Management of fecal incontinence in older adults in long-term care

Of all the health challenges frail elderly face, fecal incontinence is one of the most dreaded. Lack of knowledge within the field of fecal incontinence is evident. With life expectancy lengthening, the percentage of people who will require care in a nursing home will increase in the years to come. Nursing home patients are the most fragile of the older patients. Among this group, there are often problems connected with defecation, such as constipation, diarrhea, and fecal incontinence. Fecal incontinence is a complex problem. It is therefore necessary to have a broad approach to fecal incontinence, and it is important that nurses have high knowledge and advanced skills when it comes to meeting patients’ needs for assessment, care, and treatment. Fecal incontinence can lead to feelings of shame and embarrassment and to a downward spiral of psychological distress, dependency, and poor health. Loose stool, as well as hard stool, can be related to fecal incontinence. Urgency associated with bowel movements is also an important factor. The most important risk factors are functional incapacity, reduced cognitive function, diarrhea, constipation/impaction, stroke, some neurological diseases, diabetes, and comorbidity in general. The level of knowledge among health personnel on the value of good bowel care seems limited. There is at present a relatively limited evidence base from high-quality experimental trials of fecal incontinence, and it remains challenging to provide strong evidence for most interventions. Frail older people require a different care approach addressing the potential role of comorbid disease and current medications, in addition to the functional and cognitive impairment, and should take into account the degree of bother to the person. When appropriate, patient education is important to promote self-management and other coping mechanisms. An environment with physical or social obstacles may impair the ability to maintain continence. This is particularly relevant to individuals who have physical or mental disorders. Good care quality encompasses care personnel to acknowledge the problem of fecal incontinence compassionately. Healthcare personnel should be trained in identification and management of fecal incontinence in nursing home patients.