Journal of Gerontological Nursing

Managing Fecal Incontinence: SELF-CARE PRACTICES OF OLDER ADULTS

Donna Zimmaro Bliss, PhD, RN, FAAN; Lucy Rose Fischer, PhD; Kay Savik, MS

Abstract

ABSTRACT

Little is known about the ways in which community-dwelling elderly individuals manage fecal incontinence (FI) in their daily lives. In this study, community-dwelling elderly individuals were surveyed at clinics of a health maintenance organization (HMO) to describe the self-care practices used to manage FI and to examine factors that influenced the number of self-care practices used and the reporting of FI to a health care practitioner. Responses of 242 elderly individuals who reported that they had FI several times per year were analyzed. The self-care practices used most commonly were changing diet, wearing a sanitary pad/brief, and reducing activity or exercise. Elderly women and those with a greater severity of FI and more chronic health problems engaged in more self-care practices. Factors associated with reporting FI to a clinician were considering FI to be a problem, uncertainty about the cause of FI, and changing diet to avoid FI. There is a need to promote effective management strategies for FI to older individuals living in the community.

Abstract

ABSTRACT

Little is known about the ways in which community-dwelling elderly individuals manage fecal incontinence (FI) in their daily lives. In this study, community-dwelling elderly individuals were surveyed at clinics of a health maintenance organization (HMO) to describe the self-care practices used to manage FI and to examine factors that influenced the number of self-care practices used and the reporting of FI to a health care practitioner. Responses of 242 elderly individuals who reported that they had FI several times per year were analyzed. The self-care practices used most commonly were changing diet, wearing a sanitary pad/brief, and reducing activity or exercise. Elderly women and those with a greater severity of FI and more chronic health problems engaged in more self-care practices. Factors associated with reporting FI to a clinician were considering FI to be a problem, uncertainty about the cause of FI, and changing diet to avoid FI. There is a need to promote effective management strategies for FI to older individuals living in the community.

Fecal incontinence (FI) has been referred to as the "silent affliction" (Johanson & Lafferty, 1996) and the "unvoiced symptom" (Leigh & Turnberg, 1982), The prevalence of FI among community-dwelling elderly indihas been reported to be 4% to 17% (Kok et al., 1992; Roberts et al., 1999; Talley, O'Keefe, Zinsmeister, & Melton, 1992) compared to approximately 2% in the general community population (Nelson, Cautley, & Furner, 1995) and 20% to 54% in elderly nurshome residents (Chassagne et al, 1999; Chiang, Ouslander, Schnelle, & Reuben, 2000). Little known about the ways in which community-dwelling elderly individuals manage this potentially embarrassing condition in their daily lives. Few clinicians routinely inquire about FI, and patients are often reluctant to report its existence, even when asked '(Burgio, Ivés, Locher, Arena, & Kuller, 1994; Gordon et al., 1999; Mitteness, 1987; Thomas Oc Morse, 1991).

Self-care practices of older individuals for managing urinary incontinence (UI) have been described in several studies using various methods, including ethnography (Burgio et al., 1994; Mitteness, 1987), home interviews (Engberg, McDowell, Burgio, Watson, & Belle, 1995), and surveys (Herzog, Fultz, Normolle, Brock, & Diokno, 1989; Johnson, Kincade, Bernard, Busby-Whitehead, & DeFriese, 2000). To the authors' knowledge, this is the first systematic investigation of self-care for FI among community-dwelling elderly individuals. The authors report findings from a survey of community-dwelling elderly individuals with FI who were enrolled in a health maintenance organization (HMO). The purpose of this study was to describe the self-care practices used by those who experienced FI and to examine factors associated with the number of self-care practices and willingness to report FI to a health care practitioner.

REVIEW OF RELATED LITERATURE

Because of the lack of research on self-care for FI, the authors summarize reports of strategies used by elderly individuals to manage a related problem, UI. In an ethnographic study of 30 individuals with UI (7 men, 23 women most older than 60), Mitteness (1987) found that most managed UI without assistance from a professional health care provider. Self-management strategies included behavioral practices used to control the bladder, such as Kegel exercises to strengthen pelvic muscle, restricting fluid intake to reduce bladder filling, and frequent toileting to decrease micturition frequency. Some strategies aimed at preventing UI, such as altering the time when a diuretic was taken, rescheduling daily activities, and learning where public bathrooms were located. Many individuals with UI used containment devices such as pads or briefs, towels, and catheters. A few (n = 4) used a nutritional approach and took vitamins, minerals (e.g., zinc), or special products (e.g., white willow bark).

