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Study finds ‘pad culture’ in hospital settings for dementia patients

Dementia patients in acute hospital settings are at increased risk of developing incontinence during their hospital stay as a result of a widespread “pad culture”, according to a new study.

The study looked at continence care across six acute wards in three hospitals in England and Wales over a 12-month period.

“The will is there to do better, but we need to engender a culture of continence promotion”

Nikki Cotterill

It found an “ingrained” pad culture whereby continence pads were routinely used in people with dementia regardless of their level of continence at admission.

Continence pads were often introduced as a precautionary measure to prevent accidents. However, patients with dementia were then frequently expected to use the pads instead of going to the toilet normally.

This allowed for fewer unscheduled interruptions to the work being carried out on the ward, but the researchers warn it could put patients at risk of becoming incontinent during their hospital stay, with a subsequent loss of independence on hospital discharge.

The problem is significant because people living with dementia are now one of the largest populations in hospitals, with latest figures indicating that 25-50% of all acute hospital admissions are in people also living with dementia.

Staff working on the wards told researchers that they wanted to deliver high-quality person-centered care, but felt unsupported by their hospitals and the senior staff in charge.

They described feeling abandoned with the responsibility of caring for large numbers of people living with dementia, and did not believe it was possible to work in other ways to support their patients’ continence.

Co-author of the study and director of research and publications at Dementia UK, Dr Karen Harrison, who is also a professor of dementia nursing, said: “Staff not only require targeted education on the specific ways they can promote an individual’s independence but health care organizations should be mandated and responsible for maintaining an older person’s autonomy.”

“Healthcare professionals should ensure that trigger questions regarding bladder and bowel health are integrated in holistic assessment”

Polly Weston

Dr Nikki Cotterill, nurse and professor in continence care at the University of the West of England, Bristol, said that this study backed up the findings of her own research into bladder and bowel management.

She said that in the ECHO study, multidisciplinary hospital staff reported a tendency to “get pad happy” when managing patients aged over 65.

“There is a real concern for patients who come into hospital, with dementia and other conditions, that pad use where it is not appropriate can lead to lack of independence, skin damage, and can be so undignified,” she told Nursing Times.

“The will is there to do better, but we need to engender a culture of continence promotion, by comparison with incontinence management,” she added.

Chair of the Association for Continence Advice and clinical lead for the bladder and bowel service at the University Hospital of Morecambe Bay, Polly Weston, also a nurse, said that best practice was to ensure any patient presenting with a bladder or bowel dysfunction receives an individual continence assessment and treatment plan, using goal setting to achieve optimal bladder and bowel health.

“Healthcare professionals should ensure that trigger questions regarding bladder and bowel health are integrated in holistic assessment to ensure opportunities to assess and treat are not missed,” she told Nursing Times.

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