Older people's and formal caregivers' perspectives of value-creating continence care: a qualitative study

To explore the experiences of older people and formal caregivers of value-creating continence care, focusing on toileting and containment strategies, in relation to the Art of Connectedness framework.

A qualitative, explorative design. The interviews were conducted with 14 older people. Individual interviews and focus groups were held with 14 formal caregivers. An abductive qualitative content analysis was conducted, alternating between deductive interpretation-based on the three themes in the framework-and inductive analysis of the interview data.

In relation to the co-created care theme, establishing a relationship and respecting preferences were highlighted by the participants and aligned with the framework, while trust was less prominent. In personalized care, meeting individual needs were described in ways that extended the framework: older people stressed the importance of time, while formal caregivers highlighted incontinence pads being individualized. Maintaining self-determination was emphasized by formal caregivers, as in the framework, but varied among older people. In the reflective care theme, showing empathy and upholding dignity were valued by older people in nursing homes and by formal caregivers, which was consistent with the framework.

The findings reveal aspects of care that contribute to value-creating continence care for older people receiving toileting assistance and containment strategies. While the framework provided a useful structure, variations emerged between older people and formal caregivers what they considered important. This indicates the importance of developing a self-reported instrument to evaluate older people's satisfaction with the assistance they receive. The findings provide insights that can help increase awareness of the value of how promoting well-being for older people in daily continence care practice. The findings could inform community care policy aimed at improving continence care for older people.