Theme 3

Delivering individual continence care

3.1 The importance of individualised continence care

Targeted and individualised/person-centred continence care [10, 33, 65, 77, 81, 84] that is established after a thorough clinical assessment has taken place [10, 33, 86, 88] is identified as being important.

This would include the use of a bladder diary [10]. Individualised continence care is described as care about what is best for the PLWD, avoiding harm [10, 80] and about promoting autonomy and independent living [10].

3.2 Components of individualised care planning

Many different components that may be considered as part of individualised care plans have been identified which include being theory based [33], being concerned with the practical issues [77], and involving multi-components exploring both day time and night care of incontinence care [33].

There was a general consensus that the needs of both PLWD and their caregivers should to be considered [10, 33, 84–86]. The advice given by the Alzheimer’s Society was that a continence care plan should be tailored to the individual. This should aim “to cure toilet problems or incontinence wherever possible” [78] (and webpage).

Other components to consider include changing medication, changes to lifestyle, exercise [77], skin care [33, 86], manipulating the type, quantity and timing of food and drink, available from HCPs, and follow up advice [77].

Ostaszkiewicz et al. [86] comments that nurses and care workers need support in order to develop individualised strategies to “optimise the care-dependent person’s rest/sleep in the context of the person’s concurrent need for continence and skin care.

3.3 HCPs and caregivers working in partnership

The importance of HCPs and caregivers working together to deliver individualised/person-centred continence care was a feature of three intervention studies [72, 75, 76] and was encouraged within four pieces of non-research material [77, 81, 84, 85]. Within one intervention study, nurse practitioners worked with the carer to plan the schedule for the PLWD, and this was followed up with monthly phone calls and bi-monthly visits [72].

Occupational therapists worked with the caregivers in a further two intervention studies [75, 76] to deliver solutions to toileting and incontinence problems, which consisted of five visits over 2 or 3 months.

Other HCPs that work with PLWD and their caregivers include continence advisors [77] or other HCPs specialising in continence care [81]. Working in partnership with caregivers and PLWD is important [77, 81, 85] and enables HCPs to gather their personal story [84] to work out the best solutions and to ensure that specialist help can be accessed when needed and what is recommended is achievable.

3.4 Establishing a toileting routine within the home environment.

The importance of developing a regular toileting schedule was discussed briefly within one study [75] and one piece of non-research material [10] and was the focus of one intervention study [72].

The intervention group in the study by Jirovec and Templin [72] were taught an individualised scheduled toileting procedure, which compensated for cognitive impairment by providing these patients with toileting reminders such as verbal prompts. It was reported that incontinence decreased in the experimental group with almost no change in the control group. However, they were not statistically significant [41, 89].