Many older people with complex health conditions experience incontinence and other bladder and bowel symptoms. In 2022, NARI researchers reviewed evidence for the Australian Commission on Safety and Quality in Health Care to inform a clinical care standard about continence care for older Australians accessing aged care services in the community and in residential aged care homes. The researchers explored the question of what constitutes ‘best practice continence care’ and produced a set of recommendations for safe, quality continence care for older Australians with complex care needs.

Recommendations

1. Identify incontinence and other bladder and bowel symptoms in the older person. 
2. Identify, document and communicate the older person’s continence care values, goals and preferences through a supported shared decision-making process.
3. Consider the needs of care partners in planning care.
4. Adopt evidence-informed clinical pathways, guidelines and models of care to guide continence care.
5. Ensure the workforce has the knowledge and skills to care for an older person with continence care needs.
6. Access advanced and specialist support to ensure quality and safety in continence care.
7. Adopt a multi-modal approach to the care of older people with bladder and bowel symptoms.
8. Implement lifestyle interventions as first line therapy for bladder and bowel symptoms.
9. Ensure the older person has the support they need to maintain or improve their mobility and functional skills.
10. Ensure the older person has the support they need to use the toilet in a timely manner.
11. Ensure the physical environment optimises the older person’s ability to maintain continence.
12. Ensure the appropriate use of continence aids and incontinence products.
13. Ensure the older person has the support they need to change incontinence products in a timely manner.
14. Implement a skin care program for the prevention and management of incontinence-associated dermatitis.
15. Avoid the use of drugs for bladder symptoms such as urinary incontinence, nocturia and overactive bladder in frail older adults.
16. Ensure the appropriate use of laxatives for the prevention and management of constipation.

The review also identified several gaps in evidence, particularly in relation to the prevalence, risks, impact and management of bladder and bowel conditions among older Australians receiving in-home aged care services. This review also identified a lack of measures to evaluate the quality of continence care for people who receive aged care services in Australia. We suggest further consideration be given to the design and systematic use of quality indicators that are informed by older people and carers expectations, preferences and values.

Rapid review of the literature on continence care for older people receiving aged care services in the community and in residential aged care facilities