Features

Adult Incontinence Products: A Market Overview

the last of a three part series addresses adult incontinence

August 17, 2005

By: Karen McIntyre

Editor

Adult Incontinence Products: A Market Overview
rn

the last of a three part series addresses adult incontinence

By Colin White MCW Technologies Cumbria, U.K.

The following article is the third and final in a series of articles by Mr. White. In the January 1999 issue of Nonwovens Industry he detailed the baby diaper and training pants market, while in the February 1999 issue Mr. White covered the feminine hygiene sector. This article was made possible through Mr. White’s association with EDANA’s Absorbent Products Program.

Adult incontinence products have the same overall requirements to provide an effective absorbent structure to receive and retain either urine or fecal waste (or both in the case of the doubly incontinent). They are required to provide these functions without skin irritation or leakage and in a manner that allows the user to effectively manage their incontinence.

The product group is complex because of the differing levels of incontinence experienced by suffers and differing levels of mobility. This group also contains a number of different product forms and because some of the products are relatively large size, they can present special problems of safe and efficient disposal.

Disposable absorbent products that are specifically designed for the management of adult incontinence are the newest group of hygiene products. Although the incidence of incontinence is not new, commercial development of products for use in this field only began in the late 70’s/early 80’s.

Not surprisingly, the design of the early products owed much to the development work that had already been carried out in the fields of baby diapers and feminine hygiene products.

The key performance parameters for adult incontinence products are basically the same as for the other categories of absorbent hygiene products in that they need to provide protection from leakage, user comfort, in-use discretion, skin dryness etc. These requirements will vary considerably depending on the extent and severity of the incontinence problem to be managed.

Incontinence
rnThere is no one condition that is incontinence. The term is used to describe a range of problems that affect a wide range of the population. Some of these problems we tend not to think of as “incontinence,” i.e., in babies where the newborn child is doubly incontinent, sometimes up to and beyond the age of 42 months, normally taken as the end of the diapering period.

Similarly, not all studies take young people—age 5 years and up—into account, although there is probably a greater incidence of bedwetting (enuresis) in younger people.

Although urinary incontinence is the most common form, fecal incontinence also occurs, particularly in the institutionalized elderly. Double incontinence is also more common in older institutionalized people.

It is not therefore surprising that the development of satisfactory disposable products for the management of incontinence problems has been fraught with difficulties.

In the market today, there are a number of incontinence products available that are offered to meet the perceived needs of the sufferers from the various levels and types of incontinence. Within Europe, these disposable absorbent incontinence products are classified as medical devices Class 1 and their manufacture and control are required to follow the requirements set out in the European Council Directive 93/42/EEC 14 June 1993. Similar arrangements are in place in the U.S.

Types Of Incontinence
rnThe reasons why people develop incontinence are many and various. Incontinence is often classified, with respect to the selection of the most appropriate disposable products, into light, moderate or heavy, providing an approximate guide to the volumes of urine possibly voided and to be handled.

Light incontinence can happen at all ages. It has a tendency to be a problem that affects the female population especially after giving birth or at menopause. Although light incontinence is known to affect many women, it is often considered a nuisance rather than a disease.

Moderate incontinence is a condition that occurs less often than light incontinence and is often brought on as a result of an accident or an illness. It can become a permanent problem, but a number of medical programs exist to reduce or eliminate the condition.

Most sufferers at the light or moderate incontinence level live at home and can care for themselves. They are also capable of making an informed decision about what type of product best suits their needs. It is interesting to note that this group has the most objections to product styles that are based on a “baby diaper” format as the psychological problems that this association brings can be quite dramatic.

Heavy incontinence is found most frequently, but not exclusively, among elderly people. Both sexes can be affected by this problem. Heavy incontinence is also found among people of any age group who have severe medical problems (i.e. physically handicapped, paralyzed or paraplegic) or with major psychiatric problems (i.e., Alzheimer’s, senility, or nervous disorders).

Because of their poor physical and/or mental condition, sufferers with severe incontinence are often cared for in institutions, hospitals or nursing homes for the elderly, although many younger disabled people still work and live in the community.

As a result of the type of care provision, the products used to manage incontinence are most often chosen by the care facility and not the patient. This can give rise to a conflict of interest between what is most effective for the care institution and what is most acceptable to the patient.

Evolution Of Absorbent Products For Heavy Incontinence
rnProducts for the management of heavy incontinence owe many of their features to developments that first appeared in the baby diaper sector.

Heavy urinary incontinence usually indicates a total lack of bladder control and may occur together with fecal incontinence. The main requirements of disposable absorbent products designed to deal with this type of incontinence are:

rn
-Must rapidly absorb urine during the miction and subsequently transfer the urine within the absorbent structure. This means that a very high absorbent capacity is required.
rn
rn
rn
rn
-Retain the urine (and feces) within the product and preferably keep them separate to minimize skin irritation.
rn
rn
rn
-Isolate wetness from the skin contact layer.
rn
rn
-Reduce odor.
rn
rn
-Maximize user comfort, particularly when saturated with liquid.
rn
rn
-Be simple to use and put on/take off the patient.
rn
rn
-Have a low “noise factor” so that they do not rustle, especially if prescribed for patients who live in a community.
rn
rn

Recent feedback from users (such as physically disabled living in a community) has shown that while existing products work—within the meaning of the word—there are numerous unsolved problems stemming from their derivative design for this group of users1,2.

Existing products have evolved through a series of stepwise improvements and involve both “two-piece” and “all-in-one” systems.

