The burden of urinary incontinence (UI) related to overactive bladder on long-term care residents and staff is considerable, according to results of a survey of nursing directors.

Among 71 nursing directors at long-term care facilities, 59% said that managing UI contributes to certified nursing assistant (CNA) turnover, reported Richard G. Stefanacci, DO, of Thomas Jefferson University in Philadelphia, and colleagues in the Journal of Gerontological Nursing.

CNAs perform most UI product changes and spend 56.4% of their time managing UI needs, according to the survey. UI products were checked for wetness every 2.5 hours, with 5.6% of respondents reporting that staff always changed UI products, even if residents were dry.

Furthermore, CNAs changed an average of 36.6 UI products and assisted with an average of 25.5 toileting episodes per shift, which took 12.1 and 12.9 minutes per episode, respectively. Staff also performed an average of 1.7 bed linen changes owing to wetting accidents per shift.

“Especially with COVID, we have taken our eye off the ball a bit — particularly around the area of staff burden,” Stefanacci told MedPage Today. “Our caregivers — the CNAs and nurses — are unbelievably burned out. Having the opportunity to look at overactive bladder and understanding the negative impact it has, not only on residents, but the staff, should resonate with administrators.”

“They need to have key leaders in place in the facility who understand and appreciate that this is a priority — and put systems in place to identify who the right patients are, what the right course of action is, and the right people who can help,” he added.

According to the survey respondents, 62% of long-term care facility residents experienced UI, with 40% always incontinent. Responses showed that UI had a particular impact on long-term quality care for urinary tract infections (UTIs), as well as falls.

For example, 55% said they considered UI to be a major or significant cause of UTIs. They also noted that 26.3% of skin rashes and 30.9% of skin infections that developed as a result of urine wetness required medical treatment, and 10.4% of rashes or infections led to antibiotic use.

In addition, they reported that residents had an average of 14.3 falls per month, one-third of which occurred while the resident was attempting to get to a bathroom.

Stefanacci and colleagues found that the survey illustrated a “treatment gap” in medications for UI. Despite its prevalence, the nursing directors reported that just 14.5% of patients were currently treated with medications for UI or overactive bladder, a percentage that Stefanacci called “disappointing.”

The survey also showed that 75% of nursing directors indicated that they were unaware of the association between anticholinergic medications — “the mainstay of [overactive bladder] treatment” — and the risk of cognitive side effects. Moreover, while about two-thirds of respondents said they either traced treatment response by subjective means or quantified/documented methods, 22.5% had no process at all for formally assessing improvement.

UI also resulted in a substantial economic burden for the facilities in the survey. The average monthly cost of UI products was $5,407, with higher costs observed when purchasing at the facility level rather than the chain level. Monthly laundering costs were just as high, at $5,497, with slightly higher costs reported at the facility level versus the chain level. In addition, 53.5% of the survey respondents said the cost of UI products was higher or the highest compared with other supplies.

The survey comprised 70 questions categorized into six sections, including a background screener, facility characteristics, UI and resident care, UI product costs and burden, UI impact on CMS quality measures, and UI treatment.

Most (64.8%) of the facilities included in the survey were part of a chain, and had a mean of 115.3 residents. Facilities had an average of 68.3% female residents, 45.9% of residents had mild cognitive impairment, and 45.6% had dementia or Alzheimer’s disease.

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