Business Plan

Clinical focus

Incontinence in patients with dementia
Harriet Price

I

ncontinence is highly prevalent in people with dementia owing to deterioration in their mental and physical abilities (Wai et al, 2010). However, Yap and Tan (2006) discuss whether people with dementia have
‘true incontinence’, as Abrams et al (1988: p6) define incontinence as:
‘the involuntary loss of urine that is objectively demonstrable and presents a social or hygiene problem.’ This definition implies a failure of the controls associated with normal urine storage, whereas people with dementia who may have no problem with the micturition mechanism may only be incontinent owing to lack of mobility, which is labelled as functional incontinence. Proper management of functional and true incontinence would help to decrease the incidence and lessen the discomfort and embarrassment that surrounds this problem. However, dealing with patients with dementia would create difficulties when managing incontinence and there is little literature highlighting best evidence-based practice when combining these two longterm illnesses, as more research needs to be performed (Hägglund, 2010).

Prevalence of dementia patients with incontinence
In the UK it is estimated that there are
821 884 people living with dementia, which represents 1.3% of the entire UK population
(Alzheimer’s Research Trust, 2010). This number is expected to rise to 940 110 by 2021 because of the relatively large increase in the numbers of older people, who are most at risk of dementia (Alzheimer’s Society, 2007). The increased prevalence of dementia highlights the need to better our practice in caring for those with dementia. Miu et al (2010) state that incontinence commonly occurs in people with dementia, as it was found that the prevalence of incontinence is notably higher in people with dementia (53%), compared to those without dementia (13%). Owing to the limited research on incontinence in dementia

British Journal of Nursing, 2011, Vol 20, No 12

Abstract

The high prevalence of incontinence in dementia sufferers will only increase as the population ages (Alzheimer’s Society, 2007), but the evidence-based knowledge for management of these long-term disorders combined is lacking
(Hägglund, 2010). Management techniques for incontinence need to be developed to ensure that dementia patients receive the best care, as current methods such as behavioural techniques may not be appropriate for people with limited cognitive function. This article will address issues that arise with current incontinence management for dementia sufferers and possible courses of action to tailor them more specifically to those people with cognitive impairment.
Quite often, incontinence is just managed with incontinence pads and treatment is not discussed, which can have detrimental effects on the patient (Omli et al,
2010). Nurses have an important role in incontinence treatment and can change this misuse of incontinence pads and ensuring a holistic approach to care will help when treating a patient with dementia. Ethical and legal issues will also be discussed as they must be considered when providing holistic care.
Key Words: Dementia n Incontinence n Older people n Management n Role of the nurse n Future developments sufferers, the current incidence is difficult to approximate but Aminoff et al (2008) has estimated 80-90% of demented individuals have incontinence, whether urinary or faecal.
However, feelings of shame and embarrassment may stop the population (and the demented and their carers), from seeking treatment and advice for incontinence (Alexander et al, 2006), reducing the validity of the estimated number of sufferers.

Aetiology
Dementia and incontinence are long-term conditions separately, but when combined can be difficult to control as dementia is degenerative, worsening symptoms including incontinence. Dementia is the collective term for symptoms which can be caused by certain diseases affecting the brain (see Box 1). The severity of the cognitive impairment and the degree of immobility are important predictors of incontinence in dementia. Cognition enables continence by maintaining the ability to:
■■ Recognize the need to empty the bladder or rectum
■■ Hold on until it is appropriate to release waste ■■ Find

and recognize the toilet clothes and use the toilet correctly.
(Yap and Tan, 2006)
When cognition is impaired and the patient is unable to do any of these things, incontinence is the outcome. This functional incontinence may not be the only reason for accidental elimination as it is often multifactorial in dementia patients, which is why a complete assessment is essential. Box 2 lists other causes of incontinence.

