Urinary incontinence is a common symptom among residents of long-term care (LTC) facilities but is frequently untreated, resulting in a high incidence of falls because of urinary urgency as well as financial costs in terms of staff time and supplies, according to survey responses from directors of nursing at LTC facilities. Nearly 60% of directors said that managing urinary incontinence contributes to nursing assistant turnover, the study researchers reported at the Gerontological Advanced Practice Nurses Association (GAPNA) Annual Hybrid Conference held September 30 to October 2, 2021.
“Our survey indicated low treatment rates, low awareness of anticholinergic-related urinary incontinence or overactive bladder treatment risks, high incidence of falls due to urinary urgency, and high CNA turnover, as well as substantial financial impact of incontinence supplies and staff time,” said lead author Diane K. Newman, DNP, ANP-BC, who is co-director of the Penn Center for Continence and Pelvic Health and Adjunct Professor of Urology in Surgery at the Perlman School of Medicine at the University of Pennsylvania in Philadelphia.
Urinary incontinence affects up to 65% to 70% of patients 65 years and older living in LTC facilities. Managing urinary incontinence is burdensome and costly in terms of staff time, incontinence product use, and Centers for Medicare and Medicaid (CMS) quality measures, Dr Newman noted. Urinary incontinence is a common symptom of overactive bladder.
Dr Newman and colleagues evaluated online survey responses from 71 directors of nursing who worked at skilled nursing facilities with at least 100 beds (≥80% LTC beds) for at least 1 year between February 27, 2020, and May 11, 2020. On average, the facilities housed 115 residents (68% female), 62% of whom had urinary incontinence, 46% with dementia, and 43% with depression. Among patients with urinary incontinence, 75% were frequently or always incontinent and 81% used incontinence produces on an ongoing basis.
Impact of Urinary Incontinence on Resident Care
A mean of 14.3 resident falls per month were recorded at the LTC facilities, 36% of which occurred in patients attempting to access the bathroom. The quality measures considered by residents to be most impacted by urinary incontinence issues are as follows:
- Falls with major injury (47%)
- Urinary tract infection (47%)
- Pressure ulcers (41%)
Increased need for help with activities of daily living, worsened ability to move independently, catheter use, and antipsychotic medication use were factors also linked to urinary incontinence issues.
“The findings show the significant impact of incontinence on falls and CMS quality measures,” Dr Newman said.
Underuse of Overactive Bladder Treatments
Medications to treat urge incontinence and overactive bladder were prescribed for 15% of residents, with oxybutynin or other anticholinergic/antimuscarinic agents being the most commonly prescribed agents (59%) followed by mirabegron (15%). Three-fourths of nursing directors were unaware of the link between anticholinergic medications and risk of cognitive issues/dementia.
Among patients prescribed urinary incontinence medication, 14% discontinued treatment most commonly because of lack of efficacy or safety/tolerability issues.
Cost and Burden of Urinary Incontinence
The average monthly cost of urinary incontinence products was $5407 and laundering costs were $5497. Certified nursing assistants on average spend 56% of their time managing urinary incontinence needs, and these tasks were reported to contribute to turnover among these assistants among 59% of respondents.
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Newman DK. Impact of urinary incontinence in the long-term care setting: a view from directors of nursing. Poster presented at: Gerontological Advanced Practice Nurses Association (GAPNA) Annual Hybrid Conference; September 30 October 2, 2021; San Diego, CA: P12.