Prevalence rate of urinary incontinence in community-dwelling elderly individuals: the Veneto study

Severity of fecal incontinence in community-living elderly in a health maintenance organization

An anonymous survey containing questions about the severity of fecal incontinence (FI)--frequency, amount, and type--and its correlates was distributed to community-living elderly at four managed-care clinics. Completed surveys were received from 1,352 respondents whose mean (+/-standard deviation) age was 75 +/- 6 years and 60% of whom were female. Approximately 19% reported having FI one or more times within the past year. Incontinence that soiled underwear or was of loose or liquid consistency was most common. More frequent FI and a greater amount of FI were significantly associated with loose or liquid stool consistency, defecation urgency, bowel surgery, and chronic health conditions. Therapies aimed at normalizing stool consistency or reducing urgency may be beneficial in lessening FI severity.

Symptoms of urinary and faecal incontinence among men and women 75+ in relations to health complaints and quality of life

AIMS

The aim was to investigate the prevalence of self-reported symptom of urinary, faecal, and double incontinence (UI, FI, and DI) in men and women 75+ and to identify how other health complaints and Quality of Life (QoL) relate to incontinence symptoms.

METHODS

A randomised sample, stratified for age, of eligible men and women from the population were included in the study and 4,277 out of 8,500 completed a postal questionnaire (61.6% women). The questions focused on difficulties in controlling urine and faeces, other health complaints, socio-economic background, and social relations.

RESULTS

Among all respondents 39% reported symptom of UI (more so among women P < 0.001), symptom of FI in 16.9% (ns between sexes), DI, i.e., a combination of UI and FI, was reported among 14.5% (ns between sexes). Incontinence increased with age, and persons reporting incontinence also had significantly more of all other health complaints compared with persons without incontinence. Those reporting DI comprised an especially vulnerable group. Health complaints associated with UI were communicative and mobility problems, other urinary complaints, dizziness, cough, and fatigue. FI was associated with diarrhoea, stomach pain, fatigue, and other pain. Risk factors for DI were diarrhoea, communication, and mobility problems.

CONCLUSIONS

UI and FI were common among elderly men and women and increased with age. Furthermore, incontinence was associated with many other co-existing health complaints, and the most frail were those with DI.

Indwelling urethral catheter and mortality in frail elderly women living in community

AIM

Urinary incontinence is one of the most common, disruptive and often disabling conditions affecting frail older people living in community. The aims of present study were to describe the prevalence of bladder catheter in a population of older women living in community and to examine the relationship between urinary catheter and mortality.

METHODS

This was an observational cohort study. We analyzed data from the Italian Silver Network Home Care project that collected data on patients admitted to Home Care programs. A total of twelve Home Health Agencies participated in such project evaluating the implementation of the Minimum Data Set for Home Care (MDS-HC) instrument. A total of 1,004 women were enrolled in the present study. The main outcome measures were prevalence of bladder catheter and 1-year survival according to catheterization.

RESULTS

The prevalence of incontinent patients with bladder catheter was 38.1%. Incontinent patients with indwelling bladder catheter did not show significant difference for age and comorbidity while they showed a significant higher level of physical and functional impairment, as expressed by higher score in activities of daily living (ADL) scale (6.5 +/- 1.3 vs. 5.5 +/- 2.2, P < 0.001) and higher prevalence of sensory impairment, pressure ulcers (44% vs. 12%, P < 0.001), and urinary tract infections (21% vs. 10%, P < 0.001). After adjusting for age and for all the variables significantly different between catheterized and not-catheterized subjects at baseline, subjects with indwelling bladder catheter were more likely to die compared to those without catheter (RR, 1.44; 95% CI 1.01-2.07).

CONCLUSIONS

Catheterization has an important prognostic implication for frail old women living in the community, independent of age and other clinical and functional variables. A failure in decreasing the unnecessary bladder catheter use and the duration of catheterization among frail incontinent women should be considered an indicator of poor quality of care.

[Prevalence of urinary incontinence and linked factors in men and women over 65]

OBJECTIVES

To calculate the prevalence of urinary incontinence and to identify linked factors in a population of elderly people living in their homes.

DESIGN

Population survey.

