Improving continence care
GIAM navigation
How can we improve continence care for people with dementia in hospital?
How can we improve continence care for people with dementia in hospital?
The latest report carried out by Professor Katie Featherstone, Dr Andy Northcott, and Dr Paula Boddington of the Geller Institute of Ageing and Memory, presents the findings of our latest ethnographic research, Understanding how to facilitate continence for people with dementia in acute hospital setting. This detailed report focuses on a hidden and often poorly understood aspect of everyday continence care. The findings were discussed on BBC Radio 4’s File on 4 which is available on demand on BBC Sounds.
This research is funded by the National Institute for Health & Care Research (NIHR HS&DR programme), which delivers research for the Department of Health and Social Care. This publicly-funded study, took place across six wards in three hospitals over the course of a year.
The study identified what the authors call the ingrained practices of ‘pad culture’. This is the everyday and routine use of continence pads in the care of people living with dementia regardless of their continence and independence. The rationale was as a precautionary strategy to provide safeguards, ensure containment, and prevent ‘accidents’ or incontinent episodes, however, it led to expectations that patients living with dementia not only wear pads, but that they could and should use the pad. These practices often had irreversible impacts on the ability, dignity and identity of individuals as well as their families.
The team are using the findings of this study to deliver open access training and education to health and social care professionals and working with NHS Trusts and wards to support improvements in care throughout the NHS.
Read the report
25-50% acute hospital admissions are people living with dementia
25-50% acute hospital admissions are people living with dementia
The acute hospital setting has become a key site of care for people living with dementia. People living with dementia are one of the largest populations within our hospitals, with the Department of Health recognising that 25-50% of all acute hospital admissions are also living with dementia. However, they are a highly vulnerable group within the hospital setting. Following an acute admission their functional abilities can deteriorate quickly and significantly. Detailed research is required to explore what constitutes “good care”.
This study’s focus was a common but poorly understood aspect of everyday care for people living with dementia during an acute admission: continence care. We asked:
- What caring practices are observable when interacting with this patient group?
- How do ward teams respond to and manage continence needs?
- What informs these approaches?
- What are staff doing and why?
A study across six wards in three hospitals in England and Wales
This ethnography was informed by the symbolic interactionist research tradition, focusing on understanding how action and meaning are constructed within a setting. In-depth evidence-based analysis of everyday care enabled us to examine how ward staff responded to the continence care needs of people living with dementia and to follow the consequences of their actions.
We carried out a mixed methods systematic narrative review to refine our approach to fieldwork and analysis.
This ethnography was carried out across 180 days, across 12 months in six wards within three hospitals across England and Wales, purposefully selected to represent a range of hospitals types, geographies and socio-economic catchments.
In addition to general observations, 108 participants participated directly in this study, contributing to 562 ethnographic interviews. Ten detailed case studies were also undertaken with people living with dementia.
Pads routinely used regardless of patient's continence and independence
This study identified “pad culture” as an embedded practice within these acute wards: the routine use of continence pads in the care of a wider group of people living with dementia (regardless of continence and independence) as a precautionary strategy, with the rationale to provide safeguards, ensure containment, and prevent “accidents” or incontinent episodes, with an expectation that patients living with dementia not only wear pads, but that they could and should use them.
This pad culture enabled wards to reduce unscheduled interruptions to the institutionally-mandated, timetabled work of these wards, but had significant impacts on people living with dementia, and in turn wider impacts on the person and their identity.
Ward staff described feeling abandoned with the responsibility of caring for large numbers of people living with dementia, believing it was impossible to work in other ways to support their patient’s continence.
How can we improve care?
The findings of this study are informing the development of education and training at the interactional and organisational level in collaboration with specialist dementia care and continence teams.
GIAM podcast
In this first instalment of the GIAM podcast, Professor Katie Featherstone and Dr Andy Northcott talk to Piers Gibbon about their new publication on how we can improve continence care for people with dementia.
The Geller Institute of Ageing and Memory
This research was carried out by Professor Katie Featherstone, Professor of Sociology and Medicine and Director, The Geller Institute of Ageing and Memory.
The Institute is concerned with maintaining independence and improving quality of life for older people and for those living with dementia. The Institute responds to a pressing contemporary health and social care challenge: the need to improve the quality and humanity of care that people living with dementia receive locally and globally.
We use our research to further current understandings of cognitive decline and dementia, in turn improving the lived experiences of those affected. We develop and deliver evidence-based education and training that supports people living with dementia, their families, and the health and social care staff who care for and work with them.
The Geller Institute of Ageing and Memory
The Geller Institute of Ageing and Memory delivers research and education into how the quality of life can be improved for people living with dementia.
Follow us on social media
Get in touch
- Contact the Geller Institute of Ageing and Memory at GIAM@uwl.ac.uk.
- Follow us on X (formerly Twitter) and LinkedIn.