Skip to main content
SpringerLink
Log in
Book cover

Management of Fecal Incontinence for the Advanced Practice Nurse pp 127–148Cite as

Management of Fecal Incontinence in Frail Older Adults Living in the Community

  • Chapter
  • First Online:

Abstract

Most older adults live in the community either alone or in a family arrangement. Community-living older adults are diverse, and the health status of some is characterized by complexity related to having multiple morbidities and possibly frailty. Assessment and management of fecal incontinence in frail community-dwelling older adults with health-related complexity may be enhanced using a complexity framework that accounts for social, environmental, and political contextual factors as well as health/medical concerns. This chapter will explain common problems that contribute to fecal incontinence in these older adults such as impaction with overflow, constipation, diarrhea, and mild to moderate cognitive impairment. It will address special considerations that the advanced practice nurse must take into account including hearing and vision impairment, physical limitations, the physical environment and toilet access in the home, diet and hydration, and the role of the caregiver. The chapter will then discuss appropriate management interventions. Interventions highlight the importance of a holistic approach, client and caregiver engagement and education, and referral to other healthcare professionals and community services.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   44.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   59.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   59.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. World Health Organization. World report on ageing and health. Geneva: WHO; 2015.

    Google Scholar 

  2. De Vries N, Staal J, Van Ravensberg C, Hobbelen J, Rikkert MO, Nijhuis-Van der Sanden M. Outcome instruments to measure frailty: a systematic review. Ageing Res Rev. 2011;10(1):104–14.

    Article  PubMed  Google Scholar 

  3. British Geriatric Society. Fit for frailty: consensus best practice guidance for the care of older people living with frailty in community and outpatient settings. London. London: British Geriatric Society; 2014. http://www.bgs.org.uk/campaigns/fff/fff_full.pdf

    Google Scholar 

  4. Santos-Eggimann B, Cuénoud P, Spagnoli J, Junod J. Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. J Gerontol A Biol Sci Med Sci. 2009;64(6):675–81.

    Article  PubMed  Google Scholar 

  5. Song X, Mitnitski A, Rockwood K. Prevalence and 10-year outcomes of frailty in older adults in relation to deficit accumulation. J Am Geriatr Soc. 2010;58(4):681–7.

    Article  PubMed  Google Scholar 

  6. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol Ser A Biol Med Sci. 2001;56(3):M146–M57.

    Article  CAS  Google Scholar 

  7. Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol Ser A Biol Med Sci. 2007;62(7):722–7.

    Article  Google Scholar 

  8. Schober M. Introduction to advanced nursing practice: an international focus. Cham: Springer; 2016.

    Book  Google Scholar 

  9. Wagg A, Chen LK, Johnson IIT, Kirschner-Hermanns R, Kuchel G, Markland A, et al. Incontinence in frail older persons. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence. 6th ed. Bristol: International Continence Society; 2017. p. 1309–441.

    Google Scholar 

  10. Schaink AK, Kuluski K, Lyons RF, Fortin M, Jadad AR, Upshur R, et al. A scoping review and thematic classification of patient complexity: offering a unifying framework. J Comorb. 2012;2:1):1–9.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Zullig LL, Whitson HE, Hastings SN, Beadles C, Kravchenko J, Akushevich I, et al. A systematic review of conceptual frameworks of medical complexity and new model development. J Gen Intern Med. 2015;31(3):329–37.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kuluski K, Gill A, Naganathan G, Upshur R, Jaakkimainen RL, Wodchis WP. A qualitative descriptive study on the alignment of care goals between older persons with multi-morbidities, their family physicians and informal caregivers. BMC Fam Pract. 2013;14(1):133.

    Article  PubMed  PubMed Central  Google Scholar 

  13. De Giorgio R, Ruggeri E, Stanghellini V, Eusebi LH, Bazzoli F, Chiarioni G. Chronic constipation in the elderly: a primer for the gastroenterologist. BMC Gastroenterol. 2015;15(1):130.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Kwan D, Farell B. Polypharmacy: optimizing medication use in elderly patients. Can Geriatr Soc J Continuing Med Educ. 2014;4(1):21–7.

    Google Scholar 

  15. Westra BL, Savik K, Oancea C, Choromanski L, Holmes JH, Bliss DZ. Predicting improvement in urinary and bowel incontinence for home health patients using electronic health record data. J Wound Ostomy Cont Nurs. 2011;38(1):77–87.

    Article  Google Scholar 

  16. De Lillo AR, Rose S. Functional bowel disorders in the geriatric patient: constipation, fecal impaction, and fecal incontinence. Am J Gastroenterol. 2000;95(4):901–5.

