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We don’t ask, they don’t tell

Recommendations to address incontinence

One of the most under-reported and under-treated conditions faced by older Canadians. 

Incontinence, or the involuntary loss of urine or stool/gas, is remarkably common and one of a nationally representative epidemiological survey recently found that approximately 24 per cent of Canadian adults were living with urinary incontinence (UI). The average prevalence of fecal incontinence (FI) among those living in the community is estimated to be around 5 per cent, and much higher among those living in institutional care settings. 

Incontinence can lead to social isolation, loneliness, depression and other serious health consequences. This includes an increased risk of falls, as well as institutionalization in a nursing home or other congregate living setting. 

Exacerbating the challenge is the fact that many Canadians believe it is a normal part of ageing even though it is not. While age is a risk factor, in many cases, incontinence is both preventable and treatable. As the incidence of incontinence increases with age, older adults have a significantly higher prevalence of incontinence than younger people in Canada. In addition to age, other risk factors include lifestyle (e.g. obesity), medical conditions (e.g. diabetes, heart disease, lung disease, certain neurological conditions), medications and environmental factors (e.g. lack of access to public toilets). 

It is important to properly screen for incontinence and assess the conditions of those living with incontinence. The first line of treatment should be lifestyle approaches (such as changing one’s diet and/or losing weight) and behavioural approaches (such as pelvic floor exercises) that promote continence, before considering the use of medications or surgery. 

There is a general lack of awareness and education about incontinence both within the general public and among health care providers. Due to the stigma of incontinence, it remains underreported and many people are reluctant to seek help from professionals which  can lead to social isolation and loneliness. Some reports find that people who live with incontinence are 1.8 times more likely to experience loneliness than those who do not. It can also affect sexual intimacy and intimate relationships. In addition, there are negative physical outcomes such as skin irritation and breakdown that can lead to incontinence-associated dermatitis (IAD). 

Incontinence is a leading cause of institutionalization among older adults. It can also be a major expense and source of financial strain for those living with it as well as a source of frustration and cost for  their unpaid caregivers and the health care system as a whole.  

Infact, total costs of UI estimated at around $8.5 billion annually. When factoring in FI, costs could be as high as approximately $10 billion annually. The impact of incontinence on unpaid caregivers is also significant, affecting their quality of life and requiring a considerable amount of their effort and time to manage. 

In conclusion, this report suggests that  is imperative to increase both public and health care-provider awareness about incontinence, in order to reduce stigma and to spur better prevention and treatment efforts. Here are the following six evidence-informed policy recommendations and practices to better address incontinence in Canada: 

• Increase efforts to raise public awareness and reduce stigma around incontinence 
• Improve resources and educational opportunities for health and care professionals 
• Encourage quality and standards organizations, such as the Health Standards Organization (HSO), to incorporate and promote evidence-informed practices and measures to better address and manage incontinence 
• Promote research and knowledge translation of best practices to manage and treat incontinence 
• Ensure the availability of publicly accessible toilets, as part of the creation of more age-friendly communities 
• Promote greater equity around funding support to manage incontinence.

Source: National Institute on Ageing, Toronto Metropolitan University.

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