Urinary incontinence: basic evaluation and management in the primary care office

Urinary incontinence among urban and rural community dwelling older women: prevalence, risk factors and quality of life

Background

Urinary incontinence (UI) is known to be more prevalent among women and is associated with decline in quality of life. The aim of our study was to investigate the prevalence, risk factors of urinary incontinence and its impact on quality of life among community dwelling older women living in urban and rural populations.

Methods

This study was conducted based on secondary data analysed from the third phase of the longitudinal study “Neuroprotective Model for Health Longevity among Malaysian Elderly” (LRGS TUA). Stratification of urban and rural study areas were in accordance to that determined by the Department of Statistics. A total of 814 community dwelling older women (53% urban, 47% rural), aged 60 years and above, across four states within Peninsular Malaysia were included in this analysis. Interview-based questionnaires were used to obtain respondents’ sociodemographic details and clinical characteristics. The Timed Up and Go test and Handgrip Strength tests were used to assess physical function. Urinary incontinence was self-reported, and quality of life of those with incontinence was assessed using the King’s Health Questionnaire (KHQ).

Results

Prevalence of urinary incontinence was 16% and 23% among older women living in urban and rural areas, respectively. Ethnicity was significantly associated with incontinence among older women in both urban and rural population (p < 0.05). Chronic constipation, functional mobility and muscle strength were associated with UI in participants from rural setting (p < 0.05). Binary logistic regression analysis showed that risk of incontinence is lower among Chinese [OR 0.430, 95% C.I: 0.224–0.825, p = 0.011] compared to Malay older women living in urban population. Within the rural population, respondents with chronic constipation [OR: 3.384, 95% C.I: 1.556–7.360, p = 0.002] were found to be at a higher risk of UI. In terms of quality of life, respondents in rural areas experienced more role, physical, social, emotional limitations and sleep disturbance as compared to their urban counterparts (p < 0.05).

Conclusion

UI is more prevalent and had a more profound impact on quality of health among older women in the rural setting. The risk factors of UI were ethnicity and chronic constipation among urban and rural older women respectively. It is important to provide holistic strategies in the prevention and management of UI among older women especially within the rural population.

Diagnosis and office-based treatment of urinary incontinence in adults. Part one: diagnosis and testing

Urinary incontinence is a common problem in both men and women. This review article addresses its prevalence, risk factors, cost, the various types of incontinence, as well as how to diagnose them. The US Preventive Services Task Force, the Cochrane Database of Systematic Reviews, and PubMed were reviewed for articles focusing on urinary incontinence. Incontinence is a common problem with a high societal cost. It is frequently underreported by patients so it is appropriate for primary-care providers to screen all women and older men during visits. A thorough history and physical examination combined with easy office-based tests can often yield a clear diagnosis and rule out other transient illnesses contributing to the incontinence. Specialist referral is occasionally needed in specific situations before embarking on a treatment plan.

Comorbidity, health status, and quality of life in institutionalized older people with and without dementia

BACKGROUND

Comorbidity in older adults may lead to lower perceived health status and a decrease in quality of life (QoL). The objective of this study is to analyze the relationship between comorbidity, health status, QoL, and dementia in institutionalized older adults.

METHODS

Cross-sectional, multicenter study in residential care settings in Spain. Two groups of institutionalized older adults of 60 years of age and older were compared: 234 persons with normal cognitive function and 525 with dementia according to DSM-IV-TR criteria. Assessments included: sociodemographic questionnaire, EQ-5D index for health-related QoL, Visual Analogue Scale (EQ-VAS) for health status, number of chronic medical conditions (comorbidity), Barthel Index for functional independence, and Short Portable Mental Status Questionnaire.

RESULTS

The group with dementia presented significantly worse QoL, health, and functional status than people without dementia. The most prevalent chronic medical conditions were musculoskeletal (72.3%), followed by genito-urinary disorders (60.2%). Controlling for age and sex, people with dementia and higher comorbidity exhibited lower EQ-VAS scores; however, no significant difference was found for the EQ-5D index. The health conditions that contributed the most to the EQ-VAS differences between the dementia and non-dementia groups were sight, oral, and genito-urinary problems.

