Managing Faecal Incontinence in people with advanced dementia resident in Care Homes

Study Code / Acronym
Award Number
Health Technology Assessment
Status / Stage
2 September 2014 -
31 December 2015
Duration (calculated)
01 years 03 months
Funding Amount
Funder/Grant study page
Contracted Centre
University of Hertfordshire
Principal Investigator
Professor Claire Goodman
PI Contact
WHO Catergories
Economic Impact of Dementia
Methodologies and approaches for risk reduction research
Disease Type
Severe Dementia

CPEC Review Info
Reference ID98
ResearcherReside Team


Study Code / AcronymFINCH
Award Number13/75/01
Status / StageCompleted
Start Date20140902
End Date20151231
Duration (calculated) 01 years 03 months
Funder/Grant study pageNIHR
Contracted CentreUniversity of Hertfordshire
Funding Amount£193,298.00


Faecal incontinence (FI) is the involuntary loss of liquid or solid stool that is a social or hygienic problem. The prevalence of FI in residents of care homes is high but it is not an inevitable consequence of old age or dementia. There is good evidence on risk factors, but very few studies providing evidence about effective interventions. There is a need to draw on a range of evidence to understand how, why and in what circumstances, particular programmes to reduce FI work (or not) for people with advanced dementia in care homes. The objectives of the realist synthesis are: 1.Identify which (elements of the) interventions could potentially be effective, how do they work, on what range of outcomes 2.Identify the barriers and facilitators to the acceptability, uptake, and implementation of interventions designed to address FI in people with advanced dementia resident in care homes 3.Establish what evidence there is on the relative feasibility and (where appropriate) cost of interventions to manage FI Method: Realist synthesis aims to identify the mechanisms by which programmes to reduce FI work. By explaining the interaction between context, mechanism and outcome it will establish which interventions, or elements of interventions, work for whom and in what circumstances. An iterative four stage approach is proposed. Phase One Establishing candidate theories and interventions: will focus on the contextual conditions and mechanisms that influence how FI is effectively managed in care homes for people with dementia to develop an initial programme theory or theories that will be ‘tested’ through the review process. Consultation with five key stakeholder groups and a first mapping of the literature will identify why certain approaches to addressing FI with people with advanced dementia are thought to work (or not) and in what circumstances. In a one day workshop emerging issues and concepts will be reviewed, and an explanatory model and candidate programme theories of how FI interventions work for this population and setting will be developed. Phase Two:will systematically search the published and unpublished evidence to test and develop the programme theories identified in Phase 1. An iterative approach to targeting evidence will be used across different databases, and other information sources. Bespoke data extraction forms based on the programme theories will be populated according to what the evidence reveals about the links between Context Mechanism and Outcomes configurations (i.e. theories) of different programmes. Data synthesis will identify the patterns that cut across the evidence to either support or negate certain context mechanism-outcome configurations. A second one day workshop will review findings and resultant configurations, and the characteristics of the evidence underpinning them. Phase 3: Test and refine programme theory/ies (validation): We will validate our findings and final narrative from Phase 2 by testing them, and then iteratively refining them, through interviews with a purposive sample of participants from phase 1 as to their potential, significance, and feasibility of implementation and embedding them for people with advanced dementia in the care home setting. Phase 4: Recommendations will be developed for practice and research of what works for whom and in what context in relation to programmes to manage faecal incontinence for people with advanced dementia in care homes.


We will review the evidence using a research approach called realist synthesis, the aim is to make explicit the underlying assumptions or theories that have informed the development of different interventions to reduce or manage FI and establish an understanding of what needs to be in place for them to be effective for people with dementia living in care homes.