Urinary incontinence and sleep complaints in community dwelling older adults

Impact of Lifestyle on Urinary Incontinence Severity among Women: A Cross-Sectional Study in East China

INTRODUCTION AND HYPOTHESIS

Identifying the factors influencing the development of female urinary incontinence (UI) may facilitate early intervention, potentially delaying its progression. This study was aimed at investigating the impact of lifestyle habits on the severity of UI among women in East China.

METHODS

This study included 414 women from six communities in East China who reported symptoms of UI and was conducted between September and December 2020. Data were collected using a general information questionnaire, the Toileting Behaviours: Women's Elimination Behaviours scale, and the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form Chinese Version. Participants were categorised into two groups: those with mild UI and those with moderate-to-severe UI. Propensity-score matching was performed to balance confounding factors, and logistic regression was used to explore the relationship between lifestyle behaviours and UI severity.

RESULTS

A total of 117 pairs were successfully matched. Logistic regression analysis revealed that daily perineal cleaning significantly protected against moderate-to-severe UI (p < 0.05). Conversely, living alone, poor sleep quality and hovering over the toilet while voiding were identified as independent risk factors for moderate-to-severe UI (p < 0.05).

CONCLUSION

Several lifestyle habits significantly impact the severity of UI among adult women. Screening for mild urinary leakage symptoms and implementing timely interventions are crucial for preventing the aggravation of UI and improving ability to work and quality of life.

Exploring older care recipients' sleep status as a predictor for informal carer distress: evidence from New Zealand's interRAI home care assessment data

OBJECTIVES

Understanding factors affecting informal carers' well-being is important to support healthy ageing at home. Sleep disturbances of care recipients are increasingly recognised as affecting the well-being of both parties. This research assesses the relationship between indicators of care recipients' sleep status and carer distress, as well as carer distress with subsequent admission to residential aged care, using prospectively collected Home Care International Residential Assessment Instrument (interRAI-HC) assessment data.

PARTICIPANTS

Data were sourced from 127 832 assessments conducted between 2012 and 2019 for people aged 55 years or older who had support from at least one informal carer. The majority (59.4%) of care recipients were female and 59.1% were defined as having cognitive impairment or dementia (CIoD).

SETTING

New Zealand.

DESIGN

Logistic regression modelling was used to assess the independent relationships between indicators of care recipients' sleep status (difficulty sleeping and fatigue) and primary caregivers' distress (feeling overwhelmed or distressed). Kaplan meier curves illustrated the subsequent relationship between caregiver distress and care recipients' transitions to aged residential care.

RESULTS

Care recipients' sleeping difficulty (32.4%) and moderate-severe fatigue (46.6%) were independently associated with caregiver distress after controlling for key demographic and health factors included in the assessment. Distress was reported by 39.9% of informal caregivers and was three times more likely among those supporting someone with a CIoD. Caregiver distress was significantly associated with care recipients' earlier admission into aged residential care.

CONCLUSIONS

Indicators of sleep disturbance among care recipients are associated with increased likelihood of carer distress. This has implications for managing the overall home-care situation and long-term care needs, as well as the well-being of both parties. Findings will inform research and development of measures, services and interventions to improve the sleep and waking health of older people, including those with CIoD and family caregivers.

Urinary Incontinence in Older Adults: Impact on Caregiver Burden

The objective of the current descriptive, cross-sectional, and relationship-seeking study was to evaluate the severity of urinary incontinence (UI) in older adults and its impact on care burden of their family caregivers. This study was performed prospectively with 80 older adults (aged ≥65 years) with UI and their family caregivers who attended a urology clinic between June and December 2021. UI was assessed using the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI-SF), and caregiver burden using the Zarit Burden Interview (ZBI). Increase in care time was associated with higher burden of care (p = 0.018). Post-hoc analyses suggested that caregivers' burden of care gradually increased up to the first 9 months. Daily care time >9 hours had a higher burden compared to care times <9 hours (p < 0.001). Mean ZBI score of caregivers was 41.47 (SD = 10.18) and mean ICIQ-UI-SF score of older adults was 15.02 (SD = 3.9). A significant correlation was observed between increased ICIQ-UI-SF scores of older adults and ZBI scores of caregivers (r = 0.354, p = 0.001). Caring for older adults with UI is associated with a significant burden of care and an increase in severity of UI is associated with increased burden of care. Female sex, lower educational level, presence of comorbidities, increased care time, and daily care hours were factors associated with increased burden of care among caregivers. [Journal of Gerontological Nursing, 49(4), 39-46.].

Factors associated with poor sleep quality in midlife Singaporean women: The Integrated Women's Health program (IWHP)

Objective

To examine factors associated with poor sleep quality in community-dwelling midlife women.

