Older people who spend time in hospital are being discharged with prolonged incontinence as NHS staff are too busy to take them to the toilet while on the ward, experts warn.
One reason, specialists say, is the inappropriate use of urinary catheters – a tube inserted into the urinary tract that empties the contents of the bladder into a collection bag.
There are strict criteria for who should get one fitted, including those with existing urinary incontinence and patients who are unable to move because they have had major surgery or who have a spinal or pelvic injury. But research shows that the procedure has become almost standard in some departments.
A study published in the British Journal Of Nursing suggests that as many as 54 percent of catheterizations in elderly patients are unnecessary. In addition, even when appropriate, nearly half of patients remain with catheters longer than recommended.
In a 2017 study published in the British Medical Journal, a physician assistant shockingly admitted that “sometimes it’s easier to put a tube in” rather than find the time to check urine output – a vital indicator of health – or to help a patient go to the toilet again and again.
Older people who spend time in hospital are being discharged for suffering from prolonged incontinence as NHS staff are too busy to take them to the toilet while on the ward, experts warn
The study also found that nurses were unclear about protocols for who should have a catheter and that women were more likely to have one because “it’s easier for men to urinate when they’re less mobile.” Catheters are far from risk-free. They often cause urinary tract infections, and one in five sufferers experience 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 a patient is admitted the aim should be to keep the patient as close to their normal level of continence as possible. Too many patients are catheterized.
“There’s a risk that the bladder will lose its tone because it doesn’t fill and empty normally.”
Other research points to a “path-happy” culture in departments. Vulnerable or elderly patients are automatically provided with incontinence pads and have to relieve themselves in the dressing instead of waiting to go to the toilet.
Over time, this can cause muscles in the pelvis and anus to weaken and patients to struggle to resist the urge to go.
The use of incontinence pads is also associated with a higher risk of skin conditions such as dermatitis and urinary tract infections, due to the buildup of bacteria that can be found in 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, care assistants, under the supervision of a licensed nurse, would be on hand to assist patients to the bathroom and resolve continence issues, but there simply aren’t enough of them now.
Catheters are far from risk-free. They commonly cause urinary tract infections and one in five sufferers experience urinary leakage or difficulty starting or stopping urination after having one (file photo)
Dr. Ellis-Jones said, “I can’t think of anything worse than having to go to the toilet, but no one can take you, so you pee on yourself and then be told you’re incontinent when you’re not.”
She added that once in sanitary napkins, patients can get used to it. “If someone gets a sanitary pad, it can become the new normal for them.”
The Mail on Sunday learned of the family of an 80-year-old ‘fully independent’ man who was incontinent after a two-and-a-half week stay in a South London hospital where he was treated for a broken femur bone.
“He was a bit sloppy but independent and could only go to the toilet,” says his daughter. “As soon as he got to the hospital, the staff put him in sanitary napkins and didn’t help him go to the toilet. Now he has 24/7 care to change his diapers.’
Are you concerned about your treatment? Here’s what to do
According to the Patient Association, you are not obliged to accept medical treatments or interventions, including the placement of a catheter and the use of incontinence material.
If you have any concerns about any aspect of care as an inpatient – or as a patient’s family member – you should ask a nurse on the ward for an appointment with the consultant who has overall responsibility. You can find out the reason for a decision and ask for alternatives.
For advice, call the Patient Association’s helpline, 0800 345 7115, on working days from 09:30 – 17:00. Visit patientassociation.org.uk for more information about your rights.
Another victim is 80-year-old John Grahame, a former army officer from London. “The first time my mother visited, she had to run around to find someone to help him to the toilet or a plastic bottle,” says his daughter Charlotte, 41.
‘There were 22 people in his department and almost everyone was in sanitary towels. Finally she found a bottle. By the next time she visited him, he was quite dependent on diapers.’
The family now pays £3,000 a month for carers to visit John at home and help his 80-year-old wife change his sanitary pads.
“Eventually my dad will have to go to a nursing home, but chances are he never would have needed that care if he hadn’t gone to the hospital,” adds Charlotte.
Sylvia, 72, from North Wales, was hospitalized in November 2019 with early onset dementia. Though confused, she was in complete control of her bladder, says her daughter, Kate, 55.
Two days after her admission, Kate came to visit and was shocked to see a bucket next to Sylvia’s bed and a pillow on the bedside table.
“The nurse turned to me and said, ‘Your mother is incontinent now.’ I thought, no, she’s not!’ says Kate.
Sylvia was later discharged and transferred to a care home. “Without the pads and buckets, she could suddenly go to the toilet on her own,” says Kate.
She was also more mobile. She was up, down and everywhere because she was well taken care of.’
NHS guidelines state that a continence evaluation should be carried out in all at-risk patients on admission, such as those with dementia or who have difficulty using the toilet unassisted.
If incontinence is diagnosed, a regimen should begin to retrain the bladder – including pelvic floor exercises, improving mobility, medication, and the use of assistive devices such as bedpans. NHS guidelines state: ‘Every effort should be made to make access to toilets easy.’
‘If you feel that a loved one is being catheterised or unnecessarily associated, please discuss this with a member of the care team,’ said Prof Cotterill. “Only those close to the patient will know what their normal toilet function is like – so don’t be afraid to speak up.”