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Evidence-based approach to quality continence care for frail older adults - A right or privilege?

Friday 07 Aug 2015 {{NI.ViewCount}} Views {{NI.ViewCount}} Views

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Ageing and access to quality care is a global policy concern, and access to quality continence care is increasingly being viewed as a legal, regulatory and ethical issue. From consumers’ perspective, access to continence care affirms their dignity. Researchers have expressed long-standing concerns about the quality of continence care provided to frail older adults, highlighting a focus on containment, rather than assessment and treatment. For example, residents of care homes do not always receive the levels of assistance they require to maintain continence. Although, several modifiable health and lifestyle factors are consistently associated with frail older adults’ risk of developing incontinence, they have limited access to high quality continence assessment and treatment.

The ICS is proud to convene a workshop titled Promoting an evidence-based approach to quality continence care for frail older adults that will:

  • Provide an overview of contemporary research about assessing and managing lower urinary tract symptoms in frail older adults in different health care settings.
  • Invite debate about the concept of quality continence care and quality of life for frail older adults with incontinence.
  • Describe the implications of contemporary research for policy, research and practice.

The workshop will take place on Tuesday 6th October from 1400-1530. This innovative workshop will promote interactive discussion and networking about strategies to systematically and consistently improve the quality of continence care for frail older adults in all settings.

The workshop brings together Dr Joan Ostaszkiewicz (Chair), Professor Mary H. Palmer, Professor Brenda Roe, Dr Kristine Talley, and Ms Sharon Eustice, who share an interest in sustainable strategies to improve the quality of continence care for frail older people in acute care, subacute care, nursing home sector, and in the community. Together they have expertise in synthesising evidence on incontinence in frail older adults, quantitative and qualitative research methodologies, interdisciplinary research on the prevalence, incidence, and risk factors for and correlates of incontinence in adults, and interventional research to optimise continence in older people. The overall aim of the panel of speakers is to engage the audience into identifying sustainable strategies to improve the continence care and lives of older frail people regardless of the care setting.

Do you work with the elderly? Here is what else is happening at ICS 2015 which may be of interest:
Nocturia Podium Session
Nocturia/Male LUTS Podium Short Oral
Insights into Treating Older Adults Podium Session
Pelvic Floor Exercise Class for UI in ageing women
Treating the Frail Older Adult Podium Session


Dr Joan Ostaszkiewicz is a Postdoctoral Research Fellow in the Centre for Quality and Patient Safety Research in the School of Nursing and Midwifery at Deakin University (Australia). Her postdoctoral research qualitatively explores the concept of quality continence care for frail older adults living in care homes. She has a clinical and academic background in the management of incontinence in frail older adults, focussing on evidence-based nursing strategies to enhance continence care. Dr Ostaszkiewicz’s research has resulted in systematic reviews on toileting assistance programs, guidelines for continence care in acute, subacute and aged care settings; a book chapter on methods for integrating research from mixed design studies, a guideline for the nursing management of urinary retention in hospitalised older adults, resources for promoting continence in hospitalised older adults, and a number of reports and peer review publications. She serves on the International Continence Society Nurses Committee, and was a member of the 5th International Consultation on Incontinence’s Committee on Incontinence in the Frail Elderly.


Professor Mary H Palmer is the Helen W. and Thomas L. Umphlet Distinguished Professor in Aging in the University of North Carolina at Chapel Hill School of Nursing in the USA. She has authored two award-winning books on urinary continence, is an Associate Editor of the Journal of the American Geriatrics Society and, among other roles, serves on the Editorial Boards of Geriatric Nursing and Faculty of 1000 Medicine. She has also served two terms on the International Continence Society Ethics Committee, and she was a member of the 5th International Consultation on Incontinence’s Committee on Incontinence in the Frail Elderly. Professor Palmer has conducted interdisciplinary research on the prevalence, incidence, and risk factors for and correlates of urinary incontinence in adults. In the mid-1990s, she created a conceptual framework that addressed primary, secondary, and tertiary prevention of urinary incontinence, which has become widely adopted. Her research has identified risk factors such as mobility impairment that may be amenable to intervention. Professor Palmer’s presentation titled Evidence-based continence care for frail older adults: A right or a privilege’ explores the concept of continence care being a legal, regulatory, and ethical issue. She proposes a value proposition for provision of evidence-based continence care for all frail older persons.

