Continence Management in Aged Care: Best Practices & Approaches

“Incontinence is not only exceptionally common, but there are good treatment options available depending on the specific reason for the incontinence.” 

Gregory Amend, M.D., assistant professor of urology at Icahn School of Medicine at Mount Sinai

Caring for older people brings challenges for both carers and patients that require sensitivity and dignity. Many elderly care residents, for example, suffer from incontinence, which may arise through various associated conditions.

Continence is the ability to control your bladder and bowel movements. As we get older, our muscles may weaken, which can make it difficult to manage trips to the toilet, and patients with neurological or psychological conditions may not be able to consciously exercise control.

Incontinence can be embarrassing. For those of us caring for the elderly in residential care, it’s crucial to help people maintain their dignity and ensure they are clean and supported. Many of our customers advise that, with individual care plans, they’re able to help the people they support with sensitivity.

In this guide, we examine some of the main causes of incontinence, its impacts on those who suffer from it, and how you can help older caretakers manage it with dignity.

Types and Causes of Incontinence

While there is a burden of incontinence in aged care, there are several types of incontinence that affect people at any age:

• Urge incontinence: People suddenly feel they need to urinate, or urinate often, and quickly lose control

• Urinary retention or overflow incontinence: Where you cannot empty your bladder fully and may experience leaking

• Stress incontinence: Where pressure from exercising, sneezing, coughing, or other physical pressures cause leaking

• Functional incontinence: Where you are unable to go to the toilet on time because of a physical or mental condition

• Nocturia: Where you wake up during the night due to bladder problems or urinate during sleep

Some people may also experience mixed incontinence, where they cannot control their bladder or bowel movements.

Incontinence can also be caused by:

• Muscle and nerve damage

• Bowel disease

• Neurological problems (e.g., spina bifida and strokes)

• Urinary tract infections

• Prostate cancer and enlarged prostates

• Tumor obstruction

• Muscle aging

• Menopause

As people age, they are at greater risk for incontinence because their muscles and urethras lose strength, and their bladders may no longer be able to hold as much urine. As mentioned, conditions such as dementia can also prevent people from knowing when to go to the toilet or how to control their bladders and bowels.

Impact of Incontinence in Older People

Incontinence can cause physical and emotional challenges for people in aged care. For example, physical restrictions can mean they are unaware of when they will next be incontinent. 

The knock-on effects of incontinence for people in aged care include embarrassment and stress, feelings of shame, and wanting to isolate themselves.

Moisture buildup from incontinence may also cause skin issues and discomfort for many older people.

Those caring for older people with incontinence must treat their patients with kindness, patience, and dignity. A shift in the caring dynamic can also prove challenging and stressful for people caring for parents and grandparents.

In some cases, therefore, some older people may feel like burdens and may not be receptive to care and support with incontinence, or even other problems.

Safe and Effective Continence Assessment in Aged Care

Continence assessment in care homes must be carried out thoroughly but, again, with dignity. Given the sensitive nature of incontinence, assessments need to be accurate and efficient.

Carers must consider the extent and frequency of a patient’s incontinence, the patient’s reaction to it, and how much distress and/or physical harm it causes. It’s wise for carers to consider how much fluid intake a patient has, and if there are any patterns to suggest underlying physical or neurological issues.

Carers should also consider medical histories, current medicine intake, and physical assessments where appropriate. Monitoring intake and assessing psychological wellness, with sensitivity, is also important.

In some cases, carers must communicate with families or next of kin to determine any potential issues, and where additional consent or power of attorney is required.

Key Considerations for Continence Management in Residential Care 

Considerations in residential care will look different for each patient. Just as you must carefully consider dress code for aged care workers, it’s important to think carefully about the knock-on effect of how you approach each resident.

Carers and nurses may consider any of the following options:

• Developing individual care plans (for efficient assessment and to provide dignity)

• Creating staff training plans and building awareness of incontinence management

• Adapting facilities (e.g., installing easy-access toilets)

• Managing healthy fluid intake schedules

• Creating and managing diet plans

• Creating regular toilet schedules (where appropriate)

• Reassigning patients to other areas (in case of environmental factors)

• Adjusting certain policies

• Using incontinence products (e.g., pads and protection foams)

Ultimately, each incontinence case will differ from one to the next. Therefore, residential care workers must be willing and prepared to adapt schedules and environments to preserve dignity.

Management of Urinary Incontinence in the Elderly

In many cases, effective urinary incontinence management in the elderly can be managed with gentle adjustments to lifestyle, behaviour, and medicine.

