such as the need for additional time, training, and resources, which can be difficult in settings with limited support. There is also a risk of overlooking some causes of incontinence and encountering resistance to changing established practices. While this approach provides significant personalized benefits, it requires careful management of resources and overcoming resistance to change.
1. Discuss the research question or the main problem discussed in the article
ReplyDeleteThe paper addresses the prevalence of dementia and incontinence among older adults and advocates for more patient-centered assessment to improve outcome this particular population. There is a common assumption that incontinence is an inherent symptom of dementia, leading to the belief that nothing can be done to manage it. However, while dementia can impact continence, it is not always the sole cause, and there may be effective treatments and strategies to reduce incontinence.
2. Discuss the limitations of the article: limited sample size, design flaws, and/or author bias
While the study advocates for person-centered approaches and improved practices, it does not go into depth onto how these practices can be effectively implemented. There is limited guidance for health and social care professionals to adopt the recommended practices. The article also based their findings from secondary sources and existing literatures which may lead to potential selection bias.
Mai Tran, 4N
This comment has been removed by the author.
ReplyDeleteThis comment has been removed by the author.
Delete1)Discuss the research question or main problem discussed in the study?
DeleteIncontinence is a significant challenge for individuals with dementia, their families, and caregivers, often influencing decisions about moving to 24-hour care. Poorly managed incontinence increases caregiver burden due to extra laundry, personal care needs, and potential sleep disturbances from nocturia. Many cases are likely underreported due to shame, stigma, and misconceptions that incontinence is solely a symptom of dementia.
While advanced dementia increases the likelihood of incontinence due to reduced capacity and mobility, it may not be the primary cause in earlier stages. People with dementia often experience functional incontinence, which results from cognitive challenges rather than physical limitations. It's crucial to recognize that incontinence may stem from various factors, and not solely from dementia or functional issues, as both conditions involve more complex interactions than just physical symptoms.
2) what are the advantages and disadvantages to the proposed recommendations in the article?
Implementing the article's recommendations offers the benefit of providing person-centered care for dementia patients, tailored to their unique needs. This approach helps bedside nurses avoid assuming that all dementia patients will be incontinent, allowing patients to discuss their concerns and requirements with their caregivers, thereby enhancing their dignity.
However, a drawback of these recommendations is that delivering more individualized care can be time-consuming. Many hospitals face staffing shortages, resulting in a higher patient-to-nurse ratio, which restricts the time caregivers can dedicate to offering personalized care.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe main problem discussed in this study was incontinence in people living with dementia and it should not be assumed that dementia is the caused of urinary or fecal incontinence. Although mental capacity, mobility, and communication present challenges in people living with dementia, it is not the primary main cause of incontinence, but rather a result from physical and environmental challenges. These factors affect a person’s ability to use the toilet and can cause feeling of shame and humiliation towards their families. Educating healthcare team and family members are crucial key factors of understanding incontinence among the population living with dementia.
2.) How does this research article compare to our practice, policy and/or procedure.
As a bedside nurse at PSJMC, the population of the elderly living with dementia has increased significantly among our patients. This article presents a comparison in our current practices by assessing our patient’s memory, attention, language, and cognitive abilities. Such interventions may include requesting a physical therapy or occupational therapy consult during their hospital length of stay. A thorough patient admission questionnaire in regard to their medication use is completed upon arrival to the unit. By utilizing these first steps of assessment, a medical professional is able to utilize proper equipment, delegate tasks more appropriately to other medical staff, and promote patient’s well being and decreasing feelings of humiliation or embarrassment.
1. How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis article compares and relates to our practice because we do have a large population of patients that have history of incontinence and memory deficits such as dementia. This gave me an insight of things I can do better during my assessments and daily care of my patients. For example, I can assess what is the cause of their incontinence other than a cognitive impairment rather than to just assume they are incontinent.
2. Discuss the research question or main problem discussed in the study?
The main problem discussed in this. Study was how we can be more accommodating to our patients with dementia and incontinence. They may be incontinent due to other factors in addition to having dementia. One of the tools this article brings up is how to do an assessment to better provide care and prevent our patient from feeling like a burden, embarrassed, and even helping them decrease incontinence episodes. Some patients, as discussed in the article, have incontinence episodes because they are unfamiliar with their surroundings, a new routine, or even pain preventing them from being mobile, therefore causing incontinence.
