In Australia, it is estimated that one in three people over the age of 15 experiences incontinence. People living in residential care, most of whom are aged 65 or over, experience incontinence at higher rates than the general population, with almost five in 10 people living in residential care experiencing incontinence in 2023.
When it comes to improving continence care for older people, there needs to be a focus on psychological well-being as well as physical health. When incontinence is managed poorly, it leads to social withdrawal, increased falls, and a loss of self-esteem. The burden often falls on families and carers who must balance clinical requirements with the deeply personal nature of this condition.
Understanding incontinence and evolving care needs
Incontinence in older adults is rarely a standalone issue. It’s typically a symptom of underlying chronic conditions, ranging from diabetes and prostate issues to reduced mobility. However, the most significant driver in aged care settings is cognitive decline.
“When a resident can no longer recognise the physiological cues to use the toilet or loses the ability to locate the toilet, the risk of accidents increases exponentially.”
The intersection of neurological health and bladder function is particularly evident in those with memory loss. Effective continence care for people with dementia requires care teams to look past the physical symptom and understand the behavioural communication behind it.
Early recognition of pacing or fidgeting can be a vital indicator that a resident needs assistance, allowing for intervention before an accident occurs. Reducing the stigma around these events is critical for maintaining a resident’s dignity and ensuring they don’t feel ashamed of a biological reality.
Practical Approaches to Person-Centred Continence Care
To improve ease of care and resident comfort, aged care professionals should adopt
strategies that prioritise independence and skin health.
- Implement Individualised Toileting Programs
Standard round-the-clock checks are often inefficient and can be intrusive.
Individualised programs based on a resident’s specific habits, known as prompted voiding, can significantly reduce episodes of leakage. By aligning care with the resident’s natural rhythm, carers can support independence for longer. - Prioritise Skin Integrity and Barrier Protection
Incontinence-associated dermatitis (IAD) is a significant risk for the elderly. Constant exposure to moisture breaks down the skin barrier, leading to painful sores and infections. Caregivers should utilise high-quality, breathable, absorbent products and pH-balanced cleansing foams rather than standard soaps, which can further irritate fragile skin. - Environmental Adjustments for Mobility
For many older people, functional incontinence occurs simply because they cannot reach the toilet in time. This is often due to poor lighting, restrictive clothing, or cluttered walkways. Ensuring toilets are clearly marked with high-contrast signage, a technique supported by Dementia Australia, can make a profound difference in a resident’s ability to navigate their environment safely. - Hydration and Dietary Management
A common mistake is restricting fluids to prevent accidents. This actually leads to concentrated urine, which irritates the bladder and increases urgency. The Department of Health and Aged Care emphasises that adequate hydration is essential to prevent urinary tract infections (UTIs), which are a leading cause of sudden, acute incontinence in the elderly.
Proactive continence care is a cornerstone of professional aged care. When carers are equipped with person-centred strategies and the right clinical tools, they restore a sense of agency to the people in their care. Small, consistent improvements in how we approach toileting, skin protection, and environmental design can significantly enhance the daily lived experience of older people in Australia, ensuring they live with the comfort and respect they deserve.