For example, some carers might suggest changes to fluid intake and diet to help prevent overflow incontinence.

To manage episodes of incontinence that cannot be prevented, carers might also use products such as pads and belted products to ensure leakage is accounted for and can be disposed of safely. However, adjusting to pads can be undignified and even distressing if not handled with care.

Above all, carers must be vigilant and think critically about the causes of elderly incontinence, and be able to provide individual care to each patient. Tailoring support can feel more dignified and be more effective at managing the root cause of such problems.

A Dignified Approach to Continence Care in Aged Care Facilities

Regardless of the causes of incontinence, we all deserve dignity, respect, and privacy. Therefore, while drawing up plans for incontinence care, carers must consider the psychological needs of their patients.

This not only means approaching the condition with sensitivity, but also offering emotional support.

It is all the more reason why residential homes should develop sensitive training plans to make sure their environments are consistently safe and supportive. This way, both residents and their families can rest easy knowing someone is genuinely caring with appropriate measures.

Conclusion

Safe and effective continence management is achievable both with critical planning and empathy. A dignified approach to continence care starts with emotional availability, and the careful use of pads and resources to help elderly people stay comfortable and calm in times of distress.

Medshop provides a wide range of resources and supplies to help home and residential carers support elderly people better. Many carers advise us that the resources we provide help them to create a more sensitive, efficient, and effective care environment – particularly when it comes to incontinence of all kinds.

Sources

Australia Department of Health. Victoria. (n.d.). Continence in older people. Health.vic.gov.au. Retrieved January 30, 2025, from https://www.health.vic.gov.au/older-people-in-hospital/continence

Borrie, M. J., Bawden, M., Speechley, M., & Kloseck, M. (2002). Interventions led by nurse continence advisers in the management of urinary incontinence: A randomized controlled trial. CMAJ: Canadian Medical Association Journal, 166(10), 1267–1273. Retrieved January 30, 2025, from https://pmc.ncbi.nlm.nih.gov/articles/PMC111077/

MedicineNet. (n.d.). Bowel or fecal incontinence: Types, causes, treatment, symptoms. Retrieved January 30, 2025, from https://www.medicinenet.com/fecal_incontinence/article.htm

HealthInAging.org. (n.d.). Caregiver guide: Incontinence. Retrieved January 30, 2025, from https://www.healthinaging.org/tools-and-tips/caregiver-guide-incontinence

Croner-i. (n.d.). Continence care in care homes. Retrieved January 30, 2025, from https://app.croneri.co.uk/feature-articles/continence-care-care-homes

British Geriatrics Society. (n.d.). Continence care in residential and nursing homes. Retrieved January 30, 2025, from https://www.bgs.org.uk/resources/continence-care-in-residential-and-nursing-homes

National Institute for Health Research. (2022). Continence, dementia, and care that preserves dignity. Retrieved January 30, 2025, from https://doi.org/10.3310/nihrevidence_51255

Ausmed. (n.d.). Continence management. Retrieved January 30, 2025, from https://www.ausmed.com/learn/articles/continence-management

Edwards, D., Harden, J., Jones, A., & Featherstone, K. (2021). Understanding how to facilitate continence for people with dementia in acute hospital settings: A mixed methods systematic review and thematic synthesis. Systematic Reviews, 10(1). Springer Science and Business Media LLC. Retrieved January 30, 2025, from https://doi.org/10.1186/s13643-021-01743-0

Health Canada. (2006). Seniors and aging: Bladder control problems (incontinence). Canada.ca. Retrieved January 30, 2025, from https://www.canada.ca/en/health-canada/services/healthy-living/your-health/medical-information/seniors-aging-bladder-control-problems-incontinence.html

Atlas McNeil Healthcare Community. (n.d.). Understanding the types of incontinence. Retrieved January 30, 2025, from https://www.amhcommunity.com.au/blogs/news/types-of-incontinence

Continence Health Australia. (n.d.-a). Urinary incontinence. Retrieved January 30, 2025, from https://www.continence.org.au/types-incontinence/urinary-incontinence

Frailty Care Guides. (2023). Urinary incontinence: Te turuturu o te mimi. Retrieved January 30, 2025, from https://www.hqsc.govt.nz/resources/resource-library/urinary-incontinence-te-turutUru-o-te-mimi-frailty-care-guides-2023

Mayo Clinic. (n.d.). Urinary incontinence: Symptoms and causes. Retrieved January 30, 2025, from https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808