Cath Lab Digest

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  The University of North Carolina Chapel Hill School of Nursing; the Penn Center for Continence and Pelvic Health, Division of Urology, University of Pennsylvania Medical Center; and the American Journal of Nursing, in collaboration with the Center for Professional Development, University of Pennsylvania School of Nursing, held an invitational symposium in Philadelphia on July 12 and 13, 2002, to develop research priorities and clinical care and policy recommendations addressing the state of the art and science of continence promotion and the prevention, assessment, treatment, and management of urinary incontinence (UI) in adults, especially in vulnerable groups such as the elderly.

  Supported by unrestricted grants from the Agency for Healthcare Research and Quality and companies that manufacture products and pharmaceuticals for urinary incontinence and overactive bladder (OAB), the symposium brought together leading nurse researchers, clinicians, educators, administrators, and industry stakeholders to address the following objectives:
• to critique the current state of urinary incontinence research in various clinical settings
• to review the state of the art of nursing care of incontinent adults
• to identify barriers to improved nursing management of UI
• to provide practical and strategic recommendations for future directions in incontinence research, clinical practice, education, and policy
• to disseminate the analysis and recommendations to nurse researchers, nurse educators, healthcare professionals, policymakers, and the public.

Background

  Urinary incontinence is one of the most prevalent and costly public health problems in this country. More than 20 million adults have UI or OAB.¹ Between 15% and 30% of adult women experience UI, and the prevalence is even greater in the elderly population.² Urinary incontinence is present in half of older adults in nursing homes and in 13% to 56% of homebound elders.^{2, 3} In 2000, more than one-third of nursing home residents experienced UI all or most of the time.⁴ As large segments of the US population enter old age, the absolute numbers of people with incontinence and OAB will increase.

  Despite evidence-based guidelines developed and widely disseminated by the Agency for Health Care Policy and Research (AHCPR) in the 1990s (AHCPR is now known as the Agency for Healthcare Research and Quality, or AHRQ), UI remains underreported, underdiagnosed, and consequently, undertreated.¹ Some who have been diagnosed with UI do not receive treatment, especially those with cognitive impairment and depression.⁵ Urinary incontinence affects the quality of a patient's life and may be associated with a greater need for assistance with activities of daily living and the need for formal and informal caregiving.^6,7 It also carries a significant financial burden; at least $5.2 billion is spent on incontinence supplies and services in the institutional setting.⁸

  While research on assessing and managing incontinence, especially in adults, has proliferated, gaps remain in what can be applied across clinical settings. Little research on the efficacy of UI interventions in the acute care setting is available, although it is known that the prevalence of UI increases during hospitalization for some conditions (eg, hip fracture repair).⁹ In the long-term care setting, behavioral interventions have proven effective, but staff compliance with the interventions has been problematic.^2,10,11 The Centers for Medicare and Medicaid Services (formerly the Health Care Financing Administration) is changing the procedure for surveying nursing homes for deficient nursing practices related to UI and indwelling urinary catheters.