CONCLUSIONS

When compared to older adults with no dementia, people with dementia and high comorbidity reported the most compromised health status, especially in those with sight, oral, and genito-urinary problems. These differences should be taken into consideration when selecting strategies to maintain and improve the health status of older adults in residential care settings.

Frequency of urinary incontinence in people with chronic heart failure

OBJECTIVES

The purpose of the study was to examine the frequency and severity of urinary incontinence in people with heart failure (HF). Secondary aims were to determine the differences in known risk factors for those who were continent and incontinent, to investigate the correlates of urinary incontinence in people with HF, and to examine the relationship between urinary incontinence with medication adherence, in particular, diuretics, and quality of life.

BACKGROUND

Urinary incontinence is a common condition affecting older adults. However, the frequency of incontinence in people with HF remains largely unknown.

METHODS

This was a descriptive study. A convenience sample of 181 people with HF were surveyed to determine frequency, severity and presence of risk factors of urinary incontinence and dosages of prescribed HF medications. Instruments included the Revised Urinary Incontinence Scale, Medication Adherence Report Scale and Incontinence Impact Questionnaire Short Form. Regression analyses were used to examine relationships between variables and presence of urinary incontinence.

RESULTS

Eighty-nine people responded (66% male, mean age 67 years), 44 (49%) self-reporting urinary incontinence. Of these, 30 (34%) respondents rated their incontinence severity as slight or moderate. More incontinent respondents took furosemide doses greater than 20 mg daily (P = 0.046) and low doses of beta-blockers compared with continent respondents (P = 0.002). Taking low doses of beta-blockers explained 23% of variance for urinary incontinence (r(2) = 0.23, P = 0.015). Incontinent respondents reported altering or missing a diuretic dose (P < 0.02) compared with those who were continent.

CONCLUSIONS

Frequency of urinary incontinence in this group of people with HF appears high. It appears that screening for urinary incontinence may be important as part of routine care in HF management programmes. In addition, awareness of dosages of furosemide and beta-blockers and in particular, adherence to diuretics also should be monitored. Prospective studies investigating these issues and the effect of targeted interventions are required.

Activities of daily living in Greek cancer patients treated in a palliative care unit

GOALS OF WORK

To assess the psychometric properties of the Activities of Daily Living (ADL) scale on a Greek sample of advanced cancer patients.

PATIENTS AND METHODS

The scale was translated with the forward-backward procedure to Greek. The ADL scale was administered to 136 advanced cancer patients. It was administered twice, with a 3-day interval, to 40 (of the 136) eligible patients with advanced cancer to assess the scale's stability. For the assessment of treatment effect, the index was administered to 90 (of the 136) patients 15 days later. Together with the ADL scale, the patients also completed the Instrumental Activities of Daily Living (IADL) scale. Confirmatory factor analysis was carried out using the AMOS 7.0 analysis. The reliability was assessed by the internal consistency (Cronbach's alpha co-efficients), and test/retest (Spearman's r value) of the instrument. Validity was assessed with construct validity using the IADL scale, treatment-effect, known groups, and convergent validity.

MAIN RESULTS

The homogeneity of the scale proved to be satisfactory (cronbach alpha = 0.88). Overall test-retest reliability was satisfactory. Construct validity has shown satisfactory correlations with IADL p < 0.0005. Convergent validity and treatment effect were satisfactory at p < 0.0005 and p < 0.05, respectively. Known groups validity detected differences according to patient's performance status (p < 0.0005).

CONCLUSIONS

The results suggest that the Greek version of ADL administered in cancer patients treated in a palliative care unit is a reliable and valid clinical instrument.

Urinary Incontinence Evaluation and the Utility of Pessaries in Older Women

Urinary incontinence and pelvic organ prolapse are common conditions affecting the elderly. A careful evaluation of urinary incontinence, including history and physical examination, will often determine the etiology of this condition. Vaginal pessaries are a safe and effective treatment for both urinary incontinence and pelvic organ prolapse. They should be considered a viable alternative to surgery especially in the elderly with complicated medical histories. This article reviews the etiology of urinary incontinence, offers a guide in the evaluation of the incontinent woman, and reviews the use of pessaries for the treatment of incontinence and pelvic organ prolapse.