Nearly 36% of the average monthly falls in skilled nursing facilities occur while residents with urinary incontinence (UI) are trying to get to the bathroom.
That’s according to a new survey of 71 directors of nursing that has identified multiple aspects of UI burden and management in long-term care.
Urinary incontinence drug maker Urovant funded the peer-reviewed study, which was published in the Journal of Gerontological Nursing. Survey respondents had worked for at least one year or more in a facility of 100 or more beds. Facility bed count included at least 80% long-term care beds.
Survey respondents reported that an average of 62% of their residents had UI and that 40% of these residents were “always” incontinent. They also linked UI to resident safety. Respondents reported an average of 14 falls per month, with about one-third of those falls associated with attempts to get to a bathroom.
In addition, answers underscored the burden of UI management on facility staff members. Fully 59% of directors of nursing said that UI management contributed to turnover among certified nursing assistant staff.
Infections and pressure ulcers
Respondents said that urinary tract infections, falls with major injury and pressure ulcers were the top Centers for Medicare & Medicaid Services quality measures significantly linked to UI. They also reported that approximately 26% of skin rashes and 31% of skin infections due urine wetness required medical treatment. About 10% of these rashes or infections lead to antibiotic use, they said.
The use of drugs to treat UI and overactive bladder were fairly low, with only about 14% of residents with UI prescribed medications to address their symptoms. There was a low reported awareness of the risks of anticholinergic drugs, which have been linked to cognitive side effects in the senior population.
“The impact and management of UI related to OAB is a substantial burden to LTC facilities, as well as to their residents and staff,” wrote the study’s lead author, Richard G. Stefanacci, DO, of Thomas Jefferson University in Philadelphia.
“These results highlight the need for improved treatment and management of UI related to OAB in this population, additional methods to improve CMS quality measures with respect to UI, and more LTC facility-wide initiatives, including educational outreach to increase awareness of potential adverse effects and burden of anticholinergic treatment, as well as process development to ensure most appropriate treatment for UI in selected residents,” he concluded.
Full findings include details on the cost burden of UI and the authors pose further questions about treatment of residents with limited mobility.
Related articles:
Let’s talk: Post-acute rehab patients need to be looped in about incontinence care, study finds
Multi-drug resistance is rising in urinary E coli, analysis reveals
Nursing home clinicians still overdiagnose UTIs despite antibiotic stewardship efforts: study