Discuss the research question or main problem discussed in the study?
ReplyDeleteDementia and incontinence are common issues among the elderly, but they are not considered a normal part of aging. Although incontinence is not a direct result of dementia, it frequently occurs due to the cognitive, physical, and mental limitations faced by individuals with the condition. This issue often leads families to seek 24-hour care for their loved ones, as it significantly increases the burden on caregivers. Additionally, incontinence raises the risk of complications such as pressure ulcers, urinary tract infections, catheter use, and constipation, all of which can lead to hospital admissions. The article advocates for identifying the underlying causes of incontinence instead of attributing it solely to dementia, emphasizing the importance of maintaining dignity in continence care for patients.
How does this research article compare to our practice, policy and/or procedure?
The suggestion to perform a biopsychosocial continence assessment is valuable, as it encourages us to view patients with dementia holistically rather than making assumptions about their incontinence. However, this approach does not alter the procedures we use to manage incontinence in an acute care setting. The primary goal for clinicians is to prevent skin breakdown resulting from incontinence. While it’s crucial to investigate the underlying causes if the incontinence is unusual for the patient, we must also address the immediate physical consequences. Additionally, we could improve our efforts to maintain the dignity of patients experiencing incontinence. Often, in our routine use of products like PureWick and PrimoFit, we may overlook the psychological and emotional impact these actions have on the patient, even if they are not fully oriented.
1) Discuss the research question or main problem discussed in the study.
ReplyDeleteThe study's main problem is that people with dementia must receive adequate access to person-centered continence assessment, a management plan, and products to meet their needs and the needs of the person taking care of them. The author wishes to address the need for healthcare professionals to be more aware of the complex relationship between dementia and incontinence. The author feels that medical professionals will feel more confident and competent in exploring incontinence issues to improve outcomes and enable more dignified, centered care. He also wishes to encourage more professionals to identify and challenge the current experience of barriers that exist that prevent people living with dementia and their families from accessing the proper continence care and support at the right time.
2) Discuss the sample size used in the study.
The study does not use sample sizes. The author presented dementia statistics in the United Kingdom, which show that 944,000 older people are living with dementia in the United Kingdom, and 593,200 of those people are living with advanced symptoms. The total number of people living with dementia is projected to increase significantly to approximately 1.7 people in the United Kingdom by 2040.
This comment has been removed by the author.
ReplyDeleteValerie Dressman
ReplyDelete1. How does this research article compare to our practice, policy and/or procedure?
This article focuses on incontinence and its' causes. It suggests that there can be many causes of incontinence, not just dementia. We encounter incontinence frequently in the hospital setting. It is important to look into the potential causes more closely and possibly avoid harm that is associated with incontinence.
2. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
This article suggests looking into all potential causes of incontinence and also promoting continence. The advantages of implementing these strategies is the decrease in harm, such as skin breakdown including pressure ulcers and dermatitis. It also would improve the patient's quality of life if the root cause of the incontinence was identified and treated, or continence was promoted. I do not see any disadvantages to these recommendations, as it does no harm to further look into causes of symptoms.
-How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteThis article encourages promoting continence. In out patient surgery, this is not so much an issue that I encounter. Typically in post op we encourage patients to be as independent as they can. There are some factors that can cause incontinence, such as nerve blocks. But promoting continence in a person with dementia is not something outpatient surgery typically does in my opinion. Regular offering of timed voiding is one way to promote continence. I would agree with the article that the hospital primarily focuses on containment (pure wick, condom catheter), and disposable diapers or underpants.
-What are the advantages and disadvantages to the proposed recommendations in the article?
The biggest disadvantage in promoting continence in an acute care setting is that often times there are varying factors that may also lead to incontinence when the patient is admitted - weakness from stroke, sepsis, medications, injury, continuous IV fluids. I believe the best environment to promote this would be in an home setting, rehab setting, or nursing facility. Ideally medication is consistent, equipment is sized appropriately, there is consistency in timed toileting, enough space, and the patient is in optimal health and strength to try and promote continence training.
