Older people spending time in hospital are being discharged with prolonged incontinence because NHS staff are too busy to take them to the bathroom while on the ward, experts warn.
One of the reasons, say specialists, is the inappropriate use of urinary catheters, a tube that is inserted into the urinary tract and empties the contents of the bladder into a drainage bag.
There are strict criteria for who should get one, including those with existing urinary incontinence and patients who are unable to move due to major surgery or spinal or pelvic injuries. But investigation has revealed that in some wards the procedure has become almost standard practice.
A study published in the British Journal Of Nursing suggests that up to 54 percent of catheterizations in older patients are unnecessary. Furthermore, even when use is adequate, nearly half of patients stay on catheters longer than recommended.
In a 2017 study published in the British Medical Journal, a young doctor surprisingly admitted that “sometimes it’s easier to put a tube in” rather than find the time to monitor urine output, a vital indicator of health, or to help a patient to go. to the bathroom repeatedly.
Older people spending time in hospital are being discharged with prolonged incontinence because NHS staff are too busy to take them to the bathroom while on the ward, experts warn.
The study also found that nurses were unclear on protocols for who should have a catheter and that women are more likely to get one since “it’s easier for men to urinate when they’re less mobile.” Catheters are far from risk-free. They often trigger urinary tract infections and one in five patients have urine leakage or difficulty starting or stopping urination after having one.
Professor Nikki Cotterill, an expert in continence care at the University of the West of England, said: “When admitting a patient, the aim should be to keep them as close to their normal level of continence as possible.” Too many patients are catheterized.
“There is a risk that the bladder loses tone because it doesn’t fill and empty normally.”
Other research highlights a ‘happy pad’ culture in the wards. Frail or elderly patients are automatically given incontinence pads and told to relieve themselves in the pad instead of waiting to use the bathroom.
Over time, this can cause the muscles of the pelvis and anus to become weak and patients have difficulty resisting the urge to go to the bathroom.
The use of incontinence pads is also linked to an increased risk of skin conditions such as dermatitis, as well as urinary tract infections, due to the buildup of bacteria that can occur within the pad.
Dr Julie Ellis-Jones, senior lecturer in adult nursing at the University of the West of England, said staffing issues are a problem. In the past, healthcare assistants, supervised by a qualified nurse, would have been on hand to help patients go to the bathroom and manage continence issues, but now there aren’t enough of them.
Catheters are far from risk-free. They often trigger urinary tract infections and one in five patients have urine leakage or difficulty starting or stopping urination after having one (file photo)
Dr Ellis-Jones said: “I can’t think of anything worse than needing to go to the bathroom, but no one can take you, so you get wet and then they tell you you have incontinence, when you don’t.”
Once on sanitary pads, he added, patients can get used to them. “If someone puts on sanitary pads, it can become the new normal for them.”
The Mail on Sunday heard from the family of an 80-year-old ‘completely independent’ man who was left incontinent after a two-and-a-half week stay at a south London hospital, where he was treated for a broken thigh. bone.
“He was a bit of a coward but he was independent and could use the bathroom on his own,” says his daughter. “As soon as he entered the hospital, the staff put sanitary pads on him and did not help him get to the bathroom. Now, he has 24/7 care to change his diapers.’
Another sufferer is John Grahame, 80, a former army officer from London. “The first time my mother visited him, she had to run to find someone to help her go to the bathroom or a plastic bottle,” says his 41-year-old daughter Charlotte.
‘There were 22 people in his ward and almost all of them were on sanitary pads. In the end, she found a bottle. By the next time she visited him, he was very dependent on diapers.
The family now pays £3,000 a month for carers to visit John at home and help his wife of 80 years change his sanitary pads.
“Eventually, my father will have to go into a nursing home, but it’s very likely that he never would have needed that level of care if he hadn’t gone to the hospital,” Charlotte adds.
Sylvia, 72, from North Wales, was admitted to hospital in November 2019 with early stage dementia. Although she was confused, she had full control of her bladder, says her daughter, Kate, 55.
Two days after her admission, Kate visited and was surprised to see a bucket by Sylvia’s bed and a pad on the nightstand.
‘The nurse turned to me and said: ‘Your mother is now incontinent.’ I thought, no, she’s not! Kate says.
Sylvia was later released and transferred to a nursing home. “Without the sanitary napkins and pails, she was suddenly able to go to the bathroom on her own,” says Kate.
‘She was more mobile too. She was up, down and everywhere, because she was being properly cared for.
NHS guidance states that a continence assessment should be carried out with all high-risk patients on admission, such as those with dementia or who may have difficulty reaching the toilet without assistance.
If incontinence is identified, a regimen to retrain the bladder should be started, including pelvic floor exercises, improved mobility, medication, and the use of aids such as wedges. NHS guidance states: “Every effort should be made to facilitate access to toilets.”
“If you think a loved one is being catheterized or placed on sanitary pads unnecessarily, please raise your concerns with a member of the care team,” Professor Cotterill said. “Only those close to the patient will know what the normal operation of their bathroom looks like, so don’t be afraid to speak up.”
