Project summary
Community Vision in partnership with Essity AustralAsia (previously Asaleo Personal Care Pty Ltd) and the National Ageing Research Institute has been awarded an ARIIA grant for their project ‘A proposal to improve continence management outcomes and staff skills with the use of new sensor wear technology’.
Almost all staff enter the aged care industry without training in how to prevent or delay the onset of incontinence, and restore or manage incontinence (Ostaszkiewicz et al., 2020). Additionally, there is a lack of objective information about the frequency and severity of the Urinary Incontinence (UI) status of consumers, resulting in a trial-and-error approach to management.
This project involves establishing the feasibility and acceptability of technology to enhance continence assessment procedures. The technology will provide information on urine volume and void time to:
(i) Inform possible individualised toileting programs.
(ii) Inform appropriate product choice, reducing the number and absorbency of incontinence pads (pad/s) used.
(iii) Support workers when products require changing, minimising product waste and disruption to sleep and other activities.
(iv) Provide confidence for the workforce in knowing that continence decisions are based on accurate data and evidence.
This information can reduce workforce time managing incontinence giving more time to build trusting relationships and delivering added value in other areas. To establish the feasibility of the technology, we will evaluate uptake, completion, acceptability, and staff perceptions of the barriers and enablers to implementation, as well as any reduction in pad use and change time spent by the aged care workforce.
Project outcomes
Background and Aims
Urinary incontinence (UI) disproportionately affects older people, particularly if they have multiple comorbidities (Wagg et al., 2017). International data suggests 36.4% of people receiving home care services have UI (Schluter et al., 2017) and 17% are incontinent of faeces (Jamieson et al., 2017). As Australia’s population ages, the number of people with UI will increase. Most live in the community, either alone or with others. Many, including clients of Community Vision, access home care and home support through the CHSP or HCP. In 2020-21, 816,793 older Australians accessed CHSP (186.6 older clients per 1000 older people) and 210,309 accessed HCP (48.0 older clients per 1000 older people). Under the Aged Care Act 2014 (the Act), approved providers of home care services for older people have responsibilities for the quality of care they provide and to uphold clients’ rights. Schedule 3, Part 1 of the Act specifies the types of services providers must provide. In relation to continence care, this includes: (i) assistance with toileting; (ii) management of skin integrity; and (iii) continence management. The latter includes:
Assessment for and, if required, providing disposable pads and absorbent aids, commode chairs, bedpans and urinals, catheter and urinary drainage appliances and enemas.
Assistance in using continence aids and appliances and managing continence.
The primary aim of the project was to establish the feasibility and acceptability of a new sensor wear device titled TENA SmartCare™ technology to augment current approaches to identify and manage the continence care needs of care dependent community-dwelling older people with UI. We aimed to improve the skills of community support staff caring for those with UI, by increasing their ability to identify the frequency and severity of UI, thereby enabling more informed decision making regarding the use of incontinence products (hereafter termed ‘pads’).
What We Did
We conducted a feasibility trial with a pre/post evaluation of a technology-based intervention with a single cohort, characterised by: (i) a baseline establishment stage; (ii) an intervention stage; and (ii) a post intervention evaluation stage. The project involved the following three participant groups:
- Older clients of CV (aged 65 and >) with UI once of more a day and regularly using pads
- Informal carers of older people who participated
- Registered Nurses and Support Workers employed by Community Vision
It was anticipated the technology could:
Improve the older person’s ability to socialise which could positively impact on their quality of life, often reducing other care requirements that may arise due to social isolation related to incontinence; and
Reduce the number and/or absorbency of pads required by an older person with UI and the number of times they need help to change their pad which would translate into a reduction in the amount of time that support workers spend managing UI.
Registered Nurses and Support Workers employed by Community Vision were trained by Essity Australasia in how to use the technology. They learnt how and when to use the technology, choose the most appropriate pad, apply and remove the pad, manage episodes of UI, prevent and manage incontinence-associated dermatitis, support older people with UI and informal carers to use the technology, and who to contact for further enquiries and support. It also addressed the need to monitor the older person’s acceptance of the use of the technology. Registered Nurses additionally received training in how to conduct a case conference with an older people and informal carers, supervise support workers and informal carers in using the technology and how to interpret reports in order to advise them about the most appropriate ways to prevent and manage UI.
How we evaluated the project
Staff who had been trained were invited to complete an anonymous survey at baseline, immediately following training, and 4 weeks post intervention. They rated their knowledge, skills and confidence to use the technology, implement the intervention, provide support to older people with UI and to informal carers to use the technology and interpret the findings from the technology, convene case conferences with older people and informal carers, construct individualised continence care plans, and supervise support staff in the use of the technology. At the end of the project, they were invited to participate in qualitative interviews to share their opinions about the acceptability and feasibility of the intervention, including the feasibility and acceptability of integrating the new technology with existing clinical systems to support client care.
Older people (Clients of Community Vision) were asked to complete a survey before and after trialling the technology to measure the impact of incontinence and the intervention on their social engagement and quality of life. The survey instruments included:
The Lubben Social Network – (LSNS-6) (Lubben et al., 2006): a reliable and valid self-report measure of social engagement in older adults (aged 65 years old and above) by measuring perceived social support received by family and friends.
The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) (Avery et al., 2004): a 6-item valid and reliable tool to measure the frequency, severity and impact of incontinence on quality of life (QoL) in men and women.