Methods

Healthy women (aged 45-69 years) of Chinese, Malay and Indian ethnicities attending well-women clinics at the National University Hospital, Singapore, completed the Pittsburgh Sleep Quality Index (PSQI). A PQSI score >5 denoted poor sleep quality. The women filled out validated questionnaires covering menopausal and genito-urinary symptoms, and mental health. Physical performance was measured. Bone mineral density and visceral adiposity were assessed by dual energy X-ray absorptiometry. Binary logistic regression analyses assessed independent factors for poor sleep.

Results

Poor sleep quality was reported in 38.2% of women (n = 1094, mean age: 56.4 ± 6.2 years). Indian women had higher sleep disturbance scores than Chinese women (mean ± SD: 1.33 ± 0.58 vs 1.17 ± 0.49). Malays experienced more daytime dysfunction (0.54 ± 0.60 vs 0.33 ± 0.55) and had a higher overall PSQI score (6.00 ± 3.31 vs 5.02 ± 2.97) than the Chinese. A low education level (aOR: 1.76, 95% CI: 1.01-3.05), feelings of irritability (2.67, 1.56-4.60) and vaginal dryness (1.62, 1.03-2.54) were associated with poor sleep quality in the adjusted multivariable model. Women with moderate to severe disability were ∼3 times (2.99, 1.20-7.44) more likely to experience less than ideal sleep quality, while urinary incontinence (1.53, 1.08-2.17) and breast cancer history (2.77, 1.36-5.64) were also associates of poor sleep quality.

Conclusion

Self-reports of education level, irritability, vaginal dryness, disability, urinary incontinence, and breast cancer history were independently related to poor sleep. Ethnic differences suggest the need for targeted interventions among the ethnic groups.

Urinary Incontinence and Sleep Quality in Older Women with Type 2 Diabetes: A Cross-Sectional Study

BACKGROUND

Urinary incontinence (UI) and poor sleep negatively affect health-related quality of life (HRQoL). This study explored the UI-related factors and the relationships between UI, sleep quality, and HRQoL.

METHODS

This cross-sectional study collected data from 237 women with type 2 diabetes. Multivariate logistic regression was conducted to identify the factors associated with UI. One-way analysis of variance was used to compare the mean sleep quality and HRQoL scores of women without UI and those who experienced UI of varying severities. Correlation coefficients were estimated, and multivariate linear regression was conducted to examine the relationships between UI severity, sleep quality, and HRQoL.

RESULTS

Of the 237 women, 115 (48.52%) experienced UI and 139 (58.65%) were poor sleepers. The three factors associated with UI were advanced age, a higher body mass index, and a history of vaginal delivery. Significant associations between UI severity and sleep quality and between sleep quality and HRQoL were revealed. UI severity and night-time voiding frequency were both associated with sleep quality.

CONCLUSIONS

One factor associated with UI (body mass index) is modifiable. UI severity is associated with sleep quality as the possible influence of night-time voiding frequency on sleep quality has been considered.

Do levels of self-efficacy affect urinary incontinence, falls, quality of life, sleep, and physical activity in elderly people with urinary incontinence?

BACKGROUND

Our study aims to determine whether different self-efficacy (SE) levels affect urinary incontinence symptoms, falls, quality of life, sleep, and physical activity in elderly individuals with incontinence. Our secondary aim is to examine the relationship between SE levels and urinary incontinence severity, quality of life, sleep status, fear of falling, and physical activity level.

METHODS

One hundred twenty elderly individuals (median age: 71 years) with urinary incontinence participated in the cross-sectional study. Participants were divided into 3 groups as levels of low, moderate, and high according to their Geriatric SE Index for Urinary Incontinence (GSE-UI). Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), Incontinence Quality of Life Scale (I-QOL), Pittsburgh Sleep Quality Index (PSQI), Fall Efficacy Scale (FES), Rapid Assessment Physical Activity (RAPA), and International Physical Activity Questionnaire Short Form (IPAQ-SF) assessments associated with incontinence were performed. Data were analyzed using Mann-Whitney U, Kruskal-Wallis tests, and Spearman's correlation.

RESULTS

A significant difference was found in UDI-6, IIQ-7, I-QOL, and FES belonging to three groups according to GSE-UI levels (p ˂0.01, p ˂0.01, p ˂0.01). It was determined that the group with low GSE-UI level had the highest incontinence symptoms, fear of falling, and the lowest quality of life statistically significant. A negative moderate significant correlation was found between GSE-UI scores and UDI-6 (r: - .67, p ˂0.01), IIQ-7 (r: - .67, p ˂0.01), and FES (r: - .46, p ˂0.01).

CONCLUSION

In elderly individuals with urinary incontinence, the level of SE may affect incontinence symptoms, severity, fear of falling, and quality of life and may be an important factor for incontinence. An increased level of SE may lead to positive effects on the user interface. Further studies in this field are needed.

Prevalence and Risk Factors of Urinary Incontinence Among Elderly Adults in Rural China: A Cross-Sectional Survey

PURPOSE

The purpose of this study was to explore the prevalence of urinary incontinence (UI) and several subtypes: (stress, urge, and mixed UI) and the influence of multiple factors on the likelihood of UI.

DESIGN

Epidemiological study based on cross-sectional data collection.

SUBJECTS AND SETTING

The sample comprised 1279 inhabitants 65 years and older residing in 10 villages randomly selected from the Shanxi province, located in North China.

METHODS

The presence and types of UI were assessed using the International Consultation of Incontinence Questionnaire-Short Form. Sociodemographic parameters were also recorded, along with data on lifestyle, bowel function, and medical conditions. The Activity of Daily Living Scale and Mini-Mental State Examination instruments were used to evaluate physical and cognitive functions, respectively. A multivariate logistic regression model with the backward method was employed to identify factors associated with UI.

RESULTS

The prevalence of any UI among the rural Chinese elderly 65 years and older was 46.8%, with a female predominance (56.3% in females vs 35.0% in males). The most common incontinence subtype in women was mixed UI (n = 170, 24.0%), followed by stress UI (n = 131, 18.5%) and urge UI (n = 97, 13.7%). The most prevalent form of UI in males was urge UI (n = 190, 33.2%), followed by stress UI (n = 5, 0.9%) and mixed UI (n = 5, 0.9%). Less than one quarter of respondents (17%, n = 102) of participants with UI had consulted a doctor. Multivariate analysis found that poorer physical function, poor quality of sleep, and fecal incontinence were common factors associated with UI in both women and men. In women, higher body mass index and constipation were also independent correlates, as were poor vision and heart disease in men. Poorer physical function was associated with all UI subtypes. For female stress UI, poorer cognitive status, tea drinking, and hypertension also emerged as independent risk factors. Heart disease was an independent risk factor in both female and male urge UI; as was consumption of a non-plant-based diet for female mixed and urge UI; nonfarmer and traumatic brain injury for female urge UI; and poor vision and fecal incontinence in male urge UI.

CONCLUSIONS

Chinese rural citizens showed a high UI prevalence, but only a small proportion had consulted a health care provider. Physical function decline was the most important contributor to UI among participants. Individualized intervention programs targeting modifiable risk factors among high-risk populations should be developed.

Urinary incontinence in older adults: what you need to know

Incontinence is a problem that can affect individuals of all ages. However, it is more frequently seen in older adults. It is a common geriatric syndrome, and its investigation should form part of a comprehensive geriatric assessment. Continence problems are usually ignored by patients and not reported to a medical professional, but with simple assessment and even simpler interventions, a significant improvement can be made for those living with incontinence. Most cases need a simple clinical assessment consisting of a good history and basic examination covering the abdomen, external genitalia and rectum. If no reversible causes are found, further investigations can be considered. The treatment for incontinence can be split into non-surgical and surgical management. Simple conservative measures, such as education around fluid intake, weight loss, managing constipation and pelvic floor exercises, can make a huge and positive impact on managing incontinence. If these are not effective, pharmaceutical therapies and surgical management can be considered, but there needs to be a careful consideration of the risk vs benefit in frail older adults.

The Relationship between Urinary Incontinence Quality of Life and Sleep Quality in Women Over the Age of 60 Years

Aim

The study aimed to investigate the relationship between urinary incontinence quality of life and sleep quality in women over the age of 60 years.

Method

This cross-sectional study was conducted between May 15 and July 5, 2013. Data were collected from a total of 332 women including 68 women from 3 nursing homes in a provincial center of Eskisehir and 269 women living alone or with family in their own homes in a street of that city. Women’s urinary incontinence quality of life was assessed using the incontinence quality of life scale and sleep quality was assessed using the Pittsburgh sleep quality index.

Results

Mean age of the participating women was 71.00±7.42 years. Only 10.8% of the women had incontinence diagnosis; prevalence of anamnesis-based incontinence was 87.7%. Those who lived in their own homes, who had a urinary incontinence diagnosis, who experienced urinary incontinence according to their anamnesis, who were smokers, and who had a poor sleep quality had lower Incontinence Quality of Life Scale scores. Additionally, their quality of life was negatively affected (p<0.05). Poor sleep quality and diagnosis of urinary incontinence were important predictors of the Incontinence Quality of Life Scale of women over 60 years of age and explained 18% of the total variance. The Incontinence Quality of Life Scale scores of the women decreased by 5.67 points in the presence of poor sleep quality and 6.48 points in the presence of urinary incontinence diagnosis.

Conclusion

Urinary incontinence is a common problem seen in older women, is considered as a usual problem due to aging, and is ignored or not taken care of. It also has a negative impact on the quality of life and sleep.