■■ Remove

Pathological causes and effects
The loss of neurological function in dementia can have different causes depending on the type of dementia diagnosed. Alzheimer’s patients grow plaques in their brain containing damaged cells and abnormal proteins. These proteins produce beta-amyloid fragments that cause most of the loss of neurological function.
Harriet Price is Student Nurse, Buckinghamshire
New University, Uxbridge Campus
Accepted for publication: June 2011

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Box 1. Main causes of dementia
•
•
•
•
•

Alzheimer’s disease (possible causes include genetics or history of brain injury).
Vascular dementia (caused by lack of blood supply to certain parts of the brain).
Dementia with Lewy bodies (unknown causes, possibly mix of environmental and genetic).
Fronto-temporal dementia (unknown causes, possibly genetic).
Other rare causes e.g. Korsakoff’s syndrome, Creutzfeldt-Jakob disease, HIV related cognitive impairment. Source: Alzheimer’s Society, 2007

Box 2. Causes of incontinence
•
•
•

•
•

• •
•

•
•
•
•
•

Gender
Age
Weak or damaged pelvic floor muscles or urethral sphincter
Certain medications
Damage from childbirth (nerve damage, fistulas, prolapses)
Increased pressure in the abdomen
(pregnancy, obesity)
Overactive bladder syndrome
UTI’s and other conditions affecting the lower urinary tract
Neurological conditions
Diabetes
Englarged prostate gland
Bladder stones
Constipation

Source: Miller, 2008

Box 3. Tests for incontinence
•
•
•
•
•
•
•
•
•
•
•
•

Full medical history and physical exam
Assessment of cognitive abilities
Pelvic floor muscle assessment
Assessment of prolapse
Urine testing
Assessment of residual urine
Bladder diaries
Pad testing
Urodynamic testing
Cytoscopy/coloscopy
Imaging
Rectal exam

Vascular dementia occurs when there is an impairment of the oxygenated blood supply to certain parts of the brain, causing multi-infarcts or strokes. Microscopic holes are formed in the brains of Creutzfeldt-Jakob disease patients, neurons are lost and amyloid deposits occur
(Brooker and Nicol, 2003).These abnormalities all distort the brain function, particularly if the damage is near to the brain stem which controls elimination. The damage also causes symptoms such as memory loss and uncoordinated movement, which could lead to other issues such as incontinence.

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As well as physical effects, these symptoms have a psychological impact on individuals, carers and families. Depression, anxiety and embarrassment are common feelings among individuals that have incontinence (Miller,
2008), as they dislike the lack of control they have over previously controlled functions.
Families can feel overwhelmed and embarrassed that they now have to help their relative to the toilet, and carers may feel stressed when trying to communicate to a dementia patient the need to toilet and so support and information must be readily available to help them. The possible long-term problems of continually being incontinent include pressure sores, malodour and leakage embarrassment and related psychological effects, as well as cost implications of treatment, pads and home help or nursing home places. McNulty et al (2008) found that nursing homes that have a high prevalence of urinary catheterization among their residents provide a less proactive approach in toileting regimes and leave catheters in situ for longer periods of time. Staff in these homes suggested that staff shortages and lack of catheter care plans increased the length of time for a catheter to remain in situ as regular toileting regimes and pad changing were more difficult. Inappropriate use of catheters in care homes could lead to urinary tract infections and other health problems, which although would help limit urine leakage, would cause more harm than good.

Management
To provide the best management of incontinence in patients with dementia, a number of techniques must be applied concurrently. Primarily carrying out a detailed assessment is key in organizing specific care. It would enable the tailoring of pharmaceuticals, behavioural techniques, pad use and the minimization of functional barriers to reduce the incidence of incontinence.

Assessment
Norton (2011) states that the rigorous assessment of toileting problems when starting to manage

incontinence is extremely important. This may be a problem when communicating with people suffering with dementia because of their altered cognitive state and memory problems, which could lead to communication difficulty (Singh, 2009). Benson (2003) states that the assessment needs to include information essential to identify possible causes and plan treatment or referral, which cannot be done with limited information and lack of communication and so dementia patients may receive substandard care. Rayner et al (2006) and Barnett (2000) suggest that using ‘closed’ questions and short sentences when retrieving information from the patient would minimize confusion and allow for a better evaluation of their incontinence.

Diagnostic tests
Tests to find possible causes for incontinence are useful to determine correct management techniques and should be used as an initial evaluation when a patient complains of discomfort (Spinzi, 2007). Demented patients may not just have functional incontinence, they may have a urinary tract infection or be constipated leading to accidental elimination.
Ruling out these possibilities is crucial to treat the problem accurately. There are many tests that can be performed (Box 3), and if problems arise they can be treated to reduce elimination difficulties. If tests are negative for mechanical abnormalities, functional incontinence might be the diagnosis to which behavioural techniques have to be employed.

