Older people left with incontinence after hospital visits

Older people are being left with long-term incontinence after leaving hospital as NHS staff are too busy to take patients to the toilet and fit them with catheters unnecessarily, experts warn

• Older people spending too long in hospital end up with long-last incontinence
• Cause of this can be inappropriate use of urinary catheters which drain bladder
• British Journal Of Nursing study said 54% of use in older patients unnecessary
• MoS has heard from older people who lost bladder control after hospital visits

Older people who spend time in hospital are being discharged suffering from long-lasting incontinence because NHS staff are too busy to take them to the toilet while they’re on the ward, experts warn.

One reason, say specialists, is inappropriate use of urinary catheters – a tube inserted into the urinary tract which empties the contents of the bladder into a drainage bag.

There are strict criteria for who should have one fitted, including those with existing urinary incontinence and patients unable to move due to having undergone a major operation or suffering spinal or pelvic injuries. But research has revealed that on some wards the procedure has become almost standard practice.

A study published in the British Journal Of Nursing suggests that as many as 54 per cent of catheterisations in older patients are unnecessary. In addition, even when use is appropriate, almost half of patients are left with catheters for longer than recommended.

In a 2017 study published in the British Medical Journal, one junior doctor shockingly admitted that ‘sometimes it’s easier to stick a tube in’ instead of finding the time to monitor urine output – a vital indicator of health – or to help a patient to go to the toilet repeatedly.

Older people who spend time in hospital are being discharged suffering from long-lasting incontinence because NHS staff are too busy to take them to the toilet while they’re on the ward, experts warn

The study also found that nurses were unclear about protocols for who should have a catheter and that women are more likely to have one fitted as ‘it’s easier for men to pass urine when less mobile’. Catheters are far from risk-free. They often trigger urinary tract infections and one patient in five struggles with urinary leakage or difficulty starting or stopping urination after having one.

Professor Nikki Cotterill, an expert in continence care at University of the West of England, said: ‘When a patient is admitted, the goal should be to keep the patient as near to their normal level of continence as possible. Too many patients are catheterised.

‘There’s a risk that the bladder can lose tone because it is not filling and emptying normally.’

Other research highlights a ‘pad-happy’ culture on wards. Frail or older patients are automatically given incontinence pads and told to relieve themselves in the pad rather than waiting to use a toilet.

Over time, this can cause muscles in the pelvis and back passage to weaken and patients have difficulty resisting the urge to go.

The use of incontinence pads is also linked to a higher risk of skin conditions such as dermatitis, as well as urinary tract infections, due to the build-up of bacteria that can occur inside the pad.

Dr Julie Ellis-Jones, senior lecturer in adult nursing at University of the West of England said staffing problems are an issue. In the past healthcare assistants, supervised by a qualified nurse, would have been on hand to help patients go to the toilet and manage problems with continence, but there just aren’t enough of them now.

Catheters are far from risk-free. They often trigger urinary tract infections and one patient in five struggles with 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 needing the loo but no one is able to take you so you wet yourself and then are told you are incontinent, when you are not.’

She added that, once in pads, patients can become used to them. ‘If someone is put into pads it can become the new normal for them.’

The Mail on Sunday heard from the family of an 80-year-old ‘completely independent’ man who was left incontinent after a two-and-a-half-week stay in a South London hospital, where he was treated for a fractured thigh bone.

‘He was a bit doddery but independent and could use the toilet by himself,’ says his daughter. ‘As soon as he went into hospital, staff put him in pads and wouldn’t help him get to the toilet. Now, he has 24/7 care to change his nappies.’

Worried about your treatment? Here’s what to do

You are not obliged to accept medical treatment or interventions – and that includes having a catheter fitted and the use of incontinence pads – according to the Patients’ Association.

If you are concerned about any aspect of care as an inpatient – or as a family member of one – you should ask a nurse on the ward for a time to be arranged to speak to the consultant who has overall responsibility. You can find out the reason a decision was made and ask about alternatives.

For advice call the Patients Association helpline on 0800 345 7115, weekdays 09:30–17:00. Visit patients-association.org.uk for more information about your rights.

Another to suffer is 80-year-old John Grahame, a former Army officer from London. ‘The first time my mother visited him she had to run around to find either someone to help him go to the loo or a plastic bottle,’ says his daughter Charlotte, 41.

‘There were 22 people on his ward and pretty much everyone was in pads. In the end, she found a bottle. By the next time she visited, he was pretty much reliant on nappies.’

The family are now paying £3,000 a month for carers to visit John at home and help his 80-year-old wife change his pads.

‘Eventually my dad is going to need to go into a nursing home – but there’s every chance he would never have needed that level of care had he not gone in to hospital,’ adds Charlotte.

Sylvia, 72, from North Wales, was admitted to hospital in November 2019 with early-stage dementia. Although confused, she was in full control of her bladder, says her daughter, Kate, 55.

Two days into her admission, Kate visited and was shocked to see a bucket beside Sylvia’s bed and a pad on the bedside table.

‘The nurse turned to me and said, ‘Your mother is now incontinent.’ I thought, no she isn’t!’ says Kate.

Sylvia was later discharged and transferred to a care home. ‘Without the pads and buckets, she was suddenly able to take herself to the toilet,’ says Kate.

‘She was more mobile too. She was up, down and all over the place, because she was being properly looked after.’

NHS guidance states that a continence assessment should be carried out with all high-risk patients on admission, such as those with dementia or who may struggle to reach the toilet unaided.

If incontinence is identified, a regime should begin to retrain the bladder – including pelvic-floor exercises, improving mobility, medication and the use of aids like bed pans. NHS guidance states: ‘Every effort should be made to make access to toilets easy.’

‘If you feel that a loved one is being catheterised or put in pads unnecessarily, raise concerns with a member of the care team,’ said Prof Cotterill. ‘Only those close to the patient will know what their normal toilet functioning is like – so don’t be afraid to speak out.’

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