Manufacturers of incontinence products are regularly confronted with opposing demands. They may well be concerned with providing better products to deliver better and good quality care to the sufferers but against this is the requirement of care institutions to contain and/or reduce operating costs.

Although some lower performance products are also lower unit costs, the need to use more of them (because of the lower performance) often results either in a significant reduction in the quality of care, or in actual money terms, an increase in costs, or both.

An added complication is that there is no universal agreement on whether or not incontinence sufferers should be able to claim the cost of disposable absorbent products from health service providers, insurance companies or sick funds.

Within Europe EDANA has published a position paper on reimbursement3, which supports the principle of a harmonized reimbursement system.

The Size Of The Problem
rnIn the U.S., national statistics show that over 10 million adult Americans are incontinent. Examination of the data for the over 60’s indicates that:

rn
rn
—22% of men suffer some level of incontinence
rn
rn
rn
—40% of women suffer from some level of incontinence and
rn
rn
—over 50% of the residents in long term care facilities are incontinent.
rn

This accounts for a very large amount of money being expended in the management of incontinence. According to Diane Smith4, in the U.S. in any 24 hour period, $6.8 million is the cost of the 1.4 million staff hours spent changing adult diapers. Another $3.8 million dollars is spent in the same 24 hour period by nursing homes on adult disposable briefs.

In Europe, SCA Hygiene estimates the total number of sufferers at 10 million, of which 7 million suffer from light incontinence.

From Dr. Alan Cottenden2 the estimates are 6% of the population suffering some degree of urinary incontinence and about 1% of adults suffering from fecal incontinence.

A common method of estimating the market size at any one time is to take 5% of the over 65 adult population. Despite the obvious inaccuracies that this method contains, these figures are often used as a guide to new and emerging markets.

Often quoted rates of usage in Europe are 4-5 units per day with an additional more absorbent product at night, making six units per 24 hours. This produces a usage rate of 2190 units per year.

In Euro 15, based on the 1996 data, there are 57,625,000 adults over 65 years of age. Based on 5% of this population total the theoretical requirement could be about 6.3 billion units. EDANA estimates indicate that actual usage at about 4.0 billion, about 63.5% of theoretical.

Because of the number of assumptions made, such calculations are bound to be inaccurate but one factor that cannot be ignored is that by far the biggest percentage of incontinence occurs in older people and in Europe we have an aging population.

Summary
rnIncontinence is an area that has attracted a lot of attention over the past two years. It is a market that has been a long time coming, because over 30 years ago, industry commentators were making the observation that the incontinence market was the next big step forward in the absorbent disposables sector.

At last, real interest has been shown, with the World Health Organization Conference in Germany, the U.K. Department of Health running a campaign about incontinence care and the Royal College of Nursing investing in increased training in this area.

The U.S. Department of Health published advice and recommendations about incontinence for care personnel and private individuals. A number of research centers and nursing and doctor’s associations now have incontinence pages on the Internet.

All this activity indicates that at long last there is less taboo surrounding the topic of incontinence. As we have seen, the incontinence market only goes back in time 25-30 years and before that people were left to solve their incontinence problems with sanitary napkins, baby diapers or other makeshift solutions.

In the case of light incontinence products, we are now entering a “consumer style market,” particularly in Sweden, France, Italy and Germany with TV commercials making increased awareness of the products now available.

Users with heavy incontinence problems account for around 90% of the market and the bulk of this group can now obtain their products, at least within Europe, from the public healthcare system. This is true of both those in institutions and those who are treated at home. This market is growing at 5-6% per annum in Europe.

There has been a constantly improving situation with respect to absorbency and protection against leakage and manufacturers have tried to provide increased safety and comfort for patients and a better working environment for care givers, but there is still a long way to go.

The aim of much of the development work has been concentrated on the need to reduce costs. Research work at York University in the U.K. and the University of Louvain in Belgium has confirmed the major impact that incontinence products have on health economics and the quality of life.

SCA Hygiene, the market leader in Europe, has four major factors in its marketing profile for incontinence products:

rn
rn
—That the products are functional, of high performance and adapted to the various types of incontinence.
rn
rn
rn
—That users receive the product on the advice of medical experts.
rn
rn
rn
—That the company has a monitoring system that can evaluate the costs of use at the individual patient level.
rn
rn
—That the distribution and supply systems are effective with home delivery systems most common.
rn

The institutional costs of incontinence care break down into labor 80%, product costs 10% and washing textile products 10%, so there is some real money to be saved by the use of high performance products.

There is a considerable need for more effective products in the incontinence market. What drives the market is effective product development. It is hoped that in the near term future, truly functional products will evolve to accommodate the ever-increasing needs of incontinence care.

References:

1 Incontinence-The Engineering Chal- lenge, Presentations and Discussions, Institute of Mechanical Engineers Engineering in Medicine Group; 29 September 1995 London.

2 Incontinence-The Engineering Challenge, Dr. Alan Cottenden Report, Institute of Mechanical Engineers meeting; 30 March 1998.

3 EDANA position paper on Reimbursement of Adult Incontinence Absorbent Products; EDANA 30 September 1997.

4 Diane A Smith, “The Current State of Continence Care and Treatment,” IDEA 95 Conference Papers; INDA 25 -27 April 1995 Philadelphia, PA.

About the author: Colin White is a well-known industry consultant and an instructor for EDANA’s absorbent products training course. He can be reached at MCW Technologies, Mulberry House, Langley Gardens, Corby Hill, Carlisle, Cumbria CA4 8PS U.K; 44-1228-564-417; Fax: 44-1228-564-429.