Other investigators found that the self -management strategy used most often for UI is wearing a pad or brief (Engberg et al., 1995; Herzog et al., 1989; Johnson et al., 2000; Thomas & Morse, 1991). Determining the location of toilets outside the home is the second most frequently used strategy (Engberg et al., 1995; Herzog et al., 1989). Other practices used more variably were decreasing fluid intake, manipulating voiding frequency, and limiting activities or trips (Engberg et al., 1995; Herzog et al., 1989; Thomas & Morse, 1991). Performing pelvic muscle exercises was one of the least common practices of older adults with UI (Engberg et al., 1995; Herzog et al., 1989; Johnson et al., 1998; Thomas & Morse, 1991). Herzöget al. (1989) and Engberg et al. (1995) elicited information about medication use for UI. Seven percent of respondents used medication to treat UI, and approximately 15% avoided taking certain medications when they left their homes. There were some differences in the types of self-care practices for UI used by men and women (Herzog et al., 1989; Johnson et al., 2000). More women than men wore an absorbent pad and practiced pelvic muscle exercises.

Factors related to discussing UI with a health care provider have been investigated. Individuals who had impairments in activities of daily living (ADLs) and participated in health promotion screening activities, such as a physical or rectal examination, pap smear, or mammogram, were more likely to report UI to a physician (Burgio et al., 1994;Johnsonetal.,2000). Other factors associated with discussing UI with a physician were knowing a greater number of friends who had UI and wearing absorbent pads (Herzog et al., 1989; Johnson et al., 2000). The association between a greater severity of UI and reporting UI to a physician was inconsistent (Burgio et al., 1994; Engberg et al., 1995; Herzog et al., 1989; Johnson et al., 2000). There were different findings about the type of UI that influenced reporting UI to a physician. Herzog et al. (1989) found that having stress UI was a factor related to reporting UI, whereas Burgio et al. (1994) reported that having mixed UI (i.e., stress and urge UI) was influential.

Although there are some similarities between UI and FI, there are some distinctive differences. Normal elimination of stool and potential for leakage occur less frequently than that of urine. Leakage of feces, particularly on outer garments, is more visible because of its color and has a different odor than urine. FI is attributed to intake of various foods, whereas UI is affected by fluid intake (Blìss et al., 2000; Norton, MacDonald, Sedgwick, & Stanton, 1990; Thomas & Morse, 1991). The day-to-day ways in which community-dwelling individuals manage FI and their relation to strategies used for UI are unknown.

The findings from studies about self-management of UI guided items included in the survey and data analysis. The survey included information about the frequency with which older individuals practiced various self-care behaviors, which has not been included in studies of self-care for UI (Herzog et al., 1989; Johnson et al., 2000). The authors were interested in the number of self-care practices because their experience in investigating FI suggested that some individuals use several management strategies. The number of self-care strategies used by an individual with FI may be considered an indicator of the intensity with which they manage FI.

METHODS

Survey

A 51 -item survey was developed by a team with expertise in FI, geriatrics, and obstetrics and gynecology. The survey contained questions about demographic characteristics, health status, usual bowel habits, FI severity, constipation severity, self-management strategies for FI and constipation, UI, and obstetrical history (for women only). FI was described as accidental leakage of stool during the past 12 months. The severity of FI was characterized by questions about the frequency, amount, and type of accidental stool leakage.

Respondents were asked about a large number of potential self-care practices for managing FI including wearing a sanitary pad, panty liner, or brief; decreasing activity or exercise; skipping meals; changing diet (changing type of foods eaten or omitting foods); taking special dietary preparations (e.g., vitamins, herbal preparations); taking medications (e.g., anti-dìarrheal); performing pelvic exercises (e.g., pelvic muscle, Kegel, or anal sphincter exercises); and using special methods (bìofeedback, electrical stimulation, acupuncture). Skipping meals, taking special dietary preparations, taking medications, performing pelvic exercises, and using special methods were rated on a 5-point scale from never to daily; wearing a panty liner, pad or brief had a similar scale from never to always. The other items were dichotomous. The authors also asked whether the respondents discussed having FI with a health care provider.

Questions about the correlates of the number of self-care practices performed by older individuals were developed from a review of the literature and the experience of the research team. These included questions about:

* UI.

* Memory.

* Depression.

* Severity of FI.

* Defecation urgency.

* General health status.

* Functional status (e.g., ADLs).

* Change in severity of FI from prior year.

* Demographic characteristics (e.g., age, gender, ethnicity).

* Number of chronic health problems (e.g., arthritis, diabetes, multiple sclerosis, stroke, ulcerative colitis).

Twelve lay individuals ages 65 and older who did not belong to the HMO participating in the study previewed the survey and its directions for ease of reading and completion. These reviewers were recruited from acquaintances of the investigators and by the "snowball technique." The estimated time for completion of the survey was between 15 and 20 minutes.

Survey Distribution

The surveys were distributed at four HMO primary care clinics, one in Minneapolis, one in St. Paul, and two in the Twin Cities* suburbs, from April to September 1998. Using information from the daily appointment list, the clinic staff offered surveys to individuals 65 or older who lived in the community. Patients received surveys when they registered their arrival at the clinic. In addition, a research assistant distributed surveys on flu shot days in September and October, determining the inclusion criteria by inquiry, which were reinforced in a short cover letter. Because FI tends to be a "taboo" topic, which is under-reported, the authors distributed the surveys in a clinic setting where health problems are routinely addressed and kept the responses anonymous.

Table

TAbLE 1SELF-CARE PRACTICES OF ELDERLY MEN AND WOMEN FOR MANAGING FECAL INCONTINENCE

TAbLE 1

SELF-CARE PRACTICES OF ELDERLY MEN AND WOMEN FOR MANAGING FECAL INCONTINENCE

Elderly individuals were directed to complete the survey anonymously and only once, and to return the completed survey before leaving the clinic. Boxes for return of the surveys were placed in the waiting areas of the clinics and their pharmacies and near the clinic exits. On the cover of the survey, which was identified simply as "Patient Survey," a colorful logo was printed to assist in its recognition.

Data Analysis

Surveys were excluded from the analysis if respondents reported they were younger than 65, living in a nursing home, or if they completed only the initial demographic questions. There were two outcome variables - number of selfcare practices and reporting FI to a health care provider (e.g., physician, nurse practitioner). Bivariate statistical analyses of the association of the independent variables with the outcomes of interest were used to screen variables for selection as candidates in each multivariate analysis. A p value was set at .10 for determining candidate variables. The number of categories of some variables were collapsed because of few respondents in those categories. The following variables were evaluated as candidates for the multivariate regression analyses:

* UI.

* Age.

* Gender.

* Ethnicity.

* Onset of FI.

* Being depressed.

* Defecation urgency.

* Knowing cause of FI.

* Having an ADL deficit.

* Having memory problems.

* Needing help to complete the survey.

* Self-rating of health compared to peers.

* Self-rating health compared to last year.

* Severity of FI (frequency, amount, type).

* Change in FI severity compared to last year.

* Number and type of chronic health conditions.

The types of FI self-care practices were evaluated for their association with reporting FI to a clinician.

Reporting FI to a health care provider is a dìchotomous outcome variable and its association with the independent variables was tested using logistic regression. The alpha level was set at .05 for the final multivariate regression analyses. The outcome variable, number of self-care practices, was categorized as none, one to two, and more than or equal to three practices. Preliminary analyses showed a significant influence of gender on the number of self-care practices used (p < .05); therefore, separate regression models were analyzed for men and women.

Because the number of self-care practices is an ordinal outcome variable, its association with the independent variables was assessed using a stepwise polytomous logistic regression. A polytomous logistic regression models the relationship between a set of covariates and a response variable that can assume k (defined in this study as 5= 3) possible outcomes (Hosmer & Lemeshow, 1989). Logistic regression also produces estimates of the odds ratio, which indicates the increase or decrease in the probability of the outcome occurring given the presence of the characteristic of interest. Ap value of .05 was used as the significance level in these models. Final models that include significant correlates are reported.

RESULTS

Sample

Surveys were received from 1,352 respondents of whom 60% were women. The representation of the sample to the larger geriatric population in the HMO medical group was assessed by comparing responses to questions on our survey with those of a general health survey mailed to an age-stratified random sample of elderly enrollees in the HMO. These results, which showed few differences in the characteristics of the respondents to the two surveys, have been reported elsewhere (Bliss et al., 2004). Eighteen percent of the respondents had FI several times per year or more and were included in the analyses of this study. Of these respondents, 81% were women; 80% were White, non-Hispanic; and the mean age of men was 75 (SD ± 6) years and of women was 76 (SD ± 6) years (f = -.94, df= 24, p = .35). There was no significant difference between the percentage of men (M) and women (F) who felt depressed (M = 13%, F = 15%, p = .63), who had mild/moderate or severe memory problems (M = 56% and 20%, F = 58% and 15%, respectively, p = .73), who rated their health as worse compared to the prior year (M = 24% worse, F = 23% worse, ? = .92), who had an deficit in ADLs (M = 3%, F = 7%,/> = .18), or who required help with the survey (M = 6%, F = 10%,/» = .23). The majority of respondents (40%) reported having FI for 1 to 3 years; 25% developed FI within the year prior to the survey, and 8% had FI for more than 10 years. There was no difference in the duration of FI between men or women χp 2 = 4.07, df = 3, p = .2.5). More women (55%) than men (28%) had double incontinence (DI) (i.e., both FI and UI) (χp 2 = 14.59, df= 1, p < .001).

Figure. Self -care practices used by elderly individuals with fecal incontinence (Fl) only or both fecal and urinary incontinence (Ul).

Figure. Self -care practices used by elderly individuals with fecal incontinence (Fl) only or both fecal and urinary incontinence (Ul).

Types of Self-Care Practices for Fl

Sixty-seven percent of elderly individuals with FI several times per year or more used one or more self-care practices to manage FI. Respondents used an average of 1.9 (range = 7) self-care practices to manage FI. The most common self-care practices were changing diet (e.g., avoiding certain foods); wearing a sanitary panty liner, pad, or brief; and reducing activity or exercise (Table 1). Anti-diarrheal medications were used sporadically; few took these medications on a daily or weekly basis.

There were few differences in the types of self-care practices used by those with FI only versus those with DI (Figure). More elderly individuals who had DI wore a sanitary panty liner, pad, or brief always or most of the time and changed their diet. More individuals with DI (5%) rated their health as poor compared to others their age than those with FI only (.8%, χp 2 = 10.25, df=4,p = .036). Individuals who had FI only or DI were comparable in the other characteristics that were measured.

Self-Care Practices and Severity of Fl

Self-care practices were analyzed in relationship to each of the three aspects of FI severity (i.e., frequency, amount, type). A greater severity of FI influenced self-care (Table 2). Respondents who soiled their outer clothing were significantly (p = .014) more likely to change their diet (50%) than those who soiled only their undergarments (23.6%). A higher percentage of those with the most frequent FI wore a sanitary a panty liner, pad, or brief and took anti-diarrheal medications more often. Restricting activity or exercise was more common in those with more frequent FI and when UI accompanied FI (Figure). The self-care practice of changing diet was most frequently used by those whose amount of FI was severe enough to soil their outer clothing versus soiling only their underwear.

Table

TABLE 2ASSOCIATION BETWEEN SEVERITY OF FECAL INCONTINENCE (Fl) AND SELF-CARE PRACTICES

TABLE 2

ASSOCIATION BETWEEN SEVERITY OF FECAL INCONTINENCE (Fl) AND SELF-CARE PRACTICES

Gender and Self-Care Practices

There was a significant difference in the number and types of FI self-care practices used by elderly men versus elderly women. Fiftytwo percent of men compared to 19% of women didnot use any selfcare practices to manage FI (X2 = 32.17, df= 2,p < .001). More than three times as many women (38%) than men (11%) used three or more self-care practices. The most common self-care practice of women was wearing a sanitary panty liner, pad, or brief. Taking anti-diarrheal medications and changing diet were the next most commonly used practices (Table 1). The most common self-care practice of men was taking anti-diarrheal medications. The next most common practices were wearing a panty liner, pad, or brief and changing diet. No men reported using special methods, such as biofeedback therapy, electrical stimulation, or acupuncture to reduce or prevent FI.

Number of Self-Care Practices

The respondents had an average of 2.3 (range = 10) chronic conditions. Women who used three or more self-care practices had more chronic health problems (mean = 3.1, range = 7) than those who used one or two self-care practices (mean number of chronic conditions = 1.9, range = 7) or none (mean = 2, range = 5) (Kruskall-Wallis χp 2 = 10.887, p = .004). The relationship between a greater number of chronic health problems and use of a greater number of self-care practices by men approached significance (p = .051). More men with FI of loose/liquid stool (27%) or liquid and formed stool (22%) used three or more selfcare practices than those with FI of mucus (3.5%) (χp 2 = 11.30, df = 4, p = .023). Nearly twice as many women who soiled their outerwear (77%) used three or more self-care practices compared to those who soiled only their underwear (34%) (Xp 2 = 8.97, df=2,p = .011). The variable, amount of fecal soiling, could not be used in the multivariate analysis because it prevented the convergence of the maximum likelihood estimate. This was because virtually all women who had the greatest amount of fecal soiling also used the greatest number of selfcare practices.

Multivariate Analysis of Factors Related to Number of Self-Care Practices

Men who had FI of both formed and liquid stool were nearly 4 times more likely to use self-care practices than those with FI of loose/liquid stool or mucus (Table 3). Men and women who had more chronic health problems used more selfcare practices. Women who had urgency only some of the time or whose FI severity remained the same as in the previous year used fewer self-care practices.

Reporting Fecal Incontinence to a Health Care Practitioner

Only 43% of the respondents discussed their FI with a health care clinician. There was no significant difference between men and women in reporting FI to a health care provider (Table 4). Those who reported FI experienced the problem for an average of 2.4 years (SD = .87 years). Approximately threefourths of the individuals who reported their FI to a heath care provider considered FI a problem. Elderly individuals who reported FI had nearly twice the average number of chronic health problems compared to those who did not report. More of them needed help completing the survey. A positive relationship existed between self-rating of health compared to one's peers and reporting FI (r = .14, p = .036). More of those who had a health problem or disability that caused FI or who were not sure about the cause of FI sought professional clinical consultation. Age was not a factor associated with reporting FI to a clinician.

A greater severity of FI was associated with reporting FI to a clinician (Table 4). A greater frequency of FI and feeling urgency to defecate always or most of the time were factors related to seeking professional consultation. More individuals who were incontinent of formed feces (56%) discussed their FI with a health care provider than those who were incontinent of mucus (45%), liquid feces (19%), or both liquid and formed feces (17%) (X2 = 17.45, df= 3,/> = .001). Having UI and FI was not significantly associated with reporting FI (p = .256). More individuals who reported their FI to a clinician had decreased their activity, changed their diet, skipped a meal, or used special diet preparations to manage FI.

Multivariate Analysis of Factors Associated with Reporting Fl to a Health Care Practitioner

Considering FI a problem was one of the strongest predictors of reporting FI to a health care provider (Table 5). Another factor associated with reporting FI was being unsure about the cause of FI. Elderly individuals who reported FI tended to have a poorer rating of their health and a more recent onset of FI. Of all the selfcare practices surveyed, changing one's diet was the one significantly associated with discussing FI with a clinician when other factors were held constant.

DISCUSSION

Nearly one-third of community-dwelling older adults who were surveyed at their HMO clinics lacked strategies to manage their FI. This finding is consistent with those of previous studies and highlights the difficulty in identifying elderly individuals who have FI and may require assistance in managing it (Burgio et al., 1994; Gordon et al., 1999; Mitteness, 1987; Thomas & Morse, 1991). Most of the self-care practices used by elderly individuals to manage FI do not require a prescription from a physician or advanced practice nurse, which may partly explain the low rate of seeking professional clinical consultation. The findings in this study suggest that there is a need to develop and promote effective strategies for managing FI in this population. Incontinence is a leading factor for admission to a nursing home (Noelker, 1987; Ouslander, Kane, & Abrass, 1982). Strategies that support effective self-care of FI promote autonomy and may delay or prevent the need for nursing home placement.

Table

TABLE 3MULTIVARIATE ANALYSIS OF FACTORS ASSOCIATED WITH A GREATER NUMBER OF SELF-CARE PRACTICES TO MANAGE FECAL INCONTINENCE (Fl)

TABLE 3

MULTIVARIATE ANALYSIS OF FACTORS ASSOCIATED WITH A GREATER NUMBER OF SELF-CARE PRACTICES TO MANAGE FECAL INCONTINENCE (Fl)

Two self-care practices used by 25% or more of elderly individuals with FI were changing their diet to avoid certain types of foods and wearing a sanitary pad or brief. Prior to the current findings, dietary changes for managing FI were undocumented clinical observations (Bliss et al., 2000). Wearing a sanitary pad was the most frequent self-care practice of older individuals with UI (Herzog et al., 1989; Johnson et al., 2000; Mitteness, 1 987). Dietary changes and wearing a sanitary pad represent distinct approaches to managing FI - dietary manipulations attempt to mediate an aggravating cause of FI, namely, certain foods, while wearing a pad or brief is for the purpose of containing leaked urine and hygiene.

Elderly women were more likely than elderly men to engage in self-care practices to manage FI. More women than men made dietary changes (e.g., omitted foods, skipped meals). Because wearing a panty liner, pad, or brief is more common among women than men with UI (Herzog et al., 1989;Johnson et al., 2000; Thomas & Morse, 1991) and more women were incontinent of both urine and feces in this survey, it was not unexpected that more women regularly wore these sanitary products. Having a greater number of chronic health problems was a factor associated with using more self-care practices by both men and women. Elderly individuals with many chronic health problems may receive closer follow up by health care clinicians. They may be more engaged or experienced in managing health care problems in general.

Results have been mixed about the influence of UI severity on self-care (Herzog et al., 1989; Johnson et al, 2000; Mitteness, 1987). The authors' findings show a greater severity of FI was associated with using more selfcare practices, implying a more intense self-management routine. Studies of individuals with UI show that incontinence care routines can interfere with quality of life by becoming the focal point around which other daily activities are organized (LargoJanssen, Smits, & Van Weel, 1992; Mitteness, 1987; Thomas & Morse, 1991). The dimension of FI severity associated with a greater number of self-care practices differed between men and women. Conflicting findings in UI studies may be partly because of their inability to look at the separate dimensions of UI severity. Men who were incontinent of both formed and liquid stool were four times more likely to use a greater number of self-care practices. Women who had soiled outerwear used more self-care practices.

Table

TABLE 4FACTORS ASSOCIATED WITH REPORTING FECAL INCONTINENCE (Fl) TO A CLINICIAN*

TABLE 4

FACTORS ASSOCIATED WITH REPORTING FECAL INCONTINENCE (Fl) TO A CLINICIAN*

Having urgency only some of the time was associated with fewer self-care practices. Norton and Chelvanayagam (2000) observed that urgency can become associated with fear of an incontinence episode. Having less urgency may lessen this fear and need for as many self-care practices. That more individuals with DI used a greater number of self-care practices supports the effect of FI severity on self -care. It seems reasonable that individuals who had DI perceived being incontinent of both feces and urine as a factor in rating their health as poorer than others their age.

Questions about self-rated health status on surveys have been shown to be a reliable indicator of health and mortality (Maddox & Douglass, 1973; Mossey & Shapiro, 1982). Studies about UI have revealed an association between having UI and poorer self-rating of health (Johnson et al., 1998; Wetle et al., 1995). Of course, no conclusions can be drawn about whether UI causes the perception of poor health or vice versa. The authors' findings have added new information: as elderly individuals' self-rating of health declines, they are more likely to discuss FI with a health care practitioner. This finding is independent of other significant factors such as whether the elderly individual considers FI to be problem or is unsure about the cause of FI. The authors' findings show that the subjective perceptions of the individual who has FI (e.g., perceptions of one's health, FI as a problem, the cause of FI) are factors associated with reporting FI.