Behavioural techniques
An individualized toileting programme is a behavioural technique used when promoting and managing continence (Morgan et al, 2008).
The patient reports their toileting patterns and then a regular toileting regime is created pre-empting micturation or defecation. This is widely used and Mathur et al (2010) states that it works well at minimizing incontinence even though it is labour-intensive. However, a patient with dementia could find it hard to track their toileting patterns and may need the help of a carer to record the information.
They also may not realize they have urinated until their pad gets changed an hour later, which would defeat the point of recording correctly to anticipate toileting. However, an individualized and comprehensive care strategy that aims to reduce incontinence by regular toileting, pad changes and increases in fibre and fluid intake would make an improvement to a patient’s continence
(Tanaka et al, 2009).

British Journal of Nursing, 2011, Vol 20, No 12

clinical focus

Table 1. Pharmological Interventions
Type of urinary Brand name incontinence of drug

Generic name

Action

Side effects

Urge
Detrol
Tolterodine
Anticholinergic, decreases
Dry mouth; bladder contractility, constipation, headache increases capacity
Urge
Ditropan XL
Oxybutynin
Anticholingeric, decreases
Dry mouth, bladder contractility constipation, somnolence
Urge
Ditropan
Oxybutynin
Anticholingeric, decreases
Dry mouth, bladder contractility constipation, dizziness Urge
Trofanil
Imipramine
Tricyclic antidepressant,
Dry mouth, blocks reuptake of constipation, blurred adrenaline and serotonin, vision, dizziness therefore may have effect of increasing bladder capacity and increasing sphincteric closure
Urge
Cardura
Doxazosin
Relaxes smooth muscle of
Postural hypotension, the urethra and prostatic dizziness, oedema, capsule in men with benign dyspnea prostatic hypertrophy
Urge
Hytrin
Terazosin
Relaxes smooth muscle of
Postural hypertension, the urethra and prostatic dizziness, nausea. capsule in men with benign prostatic hypertrophy
Urge
Flowmax
Tamsulosin
Relaxes smooth muscle of
Abnormal ejaculation, the urethra and prostatic postural hypotension, capsule in men with benign dizziness, cough, prostatic hypertrophy insomnia Stress
Premarin cream, Estrogen vaginal
Treats atrophic vaginitis
Breast tenderness, estrace vaginal cream uterine bleeding, vaginal cream candidiasis, headache
Stress
ESTring
Estradiol
Treats atrophic vaginitis
Headache, leukorrhea, skeletal pain
Stress
Entex L.A
Phenylpropanolamine Increases urethral smooth
Nervousness, dizziness, muscle contraction insomnia Stress
Sudafed
Pseudoephedrine
Increases urethral smooth
Central nervous system muscle contraction overstimulation, headache, elevation in blood pressure
Source: Smith and Ouslander, 2000

Contraindications
Urinary retention, pyloric stenosis, uncontrolled narrow angle glaucoma
Urinary retention, pyloric stenosis, uncontrolled narrow angle glaucoma
Urinary retention, pyloric stenosis, uncontrolled narrow angle glaucoma
Not to be given during acute phase of myocardial infarction or with MAO inhibitors, urinary retention Not for use with patients with impaired liver function

Caution with other antihypertensives

Caution with cimetidine

Endometrial cancer, impaired liver or renal function
Caution in patients with impaired liver function
Uncontrolled hypertension, benign prostatic hypertrophy
Severe or uncontrolled hypertension, benign prostatic hypertrophy, and not for use with MAO inhibitors

Food and fluid management

Reducing functional barriers

Pharmacological involvement

Increasing fibre and fluid intake helps decrease episodes of faecal and urinary incontinence
(Newman, 2007; Bliss and Norton, 2010).
Elderly people have a decrease in thirst (Miller,
2008), so relying on drinking when thirsty leads to dehydration, which in turn reduces the sensation of a full bladder which could cause incontinence. However, Lindeman et al (2000) state that there is no real evidence that just drinking more can improve the frequency, consistency or facilitation of bowel movements, except in patients with severe dehydration. Cognitive impairment means that dementia patients may need to be reminded to eat and drink, to maintain hydration and more control of elimination.

Ensuring adequate mobility, accessible toilets and other functional needs, would also decrease incontinence, regardless of a patient having dementia or not. CarpenitoMoyet (2008) expresses that removing or minimizing these functional barriers would promote micturation in any patient, as the barriers can delay access to a toilet and allow incontinence to occur. Ouldred and Bryant
(2008) says that people with a cognitive impairment such as dementia would need constant verbal reminders to establish a routine, such as toileting regularly. This would help them to recognize the signs of needing to toilet and in turn, reduce the risk of accidental micturation.