    Article  PubMed  Google Scholar 

  17. Shah BJ, Chokhavatia S, Rose S. Fecal incontinence in the elderly: FAQ. Am J Gastroenterol. 2012;107(11):1635–46.

    Article  PubMed  Google Scholar 

  18. Petersen RC, Caracciolo B, Brayne C, Gauthier S, Jelic V, Fratiglioni L. Mild cognitive impairment: a concept in evolution. J Intern Med. 2014;275(3):214–28.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Wimo A, Jönsson L, Bond J, Prince M, Winblad B, International Alzheimer’s Disease. The worldwide economic impact of dementia. Alzheimers Dement. 2010;9(1):1–11.e3.

    Article  Google Scholar 

  20. Guthrie DM, Declercq A, Finne-Soveri H, Fries BE, Hirdes JP. The health and well-being of older adults with dual sensory impairment (DSI) in four countries. PLoS One. 2016;11(5):e0155073.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Bickley LS. Bates’ guide to physical examination and history taking. Philadelphia: Lippincott Williams & Wilkins; 2017.

    Google Scholar 

  22. Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol. 1989;42(8):703–9.

    Article  CAS  PubMed  Google Scholar 

  23. Katz S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc. 1983;31(12):721–7.

    Article  CAS  PubMed  Google Scholar 

  24. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist. 1969;9:179–86.

    Article  CAS  PubMed  Google Scholar 

  25. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9.

    Article  PubMed  Google Scholar 

  26. Finne-Soveri H, Sorbye LW, Jonsson PV, Carpenter GI, Bernabei R. Increased work-load associated with faecal incontinence among home care patients in 11 European countries. Eur J Pub Health. 2008;18(3):323–8.

    Article  CAS  Google Scholar 

  27. Gove D, Scerri A, Georges J, van Houten P, Huige N, Hayder-Beichel D, et al. Continence care for people with dementia living at home in Europe: a review of literature with a focus on problems and challenges. J Clin Nurs. 2016;26(3-4):356–65.

    Article  PubMed  Google Scholar 

  28. Mullins J, Bliss DZ, Rolnick S, Henre CA, Jackson J. Barriers to communication with a healthcare provider and health literacy about incontinence among informal caregivers of individuals with dementia. J Wound Ostomy Cont Nurs. 2016;43(5):539–44.

    Article  Google Scholar 

  29. Drennan VM, Cole L, Iliffe S. A taboo within a stigma? A qualitative study of managing incontinence with people with dementia living at home. BMC Geriatr. 2011;11:75.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Santini S, Andersson G, Lamura G. Impact of incontinence on the quality of life of caregivers of older persons with incontinence: a qualitative study in four European countries. Arch Gerontol Geriatr. 2016;63:92–101.

    Article  PubMed  Google Scholar 

  31. Bliss DZ, Mimura T, Berghmans B, Bharucha A, Chiarioni G, Emmanuel A, et al. Assessment and conservative management of faecal incontinence and quality of life in adults. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence. 6th ed. Bristol: International Continence Society; 2017. p. 1993–2085.

    Google Scholar 

  32. Registered Nurses Association of Ontario (RNAO). Strategies to support self-management in chronic conditions: collaboration with clients. Toronto: Registered Nurses Association of Ontario; 2010. http://rnao.ca/sites/rnao-ca/files/Strategies_to_Support_Self-Management_in_Chronic_Conditions_-_Collaboration_with_Clients.pdf.

  33. Markle-Reid M, Browne G, Gafni A. Nurse-led health promotion interventions improve quality of life in frail older home care clients: lessons learned from three randomized trials in Ontario, Canada. J Eval Clin Pract. 2013;19(1):118–31.

    Article  PubMed  Google Scholar 

  34. Alzheimer’s Association. 2014 Alzheimer’s disease facts and figures. Alzheimers Dement. 2014;10(2):e47–92.

    Article  Google Scholar 

  35. OECD. Pensions at a glance 2015. Paris: OECD Publishing; 2015.

    Google Scholar 

  36. Finne-Soveri H, Sørbye L, Jonsson P, Carpenter G, Bernabei R. Increased work-load associated with faecal incontinence among home care patients in 11 European countries. Eur J Pub Health. 2007;18(3):323–8.

    Article  Google Scholar 

  37. Varanese S, Birnbaum Z, Rossi R, Di Rocco A. Treatment of advanced Parkinson’s disease. Parkinsons Dis. 2010;480260. https://doi.org/10.4061/2010/480260.