Petra F.
ReplyDelete1. Was the appropriate method used, why or why not?
A holistic and person-centered method was used: The method emphasized a comprehensive, person-centered assessment, which is crucial for understanding the unique needs of individuals living with dementia. This approach is appropriate as it considers not only physical health but also cognitive and emotional factors. The method used appears appropriate as it addresses the complexities of dementia and incontinence through a comprehensive, sensitive, and inclusive approach. It acknowledges the need for ongoing education, caregiver support, and a focus on individual circumstances rather than assumptions, which is essential for improving outcomes in this vulnerable population.
2. Describe the research method used by the author
The article employs a qualitative research method focused on a comprehensive, person-centered approach to assess and manage incontinence in individuals living with dementia. Overall, the research method is qualitative and exploratory, focusing on comprehensive assessments and the integration of multiple factors affecting incontinence. This approach seeks to promote dignity and improve care for individuals living with dementia, addressing both clinical and psychosocial aspects of their experience.
Discuss the research question or main problem discussed in the study?
ReplyDeleteDementia and incontinence are both prevalent in older age; yet, neither are an inevitable or normal part of ageing. It has been recognized that there is a skills and knowledge gap in professionals assessing and managing incontinence for people living with dementia. All too often, assumptions are made that incontinence is a symptom of dementia and that nothing can be done if a person living with dementia experiences episodes of incontinence. While dementia may impact on a person's ability to remain continent, it may not be the sole cause, and there may be treatments and strategies that can reduce the incidence in those affected. Therefore, a person-centered continence assessment should be undertaken to promote continence and reduce the impact of incontinence for people living with dementia and those who care for them. This study highlighted some of the issues that are important for health and social care professionals to explore and identify, assess and manage incontinence to improve outcomes for families affected by dementia.
How does this research article compare to our practice, policy and/or procedure?
This further drives the initiative in the hospital and units in that a diagnosis of dementia should not be a barrier for a person living with dementia in receiving equitable access to a person-centered continence assessment, management plan and products to meet their individual needs and the needs of those who care for them. Promoting continence should be seen as equal to, if not more important than, managing incontinence. There is a need for health and social care professionals to be more aware of the complex relationship between dementia and incontinence, and the intrinsic and extrinsic physiological, cognitive, and environmental factors that may impact on the person's ability to remain continent. By improving awareness, it is hoped that professionals will feel more confident and competent in sensitively exploring any continence issues to improve outcomes and enable more dignified person-centered care. Moreover, the authors hope that this will encourage more professionals to identify and challenge the current extrinsic barriers that exist which prevent people living with dementia and their families from accessing the right continence care and support at the right time.
1. Discuss the research question or main problem discussed in the study?
ReplyDeleteThe main research question relates to how we as care partners can more effectively manage incontinence with those living with dementia, enabling them to achieve a better quality of life. Some of these issues and barriers include properly identifying the causes incontinence, lack of proper care and education for those treating these patients with incontinence. Being able to adequately individualize each patients needs and what can be done in particular to care for them most effectively, can be done through a comprehensive assessment of every patient with frequent follow ups to ensure we are meeting their goals.
2. What are the advantages and disadvantages to the proposed recommendations in the article?
Although there are many advantages to the recommendations made by this article, there are also many disadvantages that can arise. Some of the key advantages include creating and environment for the patient that is based on patient centered care and is also holistic in considering their needs. Other advantages include proper education for healthcare workers and thus proper care for these patients. Some of the key disadvantages include the great deal of resources and time it takes to complete these comprehensive assessments, including the complexity of certain patients with multiple health issues and being able to properly and consistently treat these patients.
Discuss the research question or main problem discussed in the study?
ReplyDeleteThe study highlights a significant issue: the misconception that all individuals with dementia experience incontinence. It emphasizes the importance of conducting precise continence assessments and improving caregiver education to enhance the care provided to patients with dementia and incontinence. By tackling these challenges, caregivers can deliver more tailored and effective support, ultimately improving the quality of life for those impacted.
What are the advantages and disadvantages to the proposed recommendations in this article?
