Abrams P, Andersson KE, Apostolidis A 6th International Consultation on Incontinence. Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence. Neurourol Urodyn. 2018; 37:(7)2271-2272

Baek MJ, Kim K, Park YH, Kim S The validity and reliability of the Mini-Mental State Examination-2 for detecting mild cognitive impairment and Alzheimer's disease in a Korean population. PLoS One. 2016; 11:(9)

Beeckman D A decade of research on incontinence-associated dermatitis (IAD): Evidence, knowledge gaps and next steps. J Tissue Viability. 2017; 26:(1)47-56

Beeckman D, Verhaeghe S, Defloor T, Schoonhoven L, Vanderwee K A 3-in-1 perineal care washcloth impregnated with dimethicone 3% versus water and pH neutral soap to prevent and treat incontinence-associated dermatitis: a randomized, controlled clinical trial. J Wound Ostomy Continence Nurs. 2011a; 38:(6)627-634

Beeckman D, Woodward S, Gray M Incontinence-associated dermatitis: step-by-step prevention and treatment. Br J Community Nurs. 2011b; 16:(8)382-389

Beeckman D, Van Lancker A, Van Hecke A, Verhaeghe S A systematic review and meta-analysis of incontinence-associated dermatitis, incontinence, and moisture as risk factors for pressure ulcer development. Res Nurs Health. 2014; 37:(3)204-218

Proceedings of the Global IAD Expert Panel. Incontinence-associated dermatitis: moving prevention forward. 2015. https// (accessed 18 April 2024)

Beeckman D, van Damme N, Schoonhoven L Interventions for preventing and treating incontinence associated dermatitis in adults. Cochrane Database Syst Rev. 2016; 11:(11)

Beeckman D, Van den Bussche K, Alves P Towards an international language for incontinence-associated dermatitis (IAD): design and evaluation of psychometric properties of the Ghent Global IAD Categorization Tool (GLOBIAD) in 30 countries. Br J Dermatol. 2018; 178:(6)1331-1340

Bliss DZ, Mathiason MA, Gurvich O Incidence and predictors of incontinence-associated skin damage in nursing home residents with new-onset incontinence. J Wound Ostomy Continence Nurs. 2017; 44:(2)165-171

Borchert K, Bliss DZ, Savik K, Radosevich DM The incontinence-associated dermatitis and its severity instrument: development and validation. J Wound Ostomy Continence Nurs. 2010; 37:(5)527-535

Boronat-Garrido X, Kottner J, Schmitz G, Lahmann N Incontinence-associated dermatitis in nursing homes. J Wound Ostomy Continence Nurs. 2016; 43:(6)630-635

Bouwstra H, Smit EB, Wattel EM Measurement properties of the Barthel Index in geriatric rehabilitation. J Am Med Dir Assoc. 2019; 20:(4)420-425.e1

Braden BJ The Braden Scale for Predicting Pressure Sore Risk. Adv Skin Wound Care. 2012; 25:(2)

British Geriatrics Society. Continence care in residential and nursing homes. 2018. https// (accessed 29 April 2024)

Buckley BS, Lapitan MCM Prevalence of urinary incontinence in men, women, and children–current evidence: findings of the Fourth International Consultation on Incontinence. Urology. 2008; 76:(2)265-270

Campbell JL, Coyer FM, Osborne SR Incontinence-associated dermatitis: a cross-sectional prevalence study in the Australian acute care hospital setting. Int Wound J. 2016; 13:(3)403-411

Charalambous C, Koulori A, Vasilopoulos A, Roupa Z Evaluation of the validity and reliability of the Waterlow Pressure Ulcer Risk Assessment Scale. Med Arch. 2018; 72:(2)141-144

Chen Y, Gao Y, Zhang J Quality and clinical applicability of recommendations for incontinence-associated dermatitis: A systematic review of guidelines and consensus statements. J Clin Nurs. 2023; 32:(11-12)2371-2382

Clark M, Semple MJ, Ivins N, Mahoney K, Harding K National audit of pressure ulcers and incontinence-associated dermatitis in hospitals across Wales: a cross-sectional study. BMJ Open. 2017; 7:(8)

Condon M, Mannion E, Molloy D, O'Caoimh R Urinary and faecal incontinence: point prevalence and predictors in a university hospital. Int J Environ Res Public Health. 2019; 16:(2)

D'Ancona C, Haylen B, Oelke M The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn. 2019; 38:(2)433-477

Ferreira M, Abbade L, Bocchi SCM, Miot HA, Boas PV, Guimaraes HQCP Incontinence-associated dermatitis in elderly patients: prevalence and risk factors. Rev Bras Enferm. 2020; 73

Flanagan L, Roe B, Jack B Systematic review of care intervention studies for the management of incontinence and promotion of continence in older people in care homes with urinary incontinence as the primary focus (1966–2010). Geriatr Gerontol Int. 2012; 12:(4)600-611

Gray M, Bliss D, Doughty D, Ermer-Seltun J, Kennedy-Evans K, Palmer M Incontinence-associated dermatitis: a consensus. J Wound Ostomy Continence Nurs. 2007; 34:(1)45-54

