Management of Fecal Incontinence in Frail Older Adults Living in the Community

Most older adults live in the community either alone or in a family arrangement. Community-living older adults are diverse, and the health status of some is characterized by complexity related to having multiple morbidities and possibly frailty. Assessment and management of fecal incontinence in frail community-dwelling older adults with health-related complexity may be enhanced using a complexity framework that accounts for social, environmental, and political contextual factors as well as health/medical concerns. This chapter will explain common problems that contribute to fecal incontinence in these older adults such as impaction with overflow, constipation, diarrhea, and mild to moderate cognitive impairment. It will address special considerations that the advanced practice nurse must take into account including hearing and vision impairment, physical limitations, the physical environment and toilet access in the home, diet and hydration, and the role of the caregiver. The chapter will then discuss appropriate management interventions. Interventions highlight the importance of a holistic approach, client and caregiver engagement and education, and referral to other healthcare professionals and community services.