SETTING

Leganés (Madrid).

PARTICIPANTS

Representative sample of people over 65 registered in Leganés (n=1560). Two interviews at home were conducted. The second interview included a medical examination. The reply rate was 75% (n=1150).

MAIN MEASUREMENTS

Frequency of involuntary losses of urine and use of medication and absorbents, health status, use of diuretics and oxybutinin, and demographic and social variables.

RESULTS

The prevalence of urinary incontinence was 14% (95% CI, 11%-17%) in men and 30% (95% CI, 26%-34%) in women. Advanced age was associated with greater prevalence in men but not in women. In the multivariate analysis, factors associated with urinary incontinence were comorbidity and cognitive deficit. In addition, in women, high Body Mass Index and seriously limited movement were added factors. 20% of women and 5% of men over 65 used absorbents. The use of diuretics and the low number of patients receiving specific treatment for urinary incontinence suggested that there was low detection of this problem.

CONCLUSIONS

Urinary incontinence is common and could be better detected and treated in primary care. Prevention of urinary incontinence in women should begin before old age.

Epidemiology and natural history of urinary incontinence in women

Understanding the epidemiology (distribution and determinants) of urinary incontinence (UI), as well as its natural history is a very important issue. In this article, we discuss prevalence, incidence, natural history, and the variations that may be related to race and ethnicity. We focus on epidemiologic population comprising community-dwelling women who are not institutionalized. Our review clearly shows that there is a lack of advanced epidemiologic analyses. Variables that better characterize UI include frequency measure, quantity of urine loss, duration, type, and severity. These factors should be incorporated into basic study design so that more advanced and informative analyses may be conducted.

Do older men benefit from curative therapy of localized prostate cancer?

PURPOSE

Prior decision-analytic models are based on outdated or suboptimal efficacy, patient preference, and comorbidity data. We estimated life expectancy (LE) and quality-adjusted life expectancy (QALE) associated with available treatments for localized prostate cancer in men aged >/= 65 years, adjusting for Gleason score, patient preferences, and comorbidity.

METHODS

We evaluated three treatments, using a decision-analytic Markov model: radical prostatectomy (RP), external beam radiotherapy (EBRT), and watchful waiting (WW). Rates of treatment complications and pretreatment incontinence and impotence were derived from published studies. We estimated treatment efficacy using three data sources: cancer registry cohort data, pooled case series, and modern radiotherapy studies. Utilities were obtained from 141 prostate cancer patients and from published studies.

RESULTS

For men with well-differentiated tumors and few comorbidities, potentially curative therapy (RP or EBRT) prolonged LE up to age 75 years but did not improve QALE at any age. For moderately differentiated cancers, potentially curative therapy resulted in LE and QALE gains up to age 75 years. For poorly differentiated disease, potentially curative therapy resulted in LE and QALE gains up to age 80 years. Benefits of potentially curative therapy were restricted to men with no worse than mild comorbidity. When cohort and pooled case series data were used, RP was preferred over EBRT in all groups but was comparable to modern radiotherapy.

CONCLUSION

Potentially curative therapy results in significantly improved LE and QALE for older men with few comorbidities and moderately or poorly differentiated localized prostate cancer. Age should not be a barrier to treatment in this group.

Cognitive impairment, physical disability and depressive symptoms in older diabetic patients: the Fremantle Cognition in Diabetes Study

OBJECTIVE

To determine whether the prevalence of dementia, depression and/or disability in older diabetic subjects warrants an active screening approach by diabetes health care workers.

PATIENTS AND METHODS

The initial 223 members of a cohort of 529 eligible diabetic subjects, aged 70 years or over, were screened for cognitive impairment (using the Mini-Mental State Examination (MMSE) and Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE)), physical impairments and depressive symptoms.

RESULTS

Virtually all subjects were community-dwelling (99%) and mobile (86%) and relatively few had moderate or severe deficits in activities of daily living (ADL) (17.5%). The prevalences of cognitive impairment and probable dementia estimated from the screening tests were high (range 10.8-17.5%) compared with population studies. Any deficit with ADL was reported by 53% of the subjects and common problems included urinary and faecal incontinence. Scores consistent with clinical depression were reported by 14.2% of the sample but 50.2% of the remainder reported one or more depressive symptoms below the cut-off point for clinical depression. Only 36% of the study subjects were free of deficits in any domain.

CONCLUSIONS

Community-living older diabetic subjects have high rates of cognitive impairment, deficits in physical function and depressive symptomatology suggesting that screening programs for functional impairments and depression may be beneficial in health care systems that manage older diabetic patients.

Urgency and urge incontinence in an older population: ten-year changes and their association with mortality

BACKGROUND AND AIMS

Urgency and urge incontinence are common urinary symptoms among older people, both men and women. The aim of this population-based prospective cohort study was to examine the independent association of urgency and urge incontinence with 10-year mortality in older men and women, and to describe the changes in these symptoms during those 10 years.

METHODS

At baseline, 1052 persons (524 men and 528 women) aged 60-89, selected by random sampling and stratified by 5-year age group and sex, were interviewed for the Tampere Longitudinal Study on Ageing. In 10 years, 541 persons had died, and 435 persons (175 men and 260 women) were re-interviewed. Cox proportional hazards models were used to examine the independent association of urgency and urge incontinence in each gender with 10-year mortality, adjusted for age, chronic diseases, activities of daily living (ADL) disability, socioeconomic status, smoking and alcohol use.

RESULTS

In 10 years, 86% of men and 54% of women who reported at least urgency at baseline had died. The respective figures for men and women without urgency were 57 and 38%. Adjusted for age, both urgency without incontinence (Risk Ratio 1.87; 95% Confidence Interval 1.28-2.74) and urge incontinence (RR 3.13; 95% CI 2.054.77) significantly predicted mortality in men, while only urge incontinence was a statistically significant predictor in women (RR 1.63; 95% CI 1.03-2.57). After further adjusting for chronic diseases and ADL disability, urge incontinence lost its predictive power (RR 1.44; 95% CI 0.88-2.23) in women, while the significant predictive power of urgency alone and urge incontinence in men persisted even after additional adjustment for socioeconomic status, smoking and alcohol use (RR 1.80; 95% CI 1.20-2.71, and RR 1.97; 95% CI 1.25-3.10, respectively).

CONCLUSIONS

Urgency and urge incontinence are significant prognostic indicators of mortality especially in older men. This emphasizes the importance of evaluation and treatment of urinary symptoms as a part of comprehensive geriatric assessment and management.

Vitamin B(12) deficiency and incontinence: is there an association?

BACKGROUND

This study investigated the relationship between B(12) (cobalamin) levels and incontinence in older outpatients using secondary data analysis.

METHODS

Between 1991 and 1999, there were 929 patients (258 men and 671 women) for whom urinary incontinence (UI), fecal incontinence (FI), and B(12) were prospectively recorded. Covariates included race, gender, age, medications, Mini-Mental State Examination, modified illness rating, and instrumental activities of daily living (IADLs).

RESULTS

Some form of incontinence (UI or FI or both) was found in 41% of subjects, isolated UI in 34%, double incontinence (DI) in 12%, and isolated FI in 4%. Having UI increased the risk of also having FI (p <.0001). Serum B(12) levels of 300 pg/ml or less were not predictive of isolated UI or isolated FI. However, in logistic regression, DI was predicted by B(12) (odds ratio [OR] = 2.113, p =.0094), IADLs (OR = 0.810, p <.0001), cathartics/laxative use (OR = 1.902, p =.126), and diuretic use (OR = 2.226, p =.006). Considering isolated UI in women, higher IADLs reduced risk of UI (OR = 0.956, p =.002), while diuretics (OR = 1.481, p =.041) and antihistamines (OR = 1.909, p =.046) both increased risk of UI. In men, only use of anticonvulsant medications (OR = 4.529, p =.023) increased risk of isolated UI. Greater physical illness in both genders increased risk of isolated FI (OR = 1.204, p =.006).

CONCLUSIONS

These findings suggest that serum B(12) at levels of 300 pg/ml or less are not associated with isolated UI or isolated FI but may play a role in DI. A possible association of low B(12) levels with DI is intriguing because of the implications for treatment and prevention. More immediately, medication side effects should be considered when evaluating this problem.