To co-design and pilot test a best practice model of continence care and knowledge translation resources for Australian residential aged care, a mixed methods study was undertaken. The study had four stages: (1) a scoping review of literature; (2) a survey, interviews and co-design workshops with residential aged care stakeholders; (3) the co-design of a draft model and knowledge translation resources; and (4) a pilot trial of an education program and qualitative interviews with residents. The pilot trial involved a convenience sample of 22 staff (registered and enrolled nurses and personal care assistants) from two Australian residential aged care homes. Staff completed one pre- and two post-education surveys, and 13 aged care residents were interviewed about their views about continence care. Pilot test data revealed post-education improvements in staff knowledge for eight of the ten questions, and 100% agreement on the feasibility, appropriateness and acceptability of the model and education program. Of the 22 participants, 63% rated the education as ‘very helpful’ in applying the model to practice and 37% rated it as ‘somewhat helpful’. There was no statistically significant difference between the results of any of the three assessment surveys. A content analysis of resident interviews validated the importance of evidence-based, safe, clinically-informed, person-centred continence care that optimises a resident's functional abilities and responds to their individual needs, choices and dignity. The Continence Foundation of Australia has used these findings to design Continence SMART Care (CSC), which represents best practice continence care, meets the Aged Care Quality Standards, and aligns with current reform strategies for the aged care sector. Further research is required to determine the impact on practice and resident outcomes, and its relevance for use in other settings or countries.
The objective of this study was to identify significant predictors of poor bladder health in middle-aged and older community-dwelling Australians that may be addressed by public health interventions. A cross-sectional study recruited 656 volunteers aged 40–75 years in one Australian state capital city. We report bladder health in this paper, measured as the summed non-sex-specific bladder health questions (N=5) in the Pelvic Floor Bother Questionnaire (PFBQ). Associations between bladder health and putative predictors identified from the literature (age; sex; health concerns; polypharmacy; smoking; cognition; nutrition; alcohol intake, regular exercise; body mass index; walking speed) were examined. Bladder health was tested as a scaled variable in three categories (no problems, some problems and many problems). Univariate linear regression models, chi square models and analysis of variance models were applied to test strength of associations. Significant crude associations between predictors and poor bladder health were stratified by gender and age groups (40–49 years, 50–59 years, 60–69 years and 70+ years) to test for confounding. The sample comprised 218 men and 438 women. Increasing age, high body mass index, slow walking speed and health concerns were significant crude predictors of poor bladder health. Gender and age were significant confounders of all these associations. Broad public health interventions that promote regular physical activity to people aged 45–75 years may result in faster walking speeds and lower body mass index, which in turn may improve general health, and prevent and improve poor bladder health.
To determine the associations between pelvic floor health and frailty, and to identify variables associated with them, this study involved656 community-dwellers aged 40–75 years who participated in a cross-sectional observational study. Participants completed the Pelvic Floor Bother Questionnaire and the Fried frailty phenotype assessment, and were assessed for putative predictors (sleep quality, body mass index, nutrition, psychological distress, hydration, smoking, alcohol, polypharmacy and health concerns). Differences were tested using analysis of variance models and chi square tests, and associations were tested using linear and logistic regression models. Bladder and bowel concerns were reported by men and women in all age groups, and 38% of participants exhibited at least one frailty element. There was a significant association between reporting frailty elements and poor pelvic floor health, and both were significantly associated with increasing age for men and women, poor sleep quality and high body mass index. Only pelvic floor health was significantly associated with health concerns and polypharmacy, and only frailty was significantly associated with smoking and alcohol consumption. Significant associations with alterable lifestyle and general health factors suggest that early interventions to improve pelvic floor health could impact on health and healthy ageing more broadly.