Implementing a structured toileting schedule and conducting regular assessments can offer several benefits, such as reducing the likelihood of skin breakdown and pressure injuries, especially in patients who struggle to communicate their needs. This approach also helps prevent prolonged moisture exposure, which is vital for preserving skin integrity in individuals with limited mobility or cognitive challenges.
However, there are some drawbacks to consider. Allocating resources like time and staff to establish and maintain the toileting schedule could affect other aspects of patient care. Additionally, encouraging patients with dementia to walk to the bathroom might elevate the risk of falls, both in hospital settings and at home.
Describe the method used by the author of the study
ReplyDeleteThe method used by the author of the study was attempted in six hospitals in five health districts in New South Wales and Australia. The aim is to evaluate the effect of an intervention on the prevalence and severity of IAD (incontinence-associated dermatitis) by assessing skin and incontinence on pre- and post-study on patients. These interventions were held during February and March as Pre-intervention and during July and August 2021 as post-intervention.
Data was collected by using two collection tools which are IAD and incontinence audit tool (looked on assessing patient incontinence and skin, used in a previous audit conducted in one of the tested local Health Districts. Analysis collected included level of incontinence soiling, stool quality and frequency, stoma, mobility status, incontinence items used, other skin injuries along with a Baseline Data Collection Form. The recording basic patient wellbeing and demographic information, such as patient primary and secondary analysis, type of admission, skin tone and how long the patient was in the hospital. Patient demographics, medical record for best practice IAD prevention and treatment intervention, was to reduce the prevalence and severity of hospital-acquired IAD. Then Data was exported to an Excel file and analyzed by SPSS Statistics.
Discuss the research question or main problem discussed in the study?
Incontinence-associated dermatitis (IAD) is an irritation skin condition that can be painful and is connected to hospital-acquired pressure injuries (PI). It is often overlooked and misdiagnosed, resulting in delayed and costly processes to cure, while causing immense patient discomfort. In various reports, the prominence of IAD in hospital patients has been documented to range from 1.44% to 21.3% but is known to be under-reported because of misdiagnosis and changes in IAD data collection methods. IAD causes physical, social and emotional impact on patients.
In this study, Hospital-acquired IAD interpretation fell by 36.3% from the pre- intervention (6.71%) to the post-intervention period (4.27%) even though there was a higher acuity and the COVID-19 pandemic in the post-intervention timeline. The practice of IAD prevention and treatment intervention reduced the prevalence and severity of hospital-acquired IAD.
- Discuss the research question or main problem discussed in the study?
ReplyDeleteThe research question/main problem discussed in this study is the common misconception that dementia can cause incontinence. While studies have shown that dementia can lead to a person's ability to remain continent, the researchers of this article bring up the notion that there may be a gap between skills and knowledge when it comes to healthcare/medical professionals correctly assessing and managing incontinence with those who have dementia. This article addresses the need for a person-centered continence assessment in hopes of managing those who are continent and minimize the impact and care of those who are incontinent living with dementia.
- Describe the method used by the author of the study
The method used by the author of the study was qualitative and introduced the use of a patient-centered continence assessment in this vulnerable demographic. In this study, the use of this assessment helped to identify barriers and aspects that those with dementia may have in hopes of a better outcome on how to manage and treat incontinence. The researchers touch upon the overall wellbeing of those living with dementia, i.e., psychosocial, physical and this qualitative approach seeks a better understanding on both intrinsic and extrinsic factors regarding the impact that management of incontinence has on people with dementia.
Paolo Largoza, 3N
1.Discuss the research question or main problem discussed in the study?
ReplyDelete-The article discusses the skills & knowledge deficits in professionals assessing & managing incontinence for patients with dementia. It reinforces not to assume incontinence & dementia go hand in hand.
2.How does this research article compare to our practice, policy and/or procedure?
- At PSJMC, we get a lot of demented patients & a lot of which are incontinent. This article helps to open dialog to better assess where the patient is at with their continence & not to assume they are incontinent based on diagnosis. We should strive to help dementia patients maintain their ADLS & help patient & families to preserve the patients independence & abilities for as long as possible.
How does this research article compare to our practice, policy and/or procedure?
