The prevalence, incidence, and correlates of fecal incontinence among older people residing in care homes: a systematic review

Abstract

Objective: Older people resident in care homes often rely on staff for support relating to their activities of daily living, including intimate care such as continence care. Managing fecal incontinence can be challenging for both residents and care staff. We conducted this review to describe the prevalence, incidence, and correlates of fecal incontinence among care home residents. Design: Systematic literature review Setting and participants: Older care home residents (both nursing and residential care) aged 60 years and above. Measures: We defined double incontinence as the presence of fecal plus urinary incontinence; isolated fecal incontinence as fecal incontinence with no urinary incontinence and all fecal incontinence as anyone with fecal incontinence (whether isolated or double). The CINAHL and MEDLINE databases were searched to 31st December 2017 to retrieve all studies reporting the prevalence and/or incidence and correlates of fecal incontinence. Results: We identified 278 citations after removing duplicates, and 23 articles met the inclusion criteria. There were 12 high quality studies, 5 medium and 6 low quality studies. The medians for prevalence (as reported by the studies) of isolated fecal incontinence, double incontinence and all fecal incontinence were 3.5% (interquartile range [IQR] = 2.8%), 47.1% (interquartile range [IQR] = 32.1%), and 42.8% (interquartile range [IQR] = 21.1%) respectively. The most frequently reported correlates of fecal incontinence were cognitive impairment, limited functional capacity, urinary incontinence, reduced mobility, advanced age, and diarrhoea. Conclusions/implications: Fecal incontinence is prevalent among older people living in care homes. Correlates included impaired ability to undertake activities of daily living, reduced mobility, laxative use, and altered stool consistency (e.g. constipation or diarrhoea) which are potentially amendable to interventions to improve fecal incontinence.