Urinary Incontinence in Community-Dwelling Populations: Issues and Challenges for Continence Care

Abstract

Keynote Address This paper reviews current issues in service provision for community-dwelling people with urinary incontinence. As the population ages, the prevalence of incontinence and demand for continence services will increase. Our challenge is to use knowledge and technology to provide care that is appropriate, effective, affordable, accessible and acceptable services for people living with urinary incontinence in the community. Treatment and therapy is needed, as well as care that will address quality of life issues and assist people with persistent incontinence to manage it in their daily lives. No one professional group has all the answers for a person seeking help for their incontinence. While specialist continence care has been found to be effective, care may be siloed within particular specialties. If everyone with urinary incontinence presented for health care, it is arguable that continence services would not cope. Further, studies over many years show that generalist health practitioners may lack knowledge, fail to address community-dwelling clients' continence needs, and fail to refer clients to continence specialists. Providing appropriate care will have costs, however, failing to provide effective care will also incur costs - both financial and in terms of human suffering. Future directions for care provision require new models of care, evidence-based practice, cost modelling and targeted funding, strengthened multi-disciplinary relationships, education of generalist clinicians, role development of continence specialists, better use of case-finding opportunities, links across sectors, clearer clinical pathways and greater visibility in the professional and general community for continence care. Future development in continence care can aspire to fulfil the principles of primary health care.