ReplyDeleteAs RNs it is important to assess the current condition to a patients baseline. Particularly in patients with dementia, it is nice when a family a member or caregiver can give that history but its not always the case. This article helps with self reflection and it highlights the importance of not assuming a patient's elimination pattern just because they may present with dementia. This article has plenty of examples of great assessment tools and questions I can use to assess for incontinence.
Discuss the research question or main problem discussed in the study?
Dementia and incontinence are both prevalent in older age and this article highlights that neither are an inevitable or normal part of ageing. This article also highlights skill and knowledge gaps in professionals dealing with dementia patients who are incontinent. All too often, assumptions are made that incontinence is a symptom of dementia and that nothing can be done if a person living with dementia experiences episodes of incontinence. While dementia may impact on a person's ability to remain continent, it may not be the sole cause, and there may be treatments and strategies that can reduce the incidence in those affected.
1. Discuss the research question or main problem discussed in the study?
ReplyDeleteThe research question discussed in this study is the idea that incontinence is prevalent in all patients with dementia. This problem then leads to the idea of the need for improved continence assessments for patients and better caregiver education on the topic. Caregivers can then provide improved care for this patient population, thereby enhancing quality of life.
2. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
There are several advantages to these recommendations. Reducing skin breakdown and pressure injuries is a major selling point. Preventing prolonged exposure to moisture can improve skin integrity, thus removing a leading risk factor for infectious etiology for those with limited mobility and cognitive skills. Disadvantages, however frustrating, are present as well. Resource allocation is a major issue. Staffing is limited as it is, thus placing another burden on overworked staff to maintain a toilet schedule can further bog down that crucial resource. Encouraging patients to self ambulate to help with toileting can also increase fall risks in that vulnerable population.
1. Discuss the research question or main problem discussed in the study?
ReplyDeleteThe research or main topic of this study was the idea or question of the relationship between dementia and incontinence. One of the article's main ideas being that dementia is not the sole cause of incontinence. Unfortunately, there is an idea of assumption when dealing with elderly population, including but not limited to misconceptions surrounding disease processes, and the correlation of brain decline leading to urinary decline.
2. What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital
Incontinence is not a normal part of dementia; caregivers, and the general public, should avoid the correlation of dementia and incontinence. Promoting positive urinary habits in a dementia patient should be part of a healthy plan of care.
Discuss the sample size used in the study.
ReplyDeleteThe article on incontinence in people living with dementia discusses various studies that explore interventions aimed at helping caregivers manage continence in dementia patients. One of the studies reviewed included 118 dyads (pairs of a caregiver and a dementia patient), with a 37% attrition rate over six months. Reasons for the attrition included relocation to care homes, refusal or inability to continue participation, illness, or death. This information shows the challenges in conducting long-term research with dementia patients and their caregivers, particularly due to the frailty of the patient population.
Describe the method used by the author of the study
The author conducted a systematic review to assess the effectiveness of various conservative interventions aimed at managing incontinence in people with dementia or cognitive impairment. The studies included in the review predominantly focused on educational or advisory interventions targeted at caregivers. For instance, in one study, occupational therapists provided problem-solving interventions for managing incontinence over five visits, while in another, nurse practitioners created individualized toileting schedules and provided continence education. It aimed to identify the best strategies to support caregivers in managing incontinence, while considering the unique challenges posed by dementia.
Describe the sample size in the study: The study suggest that 30–40% of people aged over 65 years experience episodes of urinary incontinence, increasing to between 60–70% in people living in care homes.
ReplyDeleteDiscuss the research question or main problem discussed in the study? The main focus of the article is the discussion of incontinence being prelevant with dementia patients. The study discussed a various amount of reasons to what contributes to this incontinence and how dementia can also effect individuals self confidence as it gets worse.
To elaborate on my previous comment, studies have explored the prevalence of feccal incontinence, suggest that between 8–12% of the general population experience episodes of faecal incontinence. The prevalence of feccal incontinence rises significantly to 60% in people living in care homes.
DeleteThe problem discussed in this study highlights some of the issues that are important for health and social care professionals to explore and identify, assess and manage incontinence to improve outcomes for families affected by dementia.
tanya matiossian ^
ReplyDelete