Gray M, Black JM, Baharestani MM Moisture-associated skin damage: overview and pathophysiology. J Wound Ostomy Continence Nurs. 2011; 38:(3)233-241

Gray M, Beeckman D, Bliss DZ Incontinence-associated dermatitis: a comprehensive review and update. J Wound Ostomy Continence Nurs. 2012; 39:(1)61-74

Gray M, Giuliano KK Incontinence-associated dermatitis, characteristics and relationship to pressure injury. J Wound Ostomy Continence Nurs. 2018; 45:(1)63-67

Hahnel E, Blume-Peytavi U, Trojahn C, Kottner J Associations between skin barrier characteristics, skin conditions and health of aged nursing home residents: a multi-center prevalence and correlational study. BMC Geriatr. 2017; 17:(1)

Hernández-Martínez-Esparza E, Santesmases-Masana R, Román E, Abades Porcel M, Torner Busquet A, Berenguer Pérez M, Verdú-Soriano J Prevalence and characteristics of older people with pressure ulcers and legs ulcers, in nursing homes in Barcelona. J Tissue Viability. 2021; 30:(1)108-115

Houwing RH, Arends JW, Dijk MRC, Koopman E, Haalboom JRE Is the distinction between superficial pressure ulcers and moisture lesions justifiable? A clinical-pathologic study. Skinmed. 2007; 6:(3)113-117

Safeguarding vulnerable persons at risk of abuse.Dublin: Health Service Executive; 2014

National consent policy.Dublin: Health Service Executive; 2017

Huang C, Ma Y, Wang C, Jiang M, Yuet Foon L, Lv L, Han L Predictive validity of the braden scale for pressure injury risk assessment in adults: A systematic review and meta-analysis. Nurs Open. 2021; 8:(5)2194-2207

Jachan DE, Müller-Werdan U, Lahmann NA Impaired mobility and urinary incontinence in nursing home residents. J Wound Ostomy Continence Nurs. 2019; 46:(6)524-529

Jeong S, Kim HJ, Lee YJ Prevalence and clinical features of detrusor underactivity among elderly with lower urinary tract symptoms: a comparison between men and women. Korean J Urol. 2012; 53:(5)342-348

Johansen E, Bakken LN, Duvaland E, Faulstich J, Hoelstad HL, Moore Z, Vestby EM, Beeckman D Incontinence-associated dermatitis (IAD). J Wound Ostomy Continence Nurs. 2018; 45:(6)527-531

Jung HB, Kim HJ, Cho ST A current perspective on geriatric lower urinary tract dysfunction. Korean J Urol. 2015; 56:(4)266-275

Kayser SA, Phipps L, VanGilder CA, Lachenbruch C Examining prevalence and risk factors of incontinence-associated dermatitis using the International Pressure Ulcer Prevalence Survey. J Wound Ostomy Continence Nurs. 2019; 46:(4)285-290

Kottner J, Blume-Peytavi U, Lohrmann C, Halfens R Associations between individual characteristics and incontinence-associated dermatitis: A secondary data analysis of a multi-centre prevalence study. Int J Nurs Stud. 2014; 51:(10)1373-1380

Koudounas S, Bader DL, Voegeli D Knowledge gaps in the etiology and pathophysiology of incontinence-associated dermatitis. J Wound Ostomy Continence Nurs. 2020; 47:(4)388-395

Kring DL Reliability and validity of the Braden Scale for predicting pressure ulcer risk. J Wound Ostomy Continence Nurs. 2007; 34:(4)399-406

LeBlanc K, Campbell KE, Wood E, Beeckman D Best practice recommendations for prevention and management of skin tears in aged skin. J Wound Ostomy Continence Nurs. 2018; 45:(6)540-542

Mahoney FI, Barthel DW Functional evaluation: the Barthel Index. Md State Med J. 1965; 14:61-65

Mugita Y, Minematsu T, Huang L Histopathology of incontinence-associated skin lesions: inner tissue damage due to invasion of proteolytic enzymes and bacteria in macerated rat skin. PLoS One. 2015; 10:(9)

Musa MK, Saga S, Blekken LE, Harris R, Goodman C, Norton C The prevalence, incidence, and correlates of fecal incontinence among older people residing in care homes: a systematic review. J Am Med Dir Assoc. 2019; 20:(8)956-962.e8

National Association of Tissue Viability Nurse Specialists Scotland. Scottish excoriation & moisture related skin damage tool. 2020. https// (accessed 18 April 2024)

NHS England. Excellence in Continence Care: Practical guidance for commissioners, and leaders in health and social care. 2018. https// (accessed 18 April 2024)

Qaseem A, Dallas P, Forciea MA Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014; 161:(6)429-440

Quintavalle PR, Lyder CH, Mertz PJ, Phillips-Jones C, Dyson M Use of high-resolution, high-frequency diagnostic ultrasound to investigate the pathogenesis of pressure ulcer development. Adv Skin Wound Care. 2006; 19:(9)498-505