There are several pharmacological interventions that can be used for urinary incontinence (see Table 1), however, few of them manage functional incontinence. Smith and Ouslander (2000) come to the conclusion that older people would benefit more from these treatment options because of the few systemic side effects in relation to the positive bladder effects. Although these treatments are preferred, dementia patients suffering with functional incontinence would have to use behavioural techniques to combat their incontinence, such as a toileting regime, because the problem is not a mechanical one that can be controlled with drugs. Cheetham et al (2003) found that there is limited research

British Journal of Nursing, 2011, Vol 20, No 12

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to use as a guide to select appropriate drug therapies for faecal incontinence which could deter prescribers from using a new medication to assist an uncomfortable patient.

Incontinence pads
Incontinence pads are frequently used as a management technique, although Johnson et al (2001) found that older people prefer the use of medication to pad use. However, pads can sometimes be appropriate to gain possible independence and aid in discreet management, however, they do not treat incontinence (Du
Moulin et al, 2009), so treatment options should still be discussed. Omli et al (2010) found that the use of pads increases the risk of developing a urinary tract infection, so regular toileting and frequent pad changes are important to aid the reduction of risk.
The overuse and misuse of pads, particularly in dementia patients, causes a high cost to the provider or incontinent person. Pads are seen by some as a quick fix and so authorities may sometimes be too quick to prescribe pads when other treatments are available (Brooker and Nicol, 2003).

Role of the nurse
Taking a lead in continence promotion and management are the most important roles a nurse has in treating incontinence. Limited information has been published by those in

the medical profession on treatment and so little focus is put on progressing the research around treatment options.
It is ultimately a nurse’s responsibility to assess a patient correctly, assess goals and refer appropriately. Working with the multidisciplinary team is a strong focus of current continence care (Doughty, 2006), and having nurses, general practitioners, urologists and other professionals working towards the same goals is imperative for holistic and continued care. Nurses have the right skills set to manage patients with a holistic approach to include their mental wellbeing, and it is important to use these skills to improve patients’ quality of life if they have elimination problems. Using a biopsychosocial model
(Figure 1) ensures that the nurse considers the psychological implications that could occur when caring for an incontinent demented patient, guaranteeing a holistic care approach.
Nurses also have to protect and maintain dignity as a requirement of the Nursing and
Midwifery Council (NMC) (2008) and to limit the embarrassment felt by the patient.
Many patients feel too ashamed to talk openly about their elimination habits, nurses need to encourage honesty but still be tactful when dealing with such a personal subject. On the other hand, it is the patients’ role to give the nurse the correct and consistent information to be able to receive treatment, as holding back

Figure 1. Biopsychosocial model indicating the holistic view of health

Sociological

Pyschological

Health
Biological

information can lead to an incorrect or delayed diagnosis. Unfortunately, this may happen frequently owing to the private nature of the problem. Lack of communication because of cognitive impairment might also restrain the patient from getting the correct treatment and also their decrease in mobility may also place restrictions on the treatments chosen.
Long-term incontinence in dementia patients is hard to manage with or without professional guidance, and carers and family of the sufferers might feel overwhelmed.
The National Institute of Clinical Excellence
(NICE) (2006b) has produced guidelines surrounding dementia and support for carers; however, there is no information on providing care for the demented person with incontinence. This needs to be addressed so that more can be done to focus on these problems together. The guidelines highlight memory, communication and other services for dementia patients; yet these need to be correctly equipped for incontinence, easyaccess toilets, pad store and staff to help with toileting, before all of the demented person’s needs are met.

Ethical and legal considerations
Legal issues such as consent to medical treatment, testamentary capacity and competence are best addressed while patients still have the capacity to understand and communicate. When dementia makes it difficult for a patient to communicate, powers of attorney should be appointed to make decisions about medical interventions and property. The ability to make decisions decreases as the disease progresses (Aminoff et al, 2008) which causes many ethical dilemmas regarding what is best for the patient and what he or she wants, including treatment choice for the incontinence. When dealing with any patient, nurses must respect his or her dignity and autonomy (NMC, 2008), which may be hard to maintain when dealing with such privately invasive treatments or conversations with cognitively impaired patients about their incontinence. Collaborating with patients’ relatives can help to give the patient the best support they need if they no longer have capacity to make decisions. However, a relative’s conflict of interest may obstruct the appropriate decision making and has the potential to cause the patient harm or discomfort. Future treatment alternatives
There are several new options being developed to help reduce incontinence, one

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British Journal of Nursing, 2011, Vol 20, No 12

clinical focus of which is electrical percutaneous tibial nerve stimulation (PTNS). A probe is placed above the ankle and electricity stimulates the tibial nerve and in turn the spinal nerve, which supply the sacral nerves. This stimulation improves bowel function, urinary incontinence and also reduces constipation, allowing the recipient to gain more control of their sphincter and reducing incontinence.
There have been a few promising trials using the technique showing real improvement
(Harvard Pilgrim Healthcare, 2009), however, more research needs to be carried out to be considered more than an experimental and unproven technique. The development of patient-controlled bowel irrigation is also another technique that is being used to reduce blockages and incontinence, allowing the patient to irrigate themselves. This would ensure patient dignity as it is more private, it reduces hospital admissions and has been found to increase confidence (Tod et al, 2007).
However, it would be difficult for a person with dementia to bear the responsibility of this treatment option without help from carers, which increase the cost to the provider and may prove unviable.

Conclusion
Managing incontinence in patients with dementia would be easier if communication was improved. Young and Manthorp (2009) highlight the need for a Code of Practice to address the communicative needs of people with dementia and those around them, which would be helpful to implement for nurses to communicate effectively. A thorough assessment is essential to reduce incontinence; comprehension from both the nurse and the demented patient is necessary in providing correct treatment. There is a lack of research into management of incontinence in dementia patients that needs to be resolved to improve the lives of long-term sufferers.
Future developments of incontinence treatment appear to show improvement in the symptoms, but whether they are suitable for dementia patients needs to be researched.
The nurse is indispensable in incontinence care and it is imperative that nurses continue to strive for the best evidence-based practice in caring for dementia patients with
BJN
incontinence.
Conflicts of interest: None.
Abrams P, Blaivas J, Stanton S, Anderson J (1988) The standardisation of terminology of lower urinary tract function – The International Continence Society
Comittee on Standardisation of Terminology. Scand J Urol
Nephrol 144: 5–19
Alexander MF, Fawcett JN, Runciman PJ (2006) Nursing

British Journal of Nursing, 2011, Vol 20, No 12

Practice: hospital and home. 3rd edn. Churchill Livingstone,
London
Alzheimer’s Research Trust (2010) Dementia 2010 - The economic burden of dementia and associated research funding in the United Kingdom. Alzheimer’s Research Trust,
Cambridge
Alzheimer’s Society (2007) Dementia UK – The Full Report.
Alzheimer’s Society, London
Aminoff MJ, Boller F, Swaab DF (2008) Handbook of Clinical
Neurology: Dementias. Elsevier, Amsterdam
Barnett E (2000) Involving People with Dementia in Designing and Delivering Care: I need to be me! Jessica Kingsley, London
Benson D (2003) The importance of a thorough continence assessment [Online]. Nurs Times Net 99(29): 53. Available from: http://www.nursingtimes.net/nursing-practiceclinical-research/the-importance-of-a-thoroughcontinence-assessment/205491.article [Accessed 6th Jan
2011.]
Bliss DZ, Norton C (2010) Conservative management of faecal incontinence. Am J Nurs 110(9): 30–8
Brooker C, Nicol M (2003) Nursing Adults: the practice of caring. Elsevier, London
Carpenito-Moyet LJ (2008) Nursing Diagnosis: Application to clinical practice 12th edn. Lippincott Williams & Wilkins,
Philadelphia
Cheetham MJ, Brazzelli M, Norton CC, Glazener CMA
(2003) Drug treatment for faecal incontinence in adults.
Cochrane Database Syst Rev (3) CD002116
Doughty DB (2006) Urinary and Fecal Incontinence – current management concepts. Elsevier, Missouri
Hägglund D (2010) A systematic literature review of incontinence care for persons with dementia: the research evidence. J Clin Nurs 19(3-4): 303–12
Harvard Pilgrim Healthcare (2009) Medical Policy – Tibial nerve stimulation for urinary incontinence. [Online]
Available from: https://www.harvardpilgrim.org/pls/ portal/docs/PAGE/PROVIDERS/MEDMGMT/ STATEMENTS/TIBIAL_NERVE_STIM_1210.PDF
[Accessed on 8th Jan 2011]
Johnson TM, Ouslander JG, Usman GC, Schnelle JF (2001)
Urinary incontinence treatment preferences in long-term care. J Am Geriatr Soc 49(6): 710–8
Lindeman RD, Romero LJ, Liang HC, Baumgartner RN,
Koehler KM, Garry PJ (2000) Do elderly persons need to be encourages to drink more fluids? J Gerontol A Biol
Sci Med 55(7): 361–5
Mathur A, Browning J, Mistri AK (2010) Nonpharmacological management of urinary incontinence.
Rev Clin Geront 20(4): 268–76
McNulty C, Bowen J, Howell-Jones R, Walker M, Freeman
E (2008) Exploring reasons for variation in urinary catheterisation prevalence in care homes: a qualitative study. Age and Aging 37(6): 706–10
Miller C (2008) Nursing for Wellness in Older Adults 5th edn.
Lippincott Williams & Wilkins: Philadelphia
Miu D, Lau S, Szeto S (2010) Etiology and predictors of urinary incontinence and its effect on quality of life.
Geriatr Gerontol Int 10(2): 177–82
Morgan C, Endozoa N, Paradiso C, McNamara M, McGuire
M (2008) Enhanced toileting program decreases incontinence in long-term care. Jt Comm J Qual Patient
Saf 34(4): 206–8
Du Moulin MFMT, Hamers JPH, Ambergen AW, Halfens
RJG (2009) Urinary incontinence in older adults receiving homecare diagnosis and strategies. Scand J

