Hypothesis / aims of study
This presentation will be unique in its approach to frame the need to address incontinence from a policy perspective and will present policy solutions that governments and decision-makers can consider to raise more awareness and better support older adults living with incontinence.
Incontinence, both urinary and fecal, are remarkably common. In Canada, urinary incontinence is estimated to affect approximately 10% of the population (1). Incontinence can lead to social isolation, loneliness, depression and other health consequences including an increased risk of placement in a nursing home or other congregate living settings. Many Canadians believe that incontinence is a normal part of ageing. It is not a normal and inevitable part of ageing, however incidence does increase with age. Therefore, as life expectancy continues to increase, so will the number of people living with incontinence.
The aim of this policy analysis was to comprehensively summarize the issue of incontinence for older adults. It also aims to raise awareness around some of the unique challenges for those living with incontinence in Canada, especially due to gaps in the research due to under-reporting and stigma associated with this topic. It specifically analyzed policy options that can better address incontinence.
Study design, materials and methods
A policy analysis was conducted by reviewing the current literature (over 100 documents reviewed including journal articles and grey literature from government sources and other continence societies) to inform a white paper on the impact of incontinence for older adults specifically. We have highlighted best practices nationally and internationally including from the United Kingdom, with a highlight on Scotland, and Australia. This review was supported by consultations with 20 key experts and review by 13 key experts.
Results
This analysis provides a high-level summary of the prevalence of incontinence and its associated risk factors, as well as current management approaches. It further highlights common issues that older adults living with incontinence face including a lack of awareness and education, both amongst the public and health care providers; underreporting and stigma; social consequences including social isolation, loneliness, and relationship issues; and, care and cost consequences. This review ends by specifically analyzing policy options that can better address incontinence such as promoting more publicly accessible washrooms as part of an age-friendly community’s agenda, continence promoting efforts in healthcare settings, using portable ultrasounds to reduce the incidence of urinary catheterization, and coverage of continence products.
Our research found that while incontinence is often preventable and/or treatable, it remains a largely under-reported and under-treated condition faced by older Canadians. As a result, we proposed six evidence-informed policy recommendations and practice approaches in order to better address incontinence in Canada.
1. Improve efforts to raise public awareness and reduce stigma around incontinence.
2. Improve and provide more education for health and care professionals.
3. Encourage quality-setting bodies such as Accreditation Canada/Health Standards Organization (HSO) to incorporate and adopt evidence-informed practices to account for and measure incontinence (i.e. CIHI, HQO, Ministries of Health, and PHAC).
4. Promote research and knowledge translation of best practices to manage and treat incontinence.
5. Improve the availability of publicly accessible toilets as part of the creation of more age-friendly communities.
6. Promote greater equity around funding supports to manage incontinence.
Interpretation of results
There are still too many Canadians who believe that incontinence is a normal part of ageing. If it was better recognized that incontinence is both preventable and treatable, more people would be able to remain independent, productive, and engaged citizens as they age. There is a need to improve both public awareness around incontinence, but also improve education for health and care professionals so that they are better equipped to effectively address incontinence in the people that they see. The encouragement of better data collection will make it easier to understand the prevalence and wide-ranging impact on individuals living with incontinence, their unpaid caregivers, and paid care providers. Creating more accessible communities is essential, as lack of accessibility can result in social isolation amongst older adults.