Rohwer K, Bliss DZ, Savik K Incontinence-associated dermatitis in community-dwelling individuals with fecal incontinence. J Wound Ostomy Continence Nurs. 2013; 40:(2)181-184

Royal College of Physicians. National audit of continence care. 2015. https// (accessed 29 April 2024)

Russell B, Buswell M, Norton C Supporting people living with dementia and faecal incontinence. Br J Community Nurs. 2017; 22:(3)110-114

Schofield A Incontinence-associated dermatitis 3: systems for reporting skin damage. Nurs Times. 2020; 116:(5)23-26

Stokes AL, Crumley C, Taylor-Thompson K, Cheng AL Prevalence of fecal incontinence in the acute care setting. J Wound Ostomy Continence Nurs. 2016; 43:(5)517-522

Suzuki M, Okochi J, Iijima K, Murata T, Kume H Nationwide survey of continence status among older adult residents living in long-term care facilities in Japan: the prevalence and associated risk factors of incontinence and effect of comprehensive care on continence status. Geriatr Gerontol Int. 2020; 20:(4)285-290

Van den Bussche K, Verhaeghe S, Van Hecke A, Beeckman D Minimum Data Set for Incontinence-Associated Dermatitis (MDS-IAD) in adults: design and pilot study in nursing home residents. J Tissue Viability. 2018; 27:(4)191-198

Improving continence care around the world. 2015. https// (accessed 29 April 2024)

Walsh B, Dempsey L Investigating the reliability and validity of the Waterlow Risk Assessment Scale: a literature review. Clinical Nursing Research. 2011; 20:(2)197-208

Wang X, Zhang Y, Zhang X, Zhao X, Xian H Incidence and risk factors of incontinence-associated dermatitis among patients in the intensive care unit. J Clin Nurs. 2018; 27:(21-22)4150-4157

Wounds UK. Best practice statement: maintaining skin integrity. 2018. https// (accessed 18 April 2024)

Incontinence-associated dermatitis in older adults in residential care settings: a point prevalence study

09 May 2024
Volume 33 · Issue 9


Incontinence-associated dermatitis (IAD) is a skin inflammation caused by contact with urine or faeces or both. It has a negative effect on the patient's quality of life and is indicative of the care provided. However, globally there is a lack of empirical data on the prevalence of IAD. Aim: To identify, for the first time, the proportion of older adults in extended care settings in Ireland affected by IAD. Design: Cross-sectional, multisite, point prevalence survey, across three community extended care settings for older people in Ireland. Methods: Two clinical nurse specialists, using the Scottish Excoriation and Moisture Related Skin Damage Tool, identified the presence of IAD through clinical observation and visual skin inspection. IAD prevalence was calculated for the total population and incontinent population sets using percentages and confidence intervals (CI). Results: The prevalence of incontinence was 86.4% (n=165), a significantly higher proportion were female (P=0.003). The point prevalence of IAD across the total population and incontinent population was 11.5% (22/191; 95% CI, 7.4–19.9%) and 13.3% (22/164; 95% CI, 8.5–19.5%), respectively. Being incontinent was associated with being female, more dependent (Barthel), having possible cognitive impairment, poorer mobility (Braden and Waterlow) and a high risk of pressure ulcers (Waterlow). A logistic regression analysis found no predictor variables for IAD among the variables that met the cut-off point for this analysis. Conclusions: The study provides the first point prevalence empirical data on the occurrence of IAD in Ireland. It can inform decision-making on future planning and budgeting of new quality improvement projects and act as a benchmark for ongoing auditing of IAD.

Incontinence-associated dermatitis (IAD) is a common type of moisture-associated skin damage related to prolonged exposure to urine and faecal incontinence (Gray et al, 2011). Historically, a variety of terms were used to describe this condition, including moisture lesions, irritant dermatitis, perineal dermatitis and nappy rash (Gray et al, 2007; Beeckman et al, 2015; Ferreira et al, 2020) but IAD is the accepted terminology now used across the literature, defined as ‘a type of irritant contact dermatitis (inflammation of skin) found in people with urinary and or faecal incontinence’ (Beeckman et al, 2015) and as such can occur in any age group.

IAD is a top-down injury presenting as redness of the skin including oedema of the surface of the skin, and may be accompanied by blisters, serous exudate, epidermal erosion, and secondary cutaneous infection (Gray et al, 2012; Beeckman et al, 2016). The affected skin area may have varying depths of damage to the epidermis, be patchy or continuous with poorly defined edges, while affected intact skin may be firmer and warmer than adjacent unaffected areas (Beeckman et al, 2015). Histopathological analysis of IAD reveals inflammation of the upper dermis, resulting in erythema (Houwing et al, 2007; Mugita et al, 2015). Erosion is followed by dermal and epidermal proliferation as well as vascular occlusion, resulting in necrobiosis and partial tissue loss. In contrast, pressure injuries are largely caused by bottom-up damage when pressure or shear destroys deeper tissues such as muscle (Gray et al, 2012). Histopathological analysis of pressure injury indicates ischaemia as the major culprit (Houwing et al, 2007), and ultrasonic imaging reveals subdermal pockets of oedema near underlying bone (Quintavalle et al, 2006).

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