The EQ-5D-3L (Rabin & de Charro, 2001): a 16-item reliable and valid tool to measure health-related quality of life.
A bespoke survey designed to elicit information about the person’s continence experience.
Informal carers of older people with UI were invited to complete a pre and post intervention survey designed to measure the burden associated with caregiving, and their quality of life. The survey instruments included:
The ZB1-12 [Zarit Burden Interview] (Hébert et al., 2000): a 12-item valid, and efficient option for screening the phenomenon of carer burden (Gratão et al., 2019).
The EQ-5D-3L (Rabin & de Charro, 2001) – described previously.
A bespoke survey designed to elicit information about how informal carers manage the continence care needs of the older person.
Ethics: Ethic approval was sought in August 2023. The project was approved by Austin Health Human Research Ethics Committee 2nd Jan 2024 (Ethics approval number: HREA – 406210(v2)). Consent was obtained from all participants.
Outcomes
The following section presents data from staff surveys conducted prior to training (n=17), immediately following training (n=10) and 4 weeks post intervention (n=4). Most staff members were nurses (n=9) (8 RNs and 1 EN), 7 were support workers and one was an Allied Health employee. Most had considerable experience of working in aged care, with 7 staff members having worked between 10-20 years and 2 having 20+ years of experience. Eleven had worked in the same role for 1-5 years and most (n=11) were working on a permanent part-time basis. Of the 7 support workers, 4 had a formal traineeship and 3 did not.
The project resulted in improvements in staff confidence to manage incontinence in community-dwelling older people from baseline to post intervention. All scores on the knowledge and confidence scale increased from pre to post training. For some items, scores doubled. Specifically, prior to training, staff scored low on being able to know how often a customer experienced UI and knowing how much urine is lost. Post training, scores doubled and were sustained at the post implementation stage. The data suggest staff confidence to manage incontinence increased over time.
Findings from the surveys of the 7 informal carers indicated they rated their health-related quality of life as low and their caregiver burden as high. However, as the data were limited to baseline data, it was not possible to draw conclusions about the impact of the technology on these outcomes of interest.
Complete data were available from 14 older people with continence care needs at baseline and 3 post intervention. They reported levels of social support at baseline and were therefore at risk for social isolation. They also related their health-related quality of life as low. They rated the frequency and severity of incontinence as having a moderate impact on their quality of life.
Despite considerable time and investment by the sponsor and project team, the number of older people who volunteered to participate in the project was insufficient to draw conclusions about the impact of the intervention on their social support, quality of life, and on the frequency, severity and impact of UI.
Although the project did not result in comparable data, it nevertheless yielded data to answer the question of the feasibility and acceptability of TENA SmartCare™ technology to augment current approaches to identify and manage the continence care needs of care dependent community-dwelling older people with UI. Our experience of conducting the trial in the community with older people and informal carers, and nurses and support workers suggests the technology and its use in this cohort warrants further consideration in terms of (i) its reliability, (ii) the levels of support some individuals may require engaging with it, and (iii) the most appropriate way to introduce it to this cohort. Indeed, several people suggested it would have greater uptake and benefit in residential aged care homes where professional carers were available on a 24-hour basis and could monitor its use, or by continence nurse advisors working in the community.
Impact on Aged Care and Workforce
The use of short-term technological interventions to support the older person, clinical and non-clinical staff in the prescription of appropriate continence aids is essential to enhancing the comfort and dignity of individuals living with incontinence. In community settings, it is important to recognise that many older persons experience low level incontinence. Providing tailored support and selecting appropriate aids for this group is just as critical as it is for those with more complex needs. Trialling new technology to support the older persons with low level incontinence, while collecting accurate data and insights, is essential for enhancing quality of life of this group. Reliable, appropriate technology needs to be carefully considered in future trials in the community sector to build trust and foster greater participation of older persons and engagement from their carers so insights can be validated and used to further quality of life by applying this daily living.
Early intervention for individuals with emerging incontinence concerns fosters confidence and can significantly reduce the risk of social withdrawal and isolation. Supporting older people to feel secure in social settings contributes meaningfully to their independence, social inclusion, and overall quality of life – whether they are receiving care in the community or in a residential setting.
Although the project did not yield sufficient consumer participation to draw strong comparative conclusions, it is noteworthy that participants demonstrated a willingness to engage with new technologies and collaborate with regulatory bodies to improve their wellbeing. This highlights the ongoing importance of empowering consumers to remains at home for longer through supportive care strategies and highlights the need for the sector to continue prioritising community projects such as this, but tailored to the needs of the community, which differ to those in residential aged care where higher level continence support is often required, and carer support is readily available.
Continuous improvement remains a cornerstone of aged care practice. The outcome of this report reinforces the value of comprehensive training, ongoing competency assessment and inclusive care partnerships. Engaging older persons, clinical and non-clinical care staff, and family members in feedback processes is integral to achieving successful, person-centred outcomes and delivering holistic care.
Future projects around low-level continence should be considered to support the older person who is wanting to remain living independently at home for longer, with consideration made to the effectiveness of the product trialled, and the impact on the community engagement within this cohort.
Resources
The project was not designed to produce new resources. The technology i.e. the TENA SmartCare™ technology that was trialled was designed and is owned by Essity Australasia. It is anticipated they will continue refine it to ensure it is fit-for-purpose and to target the right market.
Next Steps
There are no plans to expand, modify or replicate the project.
Key contact for further information:
Michelle Fernandes or call 1800 968 754