On the aged care ward at night, when staffing ratios are low, a patient’s urgent request to use the toilet becomes a falls risk activity (1). Patients rely on staff to assist them to void, often in a method that is not their preference or appropriate for their level of function. The aim of this study was to evaluate how bladder care at night corresponded to patients’ mobility status.

An observational study to quantify the care units related to nocturnal bladder management provided to a convenience sample of aged care rehabilitation patients over three consecutive nights (QA2012138).  Variables collected included documented type and timing of toileting and/or bladder care provided, validated measurement of comorbidities, cognition, mobility classification in bed and ambulation independence and distance. 

Mobility and ambulation were scored as 4 for independent, 3 for requiring supervision, 2 when assistance of one person was needed, 1 when two person assistance was provided and zero when the person was unable to undertake the activity being assessed. Mobility score was a sum of the sub-domains of moving around in bed, achieving a sitting position and standing from sitting. 

Bladder care were potentially recorded each hour with coding for discrete units i.e. check of continence status, change of containment product, change of bedding, assist to toilet in bed, assist to toilet at bedside and assistance to pass urine at the toilet.

Descriptive statistics were used to summarise the frequency of nocturnal bladder care provided each night and as a mean over the three nights. The median and IQR were reported for age, and counts for sex and relevant comorbidities.  The relationship between average care units provided and other variables was explored using one way ANOVA. For all analysis an alpha level of .05 was set for the determination of statistical significance.

As seen in Table 1, the mean age of the 63 participants was 82.0 years (SD ±8.7). The cohort was evenly split by sex. All separate care units were provided by a single staff member. Overall 27%, 41% and 48% of patients required assistance to move in bed, sit up in bed and stand from sitting respectively. Some form of equipment to support mobilisation was used by 82% of patients, with less than one quarter being independent. 

Over the three nights the average number of care episodes to address bladder function ranged from nil to nine. In total, patients were checked 164 times, containment products were changed 87 times and bedding on 19 occasions. Assistance to toilet was provided 254 times, 64 occasions at the bed or bedside and the remainder in the toilet. Only 9 participants were able to self-toilet during the night although 17 were classified as independent with ambulation. Assistance to pass urine accounted for 36% of care, whereas 20% of care related to incontinence management.  Bladder care activity averaged over the 3 nights is detailed in Table 2.

On ANOVA the average sum of care units was not significantly associated with age (F=0.40, p=0.99), ambulation distance (F=0.33, p=0.99), mobility in bed score (F=1.26, p=0.25), ambulation score (F=1.01, p=0.47) or number of continence product changes (F=1.57, p=0.10).  Average care units for incontinence was significantly associated with functional mobility in bed (F=5.52, p<0.001) and with ambulation score (F=3.52, p=0.001) but not with age (F=1.31, p=0.26) or ambulation distance (F=0.57, p=0.75). Average care units assisting patients to void during the night was significantly associated with functional mobility in bed score (F=2.14, p=0.02), ambulation score (F=2.04, p=0.03) and number of product changes (F=2.03, p=0.03) but not with age (F=1.25, p=0.27) or ambulation distance (f=0.39, p=0.98).

Mobility in bed and support required for ambulation, rather than age or walking distance, influences bladder care practices at night in sub-acute aged care wards. Therapy to improve independent movement in bed and functional ambulation may reduce the need for overnight incontinence care.

Prioritising skills to move around and get out of bed during rehabilitation may improve independence with continence and toileting at night; both variables are known to impact discharge destination (2).

Australian J Ageing 2020 Mar;39(1):e70-6
Disability and Rehabilitation. 2020 Dec 24:1-5