  38. Smith SM, Soubhi H, Fortin M, Hudon C, O’Dowd T. Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. BMJ. 2012;345:e5205.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Bain KT, Holmes HM, Beers MH, Maio V, Handler SM, Pauker SG. Discontinuing medications: a novel approach for revising the prescribing stage of the medication-use process. J Am Geriatr Soc. 2008;56(10):1946–52.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Bliss DZ, Norton C. Conservative management of fecal incontinence. Am J Nurs. 2010;110(9):30–8.

    Article  PubMed  Google Scholar 

  41. Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH, et al. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol. 2013;108(4):478–98.

    Article  CAS  PubMed  Google Scholar 

  42. Ostaszkiewicz J, Hornby L, Millar L, Ockerby C. The effects of conservative treatment for constipation on symptom severity and quality of life in community-dwelling adults. J Wound Ostomy Cont Nurs. 2010;37(2):193–8.

    Article  Google Scholar 

  43. Robbs L, editor. Fecal incontinence: assessment and treatment. Hamilton, ON: McMaster University Press; 2014.

    Google Scholar 

  44. Registered Nurses Association of Ontario (RNAO). Prevention of constipation in the older adult population. Toronto: Registered Nurses Association of Ontario; 2011. www.rnao.org/bestpractices/

    Google Scholar 

  45. Franklin LE, Spain MP, Edlund BJ. Pharmacological management of chronic constipation in older adults. J Gerontol Nurs. 2012;38(4):9–15.

    Article  PubMed  Google Scholar 

  46. Liu LWC. Chronic constipation: current treatment options. Can J Gastroenterol. 2011;25(Suppl B):22B–8B.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Nugent KP. Rectocele pathophysiology and presentation. In Cohen R, Windsor A, editors. Anus: Surgical treatment and pathophysiology. London: Springer; 2013. p.91–6.

    Google Scholar 

  48. Hanson L-AM, Schulz JA, Flood CG, Cooley B, Tam F. Vaginal pessaries in managing women with pelvic organ prolapse and urinary incontinence: patient characteristics and factors contributing to success. Int Urogynecol J. 2006;17(2):155–9.

    Article  CAS  Google Scholar 

  49. McClurg D, Hagen S, Hawkins S, Lowe-Strong A. Abdominal massage for the alleviation of constipation symptoms in people with multiple sclerosis: a randomized controlled feasibility study. Mult Scler J. 2011;17(2):223–33.

    Article  Google Scholar 

  50. Doughty D, Jensen LL, editors. Assessment and management of the patient with fecal incontinence and related bowel dysfunction. St. Louis, MO: Mosby Elsevier; 2006.

    Google Scholar 

  51. Norton C, editor. Bowel control and managing a misbehaving bowel. Wilmette, IL: The Simon Foundation; 2011.

    Google Scholar 

  52. Bliss DZ, Savik K, Jung HJG, Whitebird R, Lowry A, Sheng X. Dietary fiber supplementation for fecal incontinence: a randomized clinical trial. Res Nurs Health. 2014;37(5):367–78.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Nursing, University of Alberta, Edmonton, AB, Canada

    Kathleen F. Hunter

  2. Glenrose Hospital Continence Clinic, Edmonton, AB, Canada

    Kathleen F. Hunter

  3. Saint Elizabeth Health Care, Hamilton, ON, Canada

    Melissa Northwood

  4. Aging, Community and Health Research Unit, School of Nursing, McMaster University, Hamilton, ON, Canada

    Melissa Northwood

  5. Homerton University Hospital NHS Foundation Trust, London, UK

    Veronica Haggar

  6. Urology Wellness Clinic, St. Joseph’s Hospital, Saint John, NB, Canada

    Frankie Bates

Authors
  1. Kathleen F. Hunter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Melissa Northwood
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Veronica Haggar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Frankie Bates
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kathleen F. Hunter .

Editor information

Editors and Affiliations

  1. School of Nursing, University of Minnesota School of Nursing, Minneapolis, Minnesota, USA

    Donna Z. Bliss

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hunter, K.F., Northwood, M., Haggar, V., Bates, F. (2018). Management of Fecal Incontinence in Frail Older Adults Living in the Community. In: Bliss, D. (eds) Management of Fecal Incontinence for the Advanced Practice Nurse. Springer, Cham. https://doi.org/10.1007/978-3-319-90704-8_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-90704-8_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90703-1

  • Online ISBN: 978-3-319-90704-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation