Prevalence of urinary incontinence among the elderly and relationship with physical and mental health indicators

Evaluation of thirst severity, death anxiety, and complementary and supportive therapy use as predictors of urinary incontinence-related quality of life in older adults

PURPOSE

This correlational survey study aimed to evaluate thirst severity, death anxiety, and the use of complementary and supportive therapy as predictors of urinary incontinence-related quality of life in older adults.

METHODS

The study included 368 participants aged 60 or older. Data were collected by face-to-face interviews using a participant information form, the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Visual Analog Scale for thirst severity, Death Anxiety Scale, a modified version of the Mini Mental State Examination, and questions about their use of complementary and supportive therapies.

RESULTS

The participants had a mean age of 70.5 ± 6.9 years (54.9% female). Mean ICIQ-SF score was significantly correlated with daytime frequency of urine leakage and thirst severity score. Multiple linear regression analysis indicated that thirst severity was a significant predictor of urinary incontinence-related quality of life. Most of the older adults said they had never used complementary or supportive therapies for urinary incontinence.

CONCLUSION

Thirst severity should be assessed in older adults with urinary incontinence in addition to other factors that may affect ICIQ-SF scores.

Mixed urinary incontinence: Are there effective treatments?

The aim of this debate article is to discuss whether effective treatments are available for mixed urinary incontinence (MUI). Because patients with MUI have both stress and urgency urinary incontinence (SUI and UUI) episodes and current treatment guidelines currently recommend treating the predominant symptom first, this article presents standard and emerging treatments for both SUI and UUI before discussing how well these treatments meet the medical needs of patients with MUI. Standard treatments presented include noninvasive options such as lifestyle changes and pelvic floor exercises, pharmacological agents, and surgery. Treatment of all three types of urinary incontinence (UI) is usually initiated with noninvasive options, after which treatment options diverge based on UI subtype. Multiple pharmacological agents have been developed for the treatment of UUI and overactive bladder, whereas surgery remains the standard option for SUI and stress-predominant MUI. The divide between UUI and SUI options seems to be propagated in emerging treatments, with most novel pharmacological agents still targeting UUI and even having SUI and stress-predominant MUI as exclusion criteria for participation in clinical trials. Considering that current treatment options focus almost exclusively on treating the predominant symptom of MUI and that emerging pharmacological treatments exclude patients with stress-predominant MUI during the development phase, effective treatments for MUI are lacking both in standard and emerging practice. Ideally, agents with dual mechanisms of action could provide symptom benefit for both the stress and urgency components of MUI.

Urinary incontinence and related quality of life among elderly women in Tabas, South Khorasan, Iran

BACKGROUND

Urinary incontinence (UI) is one of the most common problems in old age that is often seen in women, which causes not only physical problems but also psychological, social, economic problems and poor quality of life. The aim of the present study was to evaluate the UI and related quality of life (QoL) in elderly women.

METHODS

This cross-sectional study enrolled 369 women over 60 years old and living in Tabas city, Iran who were selected by cluster random sampling method. The instruments included the International Consultation on Incontinence Questionnaire-Short Form, the International Consultation on Incontinence Questionnaire Urinary Incontinence Quality of Life Module, and a demographic questionnaire. Data analysis was carried out using independent t-test, chi-square, and logistic regression in SPSS software.

RESULTS

The UI prevalence among participants was 24.9% and stress urinary incontinence was the most common type (40.2% of all elderly patients). The mean UI-related QoL score was 38.04 ± 11.67 from the score range of 22-76. There was a significant positive correlation between UI-related QoL score and UI score (r = 0.585, p < 0.001). Age, body mass index (BMI), constipation, history of cesarean section, hypertension, and the use of angiotensin receptor blockers are factors increasing the odds of having UI in this study population.

CONCLUSION

Aging, some chronic diseases, high BMI, and the use of some drugs are related to UI prevalence. Also, it is associated with lower QOL among elderly women. Designing appropriate intervention programs, controlling chronic diseases, training in the proper use of drugs, and also some physical exercises can be effective in controlling and improving this common syndrome of old age and promoting their QoL.

Efeito da incontinência urinária na autopercepção negativa da saúde e depressão em idosos: uma coorte de base populacional

Resumo Objetivou-se medir a prevalência de autopercepção negativa da saúde e sintomas depressivos em idosos segundo a presença de incontinência urinária, após nove anos de acompanhamento. Trata-se de um estudo de coorte prospectivo de base populacional intitulado Saúde do Idoso Gaúcho de Bagé, no Rio Grande do Sul. Foram entrevistados 1.593 idosos no estudo de linha de base (2008) e 735 entre setembro de 2016 e agosto de 2017. A exposição “incontinência urinária (IU)” foi avaliada no estudo de linha de base e os desfechos “autopercepção negativa da saúde” e “sintomas depressivos” em 2016/17. A razão de odds e o intervalo de confiança de 95% foram calculados com regressão logística bruta e ajustada para variáveis demográficas, sociais, comportamentais e de condições de saúde. A prevalência de IU foi 20,7% em 2008 e 24,5% em 2016/17; a incidência foi de 19,8%, sendo 23,8% entre as mulheres e 14,6% entre os homens (p = 0,009). Idosos com IU no estudo de linha de base apresentaram chances 4,0 (IC95%:1,8-8,8) e 3,4 (IC95%:1,8-6,2) vezes maior de desenvolver autopercepção negativa da saúde e sintomas depressivos, respectivamente, após nove anos de acompanhamento, comparados àqueles sem IU. Os resultados evidenciam maior chance de problemas mentais entre idosos com IU.

Incontinência urinária, senso de controle e autonomia, e participação social em idosos residentes na comunidade

Resumo Objetivo Identificar a presença de sintomas de incontinência urinária (IU) e testar um modelo de associações diretas e indiretas com as variáveis psicossociais senso de controle/autonomia e participação social em idosos residentes na comunidade. Método Estudo transversal, realizado com 419 idosos de 72 anos ou mais (70,2% feminino) participantes das medidas de seguimento do Estudo Fibra-Polo Unicamp. Idade, sexo e escolaridade foram as variáveis sociodemográficas selecionadas como antecedentes das relações entre IU e participação social. Senso pessoal de controle e autonomia foi testado como mediador dessas relações em análise de caminhos via método de equações estruturais (Path Analysis). Resultados A IU foi relatada por 38% da amostra, com diferenças significativas entre os sexos (41% feminino versus 31,3% masculino). Foram propostos três níveis de participação social a partir do grau de envolvimento dos indivíduos com a sociedade. O modelo de associações explicou 15% da variância em participação social. Efeitos diretos foram encontrados entre controle e autonomia e participação social. Efeitos indiretos entre escolaridade e participação foram mediados pela presença de IU. Conclusão IU contribuiu para a restrição em participação social em todos os níveis. Controle e autonomia não se mostrou um mediador psicológico para as relações entre IU e participação, embora associada a ambas variáveis. A presença de IU potencializou as relações desvantajosas entre escolaridade e participação social. Enquanto fatores de natureza modificável, iniciativas clínicas e psicossociais sobre IU podem resultar em diminuição de efeitos psicológicos negativos e redução de desigualdades educacionais em participação social.

Urinary incontinence, sense of control/autonomy and social participation in community-dwelling older adults

Abstract Objective Identify the presence of urinary incontinence (UI) symptoms and test a model of direct and indirect associations with the psychosocial variables sense of control/autonomy and social participation in community-dwelling older adults. Method Cross-sectional study conducted with 419 adults aged 72 years or over (70.2% female) participating in the follow-up survey of the FIBRA Study - Polo Unicamp. Age, sex and educational level were the sociodemographic variables selected as antecedents of the relationship between UI and social participation. A sense of control/autonomy was tested as a mediator of these relationships in a path analysis through structural equation modelling. Results UI was reported by 38% of the sample, with significant differences according to sex (41% female versus 31.3% male). Three levels of social participation were proposed, based on the degree of interaction between the individual and society. The model of relationships explained 15% of the variance in social participation. Direct effects were observed between control/autonomy and social participation; indirect effects between education and participation, mediated by the presence of UI. Conclusion UI contributed to restrictions in social participation at all levels. Control/autonomy, although related, did not prove to be a psychological mediator for the relationship between UI and participation. The presence of UI potentialized the disadvantageous relationships between education and social participation. As modifiable factors, the treatment and management of UI through clinical and psychosocial initiatives can act to reduce negative psychological effects and reduce socioeconomic inequalities in social participation.

Impact of urinary incontinence on physical performance and quality of life (QOL) amongst a group of elderly in Cairo

OBJECTIVES

Urinary incontinence (UI), involuntary loss of urine, is a common disorder affecting the elderly population worldwide. UI can be associated with poor quality of life (QOL) in this vulnerable population, as it limits both physical and social activities of daily living (ADLs). Additionally, it has a psychological and economic burden on individuals, healthcare services and society. This study was conducted to measure the frequency of UI amongst the elderly and determine its impact on the overall QOL, physical performance, and ADLs.

PARTICIPANTS AND METHODS

A cross-sectional study was conducted in four primary healthcare centres in El-Obour City. Data collection was performed weekly on randomly chosen days. All elderly individuals aged 60 or above, who attended the centres on those days, were included.

RESULTS

The overall frequency of UI was 38% amongst the population under study. UI ranged from mild (12.3%) to moderate (57.9%) to severe (29.8%). Amongst incontinent participants, the frequency of UI was 47.4% in men and 52.6% in women. The frequency of stress, urge, mixed and other types of UI were 7%, 33.3%, 40.4% and 19.3%, respectively. Incontinent elderly had significantly lower QOL regarding mental and physical indices than their continental counterparts. UI severity was inversely related to physical performance.

CONCLUSION

UI has a high prevalence rate amongst elderly individuals and significantly affects all aspects of QOL, especially physical performance.

A multidimensional model of healthy ageing: proposal and evaluation of determinants based on a population survey in Ecuador

BACKGROUND

Healthy ageing is a complex construct which involves multiple dimensions. Previous studies of healthy ageing have focused only on measuring the intrinsic capacity of the older person. The objectives of this study were to design a multidimensional model of healthy ageing and to identify its determinants from national data in Ecuador.

METHODS

A cross-sectional analytical study was carried out from the National Survey of Health and Well-being of the Older Adult, 2010. Sample was 1797 adults aged 65 years or more. A multidimensional model was designed based on the World Health Organization's concept of healthy ageing. For the analysis, two groups were created: a healthy ageing and a less healthy ageing group. Bivariate and multivariate logistic regressions were performed to analyze the probability of belonging to the healthy group according to sex, age, area of ​​residence, level of education, perceived health status, perceived life satisfaction, and poverty by income level.

RESULTS

The 53.15% of the sample was classified in the healthy ageing group. Women and the poorest older adults were less likely to be in the healthy ageing group (OR 0.58; 95% CI 0.464-0.737; OR 0.44; 95% CI 0.343-0.564). Older adults with secondary education or higher, who considered their health as excellent and who were satisfied with their life, had a greater probability of being in healthy ageing group (OR 2.61; 95% CI 1.586-4.309; OR 28.49; 95% CI 3.623-224.02; OR 0.23; 95% CI 0.165-0.341).

CONCLUSIONS

This study contributes with a multidimensional approach to healthy ageing. It proposes to evaluate the intrinsic capacity of the individual, the social and political environment and the interaction with it, through indicators that discriminate who are ageing in a healthy way and who are not. By using this model, it was identified that gender and economic situation seem to play an important role on heathy ageing of the Ecuadorian population. Public policies are necessary to promote healthy ageing, especially focused on improving socioeconomic conditions and gender equity.

Epidemiology of Frequent/Urgent Urination in Older Adults in China: A Multicenter, Cross-Sectional Study

Background: Frequent/urgent urination is an event of multifactorial origin where involuntary leakage of urine occurs. Epidemiological study of this condition is of high importance due to its negative impact on the psychological, physical, and social well-being of the victims. Objective: This cross-sectional study aimed to investigate the prevalence of frequent/urgent urination in older adults in China. Method: In this study, a face-to-face questionnaire survey was conducted between April 2019 and August 2019 among 4,796 older adult populations in the communities of Tianjin jizhou and Xiamen jimei of China. Descriptive analysis, univariate regression, and all statistics were conducted in IBM SPSS v22. The count data were analyzed by chi-square test. P < 0.05 was considered statistically significant. Results: In the total investigated population, the prevalence of frequent or urgent urination was found in 1,164 patients (24.3%) where 31.7% (664/2,097) were male patients and 18.7% (500/2,699) were female patients, having a male-to-female ratio of 1.7:1. The prevalence was higher in the 70- to 84-year-old group (men: 33.3-34.8%, women 19.5-20.8%), whereas it was relatively low in the 65- to 69-year-old group and in older adults over 85 years of age (men 28.8, 30.3%, women 16.7, 18.5%, respectively). In terms of the course of the disease, among the population aged 65 years and above, 17.3% men and 9.9% women had frequent urination/urgency lasting for 1-4 years; 5-9 years in about 4.5% population (7.4% men and 4.2% women); 10-19 years in 4.9% men and 2.3% women; and more than 20 years duration in 1.6% men and 1.9% women. On the severity scale, mild frequent/urgent urination was observed in 24.6% of men and 15.4% women of Chinese older adults. Moderate cases were observed in 6.3% of men and 2.9% of women, whereas severe cases were found in 0.8% men and 0.2% women. Benign prostatic hyperplasia (BPH)/hypertrophy was the main risk factor for frequent/urgent urination in Chinese older adult men (P < 0.001). Obesity, hypertension, diabetes, heart disease, anxiety, depression, constipation, and brain injury were the other risk factors for frequent/urgent urination in Chinese older adult men and women. The results of this survey showed that smoking or drinking habits did not increase the prevalence of frequent/urgent urination in Chinese older adults. Conclusions: According to the results of this survey, the prevalence rate of frequent/urgent urination is high, and the course of the disease is long in Chinese older adults. BPH and depression, anxiety, and age-related chronic diseases increase the risk of frequent/urgent urination in Chinese older adults.

Cohort study of ageing from Bagé (SIGa-Bagé), Brazil: profile and methodology

BACKGROUND

The Bagé Cohort Study of Ageing is a population-based cohort study that has recently completed the first follow-up of a representative sample of older adults from Bagé, a city with more than 100,000 inhabitants located in the state of Rio Grande do Sul, Brazil. This is one of the first longitudinal studies to assess the impact of primary health care coverage on health conditions and inequalities. Our aim is to investigate the prevalence, incidence and trends of risk factors, health behaviours, social relationships, non-communicable diseases, geriatric diseases and disorders, hospitalisation, self-perceived health, and all-cause and specific-cause mortality. In addition, we aim to evaluate socioeconomic and health inequalities and the impact of primary health care on the outcomes under study.

METHODS/DESIGN

The study covers participants aged 60 or over, selected by probabilistic (representative) sampling of the urban area of the city of Bagé, which is covered by Primary Health Care Services. The baseline examination included 1593 older adults and was conducted from July 2008 to November 2008. After eight to nine years (2016/2017), the first follow-up was conducted from September 2016 to August 2017. All participants underwent an extensive core assessment programme including structured interviews, questionnaires, cognitive testing (baseline and follow-up), physical examinations and anthropometric measurements (follow-up).

RESULTS

Of the original participants, 1395 (87.6%) were located for follow-up: 757 elderly individuals (47.5%) were re-interviewed, but losses in data transfer occurred for 22. The remaining 638 (40.1%) had died. In addition, we had 81 (5.1%) refusals and 117 (7.3%) losses. Among the 1373 older adults who were followed down, there was a higher proportion of female interviewees (p=0.042) and a higher proportion of male deaths (p=0.001) in 2016/2017. There were no differences in losses and refusals according to gender (p=0.102). There was a difference in average age between the interviewees (68.8 years; SD ±6.5) and non-interviewees (73.2 years; SD ±9.0) (p<0.001). Data are available at the Department of Social Medicine in Federal University of Pelotas, Rio Grande do Sul, Brazil, for any collaboration.

Urinary Incontinence in Physically Active Older Women of Northeast Brazil

Low- and moderate-impact physical activity (PA) is associated with the prevention of urinary incontinence (UI). The objective of the cross-sectional study presented herein is to analyze the factors associated with UI in physically older active women who participate in senior community groups. The variable UI was measured by the International Consultation Incontinence Questionnaire Short Form (ICIQ-SF). Socioeconomic variables were also collected, along with data on life habits and clinical history. The multivariate analysis employed Poisson's Regression with robust variance for factors associated with UI. Of the 106 participants evaluated, 54.7% presented UI, of which stress incontinence was more frequent, with 40.6%. UI presented a statistically significant association with dizziness/loss of balance during Activities of Daily Living (ADL) (prevalence ratio-PR 1.48; 95% CI 1.06-2.07) and nocturia (PR 1.63; 95% CI 1.05-2.55). Despite PA being a protection factor, UI presented an elevated prevalence in the older population, and therefore, other biological, social, and cultural aspects could also contribute to the occurrence of UI in this age group. Moreover, physically active older women with UI presented nocturia and dizziness/loss of balance during ADL, regardless of education levels and the number of births. These findings can help improve multi-professional programs aimed at promoting, preventing, and managing UI in the public.

Health Status and Functional Abilities of Elderly Males Visiting Primary Health-care Centers in Khamis Mushait, Saudi Arabia

Background

There is an aging population all over the world, and Saudi Arabia is no exception to it. An aging population poses several challenges to the health-care sector.

Aim

The aim of this study was to examine the health status and functional abilities of elderly people visiting primary health-care centers in Khamis Mushait, Saudi Arabia.

Methods

This cross-sectional study involved elderly male Saudi nationals aged 60 years and above. Self-rated health status and body pain, functional status, geriatric review of systems and other relevant data were collected using the Geriatric Health Questionnaire of University of Iowa Health Care. All statistical analyses were performed using SPSS version 21.

Results

The study results showed that the overall health of the elderly was either good (32.9%) or very good (32.3%), while 14.2% rated their health as excellent. Only two participants rated their health as poor. The majority of the participants (71.9%) had no functional impairment in basic activities of daily living (BADL), while 35.7% had mild impairment in instrumental activities of daily living (IADL). Only two participants were found to have total impairment in IADL. The most common limitation among BADL was walking (21.1%) and among IADL was doing the housework. The notable factors associated with functional impairment in BADL and IADL were old age (≥80 years), poor eyesight, memory impairment, having trouble with control of bladder, falls twice or more, taking more than two medications, being sexually inactive, poor self-rated general health and severe self-rated body pain (all P<0.05) among others.

Conclusion

The majority of the elderly were able to perform BADL independently and to a lesser extent IADL; the overall self-rated general health was found to be good. Further research in the field of geriatrics is warranted to plan better, and design public health policies and provide efficient care to elderly patients.

Características sociodemográficas e clínicas em nonagenários e centenários com e sem incontinência urinária

Objetivos: analisar as características sociodemográficas e clínicas em indivíduos nonagenários e centenários com e sem incontinência urinária. Métodos: trata-se de um estudo transversal e analítico, envolvendo 234 nonagenários e centenários avaliados nos seus domicílios, que foram aleatoriamente selecionados na cidade de Porto Alegre, RS. A presença de incontinência foi avaliada com relação às características clínicas e sociodemográficas cujas associações foram testadas pelo qui-quadrado e as diferenças nas médias testadas pelo t de Student usando o Programa Epi Info. Resultados: a prevalência de incontinência urinária foi de 56,41%, sendo 63,53% entre as mulheres e 37,5% entre os homens (p=0,0003). A relação entre presença de perda de urina e de estado conjugal foi significativa (p=0,0049), com maior frequência entre os viúvos. Os incontinentes saíam menos de casa, participavam menos de atividades físicas e sociais, tinham maior número de doenças crônicas e sintomas depressivos e pior pontuação na avaliação cognitiva. Em relação aos sintomas urinários, a maioria dos incontinentes referiu que a urina ou bexiga atrapalha a sua vida (p<0,0001) e, que a urina ou bexiga, causa embaraço (p<0,0001). Entre os participantes continentes, 25% relatou que a urina ou bexiga atrapalha a sua vida. Conclusões: a incontinência urinária foi mais frequente entre mulheres, participantes mais velhos, viúvos e indivíduos que moravam sozinhos. Apesar de maior prevalência entre as mulheres, chama atenção uma prevalência importante entre os homens. Ao fim, concluímos que a incontinência urinária impacta diretamente na vida social e na saúde de nonagenários e de centenários. Então, a incontinência urinária deve ser um importante componente na avaliação desse grupo. Observamos, também, que um número importante de nonagenários e de centenários apresentam incômodos relacionados à urina, mesmo sem incontinência urinária.

Incontinência urinária em idosos da estratégia saúde da família: prevalência e fatores de risco

Objetivos: determinar a prevalência da incontinência urinária (IU) e a sua relação com aspectos sociodemográficos, antropométricos, funcionais e clínicos em idosos da Estratégia Saúde da Família de Porto Alegre/RS (ESF/POA).Métodos: estudo transversal analítico, coletado prospectivamente em amostra aleatória (30 unidades da ESF/POA). Foram coletados dados sociodemográficos, antropométricos e de saúde, sendo aplicados o Questionário Minessota de atividades físicas e de lazer, o Miniexame do Estado Mental, a Escala de Silhuetas de Stunkard (imagem corporal) e testes funcionais (Senta/Levanta, força de preensão manual e velocidade de caminhada).Resultados: foram estudados 575 idosos (68,9±7,1 anos; mulheres= 64,35%) dos quais 33,04% relataram IU (mulheres= 69,5%). Foram estimados como fatores de risco para a IU: menor escore do Miniexame (OR= 0,939; p= 0,033; IC95%= 0,887– 0,995); presença de prejuízo cognitivo (OR= 1,625; p= 0,010; IC95%= 1,351– 3,113); velocidade de caminhada mais lenta (OR= 1,160; p= 0,016; IC95%= 1,028– 1,309); e menor escore no teste Senta/Levanta (OR= 0,013; p= 0,874; IC95%= 0,712 – 0,932). Quedas, atividade física, satisfação com a imagem corporal e ingestão medicamentosa não apresentaram associação significativa com a IU.Conclusão: nessa amostra, foi alta a prevalência da IU. Apresentar menor força de membros inferiores, menor velocidade de caminhada e prejuízo cognitivo foram identificados como fatores de risco para a incontinência, todos modificáveis.