Specifics of continence care in remote areas
Prepared by The Emonicum Institute for active and healthy life, Ljubljana, Slovenia, June 2019
Rural and remote areas are, in comparison with urban environments, specific and there are also important differences between rural and remote areas. Residents in rural areas have access to basic education, health care, post and bank offices, small markets, good connections etc. In remote areas (1) residents have less access to basic facilities and some of them are not present at all. Reduced job possibilities are causing emigration of young people with old residents left. Declining population with prevalent elderly is a common feature in remote areas (2). Poverty, low social capital, social exclusion and dwelling isolation are frequent, health and social needs are high, but underserved (3).
Elderly in remote areas are from the health and social point of view particularly vulnerable. Geriatric syndromes, among which incontinence is a dominant one, are frequent in remote areas. Incontinence, as a syndrome with different aetiology and forms, is interdependently linked with dementia, falls and other syndromes in the form of complex poly-morbidity, which is a frequent everyday burden of many in old age and a reason for long-term care at home or an institution. Attempts to the reduction of incontinence have to include the influence of other diseases or disorders on its expression, e.g. diabetes, Parkinson disease, MS, urological infections, neurological causes, obesity, mobility obstacles etc. Family long term care with urine and faecal incontinence can be accompanied by neglect and even abuse.
Each remote community has its demographic, social, health, environmental and infrastructural specifics. General principle of each programme is to increase the literacy about incontinence, to combat its stigma by social inclusion of those with disorders and to improve their self-respect and dignity. No one with continence disorders should remain socially isolated. An active residential life supports residents to longer stay at home.
Community potentials can be used in collaboration with local stakeholders, according to their capacities and duties.
There is no uniform approach to incontinence and stigma reduction in remote areas. Their specifics open together with community diagnoses doors to innovative solutions and practices.