This study had some limitations. Self-care practices for FI were based on self-report rather than more rigorous methods such as observation. Because the population included elderly individuals who visited HMO clinics, generalizability to other populations and studies is limited. Because of the cross-sectional nature of the study, associations between variables do not indicate that one causes the other.

PRACTICE IMPLICATIONS

The findings of this study suggest that nurses who care for elderly individuals living in the community need to routinely inquire whether elderly individuals have FI. Reports of recent changes in diet should prompt questioning about FI. The results suggest that those elderly individuals who discuss their FI with a health care clinician likely have a greater severity of FI and a recent onset of FI. Elderly patients need education about FI and its potential role as a symptom of an underlying health problem. Discussing FI with a clinician, especially FI of new onset, enables an appropriate work-up of health problems for which FI is a symptom, such as cancer or rectal prolapse. Some elderly individuals consider incontinence to be an inevitable consequence of aging or childbirth or minimize its significance compared to other, systemic health problems (Garcia Iglesias et al., 2000; Mitteness, 1987). Others wish to avoid invasive treatments such as surgery (Hellström, Ekelund, Milsom, & Mellström, 1990). These misconceptions and minimizations may deter seeking treatment for FI and appropriate diagnostic testing.

If FI is unrelated to another health problem that requires specific medical or surgical treatment, then the elderly patient may require support for self-care. Appropriate nursing management would begin by identifying the use of any self-care practices, evaluating the effectiveness of those practices, and assessing the older individual's ability to continue performing them. Assessment of self-care practices should be comprehensive and include use of sanitary pads or briefs, anti-diarrheal medication, and an evaluation of diet and activity and exercise. The results of this study suggest that older men with FI will require assistance in identifying appropriate self-care practices to manage FI and follow-up to assess their performance.

Table

TABLE 5MULTIVARIATE ANALYSIS OF FACTORS RELATED TO REPORTING FECAL INCONTINENCE (Fl) TO A CLINICIAN

TABLE 5

MULTIVARIATE ANALYSIS OF FACTORS RELATED TO REPORTING FECAL INCONTINENCE (Fl) TO A CLINICIAN

The authors' findings suggest that future research investigate reasons for the differences in self-care practices between men and women. These findings would guide the development of gender-sensitive strategies that promote management of FI. Effective strategies that reduce the severity of FI, if not eliminate the problem altogether, may reduce the burden of using several practices to manage FI on a daily basis.

SUMMARY

Many elderly patients need education related to fecal incontinence. Nurses should inquire, in an accepting manner, whether elderly individuals are experiencing involuntary stool leakage and not rely on them to initiate a discussion about the problem. Elderly patients may require further diagnostic testing of diseases for which fecal incontinence is a symptom. Of those elderly individuals for whom conservative symptom management is appropriate, some may require support for self-care. Appropriate nursing management would begin with a comprehensive assessment of effective self-care practices and an evaluation of the older individual's ability to continue performing them.

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TAbLE 1

SELF-CARE PRACTICES OF ELDERLY MEN AND WOMEN FOR MANAGING FECAL INCONTINENCE

TABLE 2

ASSOCIATION BETWEEN SEVERITY OF FECAL INCONTINENCE (Fl) AND SELF-CARE PRACTICES

TABLE 3

MULTIVARIATE ANALYSIS OF FACTORS ASSOCIATED WITH A GREATER NUMBER OF SELF-CARE PRACTICES TO MANAGE FECAL INCONTINENCE (Fl)

TABLE 4

FACTORS ASSOCIATED WITH REPORTING FECAL INCONTINENCE (Fl) TO A CLINICIAN*

TABLE 5

MULTIVARIATE ANALYSIS OF FACTORS RELATED TO REPORTING FECAL INCONTINENCE (Fl) TO A CLINICIAN

10.3928/0098-9134-20050701-08

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