Caring Sci 23(2): 222–30
Newman D (2007) Conservative therapy for incontinence.
In: Goldman HB, Sandip PV eds. Female Urology: A
Practical Clinical Guide. Humana Press, New Jersey
National Institute for Clinical Excellence (2006a) Urinary
Incontinence:The management of urinary incontinence in women.
Royal College of Obstetricians and Gynaecologists,
London
NICE (2006b) Dementia – supporting people with dementia and their carers in health and social care.
Clinical Guideline 42. National Institute for Clinical
Excellence, London
Norton C (2011) Discussion on Incontinence [conversation]
(Personal communication, 6 Jan 2011)
Nursing & Midwifery Council (2008) The Code. Standards for Conduct, Performance and Ethics. Nursing & Midwifery
Council, London
Omli R, Skotnes LH, Romild U, Bakke A, Mykletun A,
Kuhry E (2010) Pad per day usage, urinary incontinence and urinary tract infections in nursing home residents.
Age and Ageing 39(5): 549–54
Ouldred E, Bryant C (2008) Dementia Care. Part 1: guidance and the assessment process. Br J Nurs 17(3):
138–47
Rayner AV, O’Brian JG, Schoenbachler B (2006) Behaviour disorders of dementia: Recognition and treatment. Am
Fam Physician 73(4): 647–52
Singh R (2009) The effect of dementia on communication and memory. West Virginia University Speech Pathology and
Audiology Capstone Anthology 1: 164–8
Smith DA, Ouslander JG (2000) Pharmacological management of urinary incontinence in older adults. Top
Geriatr Rehabil 16(1): 54–60
Spinzi GC (2007) Bowel care in the elderly. Dig Dis 25:
160–5
Tanaka Y, Kumiko N, Tomoe T et al (2009) Can an individualise and comphrehensive care strategy improve urinary incontinence (UI) among nursing home residents? Arch Geront Geriatr 49: 278–83
Tod AM, Dean J, Goodfellow V,Stringer E, Levery C, Brown
J (2007) Managing bowel disorders with rectal irrigation.
Nurs Times 103(36): 32–3
Wai AAP, Fook FS, Jayachandran M, Biswas J, Lee JE, Yap
P (2010) Implementation of context-aware distributed sensor network system for managing incontinence in patients with dementia. International Conference on Body Sensor Networks. Networking Protocols
Department, Singapore. 102–5
Yap P, Tan D (2006) Urinary incontinence in dementia:
A practical approach. Aust Fam Physician 35(4):
237–41
Young T, Manthorp C (2009) Towards a Code of Practice for effective communication with people with dementing illnesses. J Lang Soc Psychol 28(2): 174–89

Key points n The prevalence of incontinence in dementia patients will grow as the population ages n Treatment options for dementia patients should be discussed, not simply managed with incontinence pads n Incontinence management techniques can be specifically tailored to dementia patients n Nurses need to lead the way in continence promotion and incontinence management n As cognitive ability decreases, legal and ethical perspectives become an important consideration 725

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