2. 2 Urinary Incontinence in Community- Dwelling Populations: Issues & Challenges for Continence Care Assoc Prof Winsome St John RN, PhD School of Nursing & Midwifery Gold Coast Campus Research Centre for Clinical & Community Practice Innovation (RCCCPI)

3. Acknowledgements Prof Marianne Wallis RN, PhD –Clinical Chair GCHSD & Griffith University Shona McKenzie RN, BSc, AssDipHealthEd, PostGradCert in GeronotNurs, CNA, NP –Nurse Practitioner – continence, RBH Susan Griffiths BA –Project manager, Griffith University Heather James BN, MN – Research assistant, Griffith University Waterworx Centre Clinical Team –Shona McKenzie –Sheridan Guyatt BPhyso –Jennifer Rayner RN, CNA, Stomal Therapist –Sue Walker RN, CNA –Lisa Sissons BPhysio

4. Why are community continence services important? Epidemiology and an ageing population The community is where people are Policy issues –Demand for services will increase –Urinary incontinence is expensive –Urinary incontinence is a major reason for nursing home admission Prevention - 1 , 2  & 3  Just because it is low tech, doesn’t mean it isn’t important Urinary incontinence has a major impact

5. Impact of UI PhysicalEmotionalSocialGeneral well-being  Loss of sleep  Falls  Need for care  Reduct- ion in physical exercise  Psychological distress  Shame/  Depression/ Anxiety  Impaired self- esteem  Loneliness  Affect on self- perception and confidence  Embarrassment  Restrictions in social life/ isolation  Travel  Need for secrecy  Avoidance of relationships/ impact on sex life  Leisure  Stigma  Financial burden  Health care use  Increased risk of nursing home admission  Quality of life

6. Why are community continence services important? Epidemiology and an ageing population Policy issues –Demand will continue to increase –Urinary incontinence is expensive –Urinary incontinence is a major reason for nursing home admission Prevention - 1 , 2  & 3  The community is where people are Just because it is low tech, doesn’t mean it isn’t important Urinary incontinence has a major impact Continence services can make a difference

7. Primary Health Care … is essential care based on practical, scientifically sound and socially acceptable methods and technology made universally acceptable to individuals and families in the community through their full participation and at a cost that the community and country can afford … It brings health care close to where people live and work. World Health Organization. (1978). Declaration of Alma Ata: International conference on primary health care. Alma Ata, USSR, 6-12 September 1978. Retrieved on 28-10-2007 from

8. Primary health care Effective Acceptable Accessible Affordable Appropriate

9. Australian context National Continence Management Strategy Continence Foundation Australia National strategies eg. the National Helpline A research agenda Continence journal Chronic diseases management strategies – nationally and in states Many local initiatives

10. Effectiveness What has been achieved? Research into effectiveness of therapies and treatments More precise diagnostics Evidence based clinical guidelines –First steps & second steps (HACC) –Assessment guidelines Evaluation of demonstration projects and models of service delivery (St John & Mackenzie, 2002; St John et al, 2004; St John & Wallis, 2004) Better research tools (Sansoni et al, 2006)

11. The Waterworx Model Creating referral pathways Providing services within a generalist framework Community- based services Development of multi-disciplinary Assessment tools Expertise, Providing multi – disciplinary continence care Facilitating Ensuring access client Multidisciplinary case management Interdisciplinary referral Links to diagnostic & specialist services Specialist continence staff Clinic & home visits Active promotion of service Targeting a community-dwelling client group Promotion of client self - management Development of continence knowledge & health literacy Multi-disciplinary assessment Comprehensive conservative management of UI tailored to community-based client needs Staff development & professional education inter- disciplinary collaboration & linkages Exercises / Pelvic floor retraining Facility for self-referral Providing services within a generalist framework Creating referral pathways St John et al, 2004a St John, et. al, 2004