A new approach to providing continence care in an ageing population
Adrian Wagg is a Professor of Healthy Ageing at the University of Alberta, a regular author for the BGS Age and Ageing journal and General Secretary of the International Continence Society. He will present a guest lecture on continence at the BGS Spring Meeting in March 2015. Incontinence is a hugely debilitating condition which affects millions of men and women worldwide. Its incidence is rising as the proportion of people surviving into late life increases and with increasing rates of long-term conditions such as diabetes, heart disease and dementia for which it is a symptom or complication. It has a huge impact on the lives of our patients and their caregivers, and comes at significant cost to health and social care services. However, it remains one of the least discussed and most poorly understood conditions. Earlier this year, along with colleagues Diane Newman, Kai Leichsenring and Paul van Houten, I undertook a review of the way continence service are organised, which was funded and supported by leading global hygiene company, SCA. We concluded that there is a need for a greater focus on incontinence as a health and social care issue and to ensure that adequate resources are devoted to it. In the UK, patients are still not being seen by the right professional at the right time. The NHS needs to develop better models of multi-disciplinary working to ensure care is person-centred, and prioritises quality of life. Geriatricians should take a more active interest in incontinence and help to optimise services for older people and their families. Services are best delivered in primary care, led by appropriately trained continence nurses in, carrying out initial assessments, discussing treatment options and supporting self-management. This will reduce the number of referrals to specialist care and ensure guideline appropriate treatment. We identified a need for an increased awareness of local NHS services, and better partnership working with the voluntary sector, in order to reduce the level of unmet need that continues to exist. We also found that the use of containment products continues to be inconsistent, sometimes random and insensitive to the needs of patients and their carers. A range of products needs to be provided to enable patients and their caregivers to effectively evaluate which type of product offers the best solution to meet their needs. Whilst it is unlikely that continence care will be included in the Quality and Outcomes Framework, we believe the profile of continence care should be raised by commissioning services with appropriate incentive payments, such as CQUINs (Commissioning for Quality and Innovation). The recently updated NICE guidelines for urinary incontinence for women could also be used to monitor clinical practice. There are still real challenges in delivering effective, patient-centred continence services, and much more needs to be done to ensure the appropriate services are in place. I hope that the Optimum Continence Service Specification report will encourage geriatricians to support policy makers and commissioners to review their continence services, and work in partnership with patients, their families and caregivers, to improve treatment and care, and enhance quality of life for everyone affected by the condition.