**Professor Brenda Roe** is Professor of Health Research, Evidence based Practice Research Centre, Faculty of Health & Social Care, Edge Hill University; Honorary Fellow, Personal Social Services Research Unit, at the University of Manchester in the UK. She is also a Fellow of the Queen’s Nursing Institute and Fellow of the Royal Society for Public Health. She is also the Editor of the Journal of Advanced Nursing and was one of the founding editors of the Cochrane Incontinence Review Group (1996-2000) with particular responsibility for reviews on behavioural interventions for the management of urinary incontinence. Professor Roe has recently completed a systematic review of systematic reviews of studies for the management of incontinence and promotion of continence using conservative approaches in older people in care homes. She will share the findings of this large body of work including the findings that: * Toileting programmes, in particular prompted voiding, comprise the main interventions used for managing incontinence in older people in care homes. * Intervention studies - trials predominate with fewer descriptive mixed methods and minimal qualitative studies available. * Toileting programmes and use of incontinence pads are the most prevalent forms of care in this client group. * Economic evaluations and studies to maintain continence in older people in care homes are needed. **Dr Kristine Talley** from the University of Minnesota in the US is a certified Gerontological Nurse Practitioner with clinical experience in nursing homes. Her research focuses on identifying risk factors, prevention strategies, and treatments for late-life disability related to geriatric syndromes in frail older women. She teaches courses on the nursing care of older adults in the Adult/Gerontological Nurse Practitioner Doctorate of Nursing Practice program and to undergraduate students. Dr Talley has reviewed evidence on interventions for incontinence in community-dwelling frail older adults, and developed and evaluated a multicomponent intervention to prevent toileting disabilities in frail older women in senior housing. Dr Talley will share her experiences of developing and implement this prevention/management program, including how to identify individuals at risk, how to measure outcomes, and how to work with community partners to implement the program. She argues that interventions to treat incontinence in frail older adults must be multi-component and accommodate their physical and cognitive function, and maintaining or improving physical function is a key component in treating incontinence in frail older adults


Ms Sharon Eustice is a Nurse Consultant in Continence in the UK. Sharon has been a Nurse Consultant for 12 years, championing bladder and bowel health across a population of 550,000. Central to this role has been promoting dignity and providing evidence-based treatment for patients who experience bladder and/or bowel dysfunction. She specializes in the diagnosis and conservative management of urinary and faecal incontinence for all populations. Sharon has recently started a PhD programme with the University of Plymouth and her work centres on her medical device invention to help women with obstructive defaecation. In her efforts to influence and shape policy and practice, she has chaired a UK national membership organization (Association for Continence Advice), contributes to the All Party Parliamentary Group on Incontinence in the UK; and serves on the International Continence Society Nurses Committee. She is a member of the Cochrane Incontinence Review Group and was the lead author on a review on prompted voiding and is a co-author on a current review about toileting assistance programs. She has also co-authored a book chapter about the management of incontinence in frail older adults.Her presentation titled ‘Frailty in the primary and community setting: can integrated care support us growing old?’ will describe national strategic policy initiatives to enhance integrated continence care for frail older adults in primary and community settings. Sharon notes:
  • There are recognised indicators of frailty that can be detected in clinical practice
  • Screening tools can be used to detect frail older people
  • There are simple interventions which can be used to slow further deterioration in frail older people
  • Frailty can be managed in primary and community care with effective specialist support and integrated care

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