Self-reported social and emotional impact of urinary incontinence.

OBJECTIVE: Incontinence-specific and generic measures of well-being were regressed on potential predictors to identify incontinent respondents at risk for psychosocial distress and to understand the relationship between urinary incontinence (UI) and other determinants of social and emotional status. DESIGN: Survey data were collected May 1994 through April 1996. SETTING: Telephone interviews as a supplement to a nationally representative monthly consumer survey. PARTICIPANTS: Analyses were based on 1,116 continent and 206 incontinent respondents age 40 and older. MEASUREMENTS: Incontinent respondents self-reported the extent to which urine loss restricted social activities or affected their feelings about themselves. All respondents were asked whether they felt depressed, lonely, or sad. Covariates included sex, age, race, education, social desirability, health status, frequency of urine loss, quantity of loss, and urgency. RESULTS: The majority of incontinent respondents reported that urine loss did not restrict activities or diminish self-esteem. Incontinent respondents who were younger, male, less educated, lower in social desirability, in poorer health, or losing greater quantities of urine were more likely to report psychosocial distress, although these correlates were not consistently significant. Compared with continent respondents, significantly higher percentages of incontinent respondents reported feeling depressed, lonely, or sad. In the multivariate models, incontinence retained an independent association with loneliness, but not with sadness or depression. CONCLUSION: Even though the direct psychosocial impact of urine loss may be minor in many cases, UI is associated with a constellation of physical and behavioral factors that can impose a social and emotional burden. This suggests that UI cannot be adequately evaluated or treated without consideration of the patient's overall quality of life.

Prevalence of urinary incontinence in middle-aged and older women: a survey-based methodological experiment.

OBJECTIVE: To determine whether self-reports of urinary incontinence are influenced by the context in which survey questions are presented. Variation in the extent to which surveys promote complete and accurate reporting may help explain the wide range of published prevalence estimates. METHODS: Respondents to a nationally representative telephone survey were randomly assigned one of two questionnaire forms. Both forms contained the same incontinence question. One form included an introduction and follow-up probe, which acknowledged the embarrassment of discussing incontinence and stressed the importance of thorough reporting. RESULTS: Use of the introduction and probe produced a significantly higher prevalence rate, with the effect varying by respondent's age. DISCUSSION: The prevalence of incontinence is likely to be underestimated unless studies attend to the possibility of biased reporting. The finding of a form by age interaction suggests the importance of survey context in studies of risk factors, as well as in prevalence studies.

Prevalence and severity of urinary incontinence in older African American and Caucasian women.

BACKGROUND: Few studies have investigated the prevalence and severity of urinary incontinence in older African American women. Comparisons of findings with those for older Caucasian women could provide important clues to the etiology of urinary incontinence and be used in planning screening programs and treatment services. METHODS: Data are from the first wave of the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. A nationally representative sample of noninstitutionalized adults 70 years of age and older was interviewed. African Americans were oversampled to ensure that there would be enough minority respondents to compare findings across racial groups. RESULTS: A statistically significant relationship was found between race and urinary incontinence in the previous year: 23.02% of the Caucasian women reported incontinence, compared with 16.17% of the African American women. Other factors that appear to increase the likelihood of incontinence include education, age, functional impairment, sensory impairment, stroke, body mass, and reporting by a proxy. Race was not related to the severity (as measured by frequency) of urine loss among incontinent older women. CONCLUSION: This study identifies or confirms important risk factors for self-reported urinary incontinence in a national context, and suggests factors leading to protection from incontinence. Race is found to relate to incontinence, with older African American women reporting a lower prevalence.

Epidemiology of urinary symptoms in the geriatric population.

As the US population ages, there is a growing need for information about the urologic health problems facing older adults. In conjunction with findings from clinical studies and basic research on biological mechanisms, the epidemiologic approach offers insights on the prevalence, etiology, and impact of these geriatric conditions. This information can provide the basis for planning health care services and intervention programs. The authors discuss trends associated with population aging and the challenges posed by the epidemiologic study of older adults. Also reviewed are current findings on the prevalence, incidence, and correlates of urinary incontinence and other common urologic symptoms.

Quality of survey informants' reports about death: verification of dates through a record check.

To determine whether relatives and others can provide valid information about the dates of survey respondents' deaths, informants' reports were compared with death certificates for 328 deceased respondents from the MESA study of older adults. About two-thirds (64.6%) of the informants accurately reported the complete date of death. A somewhat larger percentage (70.4%) correctly reported the day of death, whereas 86.9% and 89.6% remembered the year and month, respectively. The percentage of correct reports varies by the relationship between informant and respondent. Also, the findings suggest that women are more accurate reporters than are men, and that the percentage of accurate reports is greater for longer-term relationships.

Urinary incontinence as a risk factor for mortality.

OBJECTIVE: To determine whether mortality is independently associated with urinary incontinence. DESIGN: 6-year prospective study that started in 1983/84. SETTING: A Midwestern County. PARTICIPANTS: Probability sample of 1956 community-residing persons 60 years of age and older in 1983/84. MEASUREMENTS: The independent variables of urinary incontinence, its types and severity, were measured by survey self-report, which was validated with clinical exams. The control variables of age, education, and health status were also self-reported. The dependent variable of death was established during follow-up interviews from reports of previously designated contact persons. RESULTS: Neither incontinence status nor its severity level or types were found to be positively associated with 6-year mortality in logistic regression analyses that adjusted for age, education, and health status. CONCLUSION: Whereas urinary incontinence can be an embarrassing and socially debilitating condition, it does not itself predict or contribute to mortality.

Measuring urinary incontinence in surveys.

This article discusses aspects of urinary incontinence that require special attention for valid survey measurement. Comments from incontinent older adults illustrate the difficulty of identifying, remembering, and reporting the condition given its gradual onset, episodic course, and embarrassing nature. Ideas for further research and some suggestions for improving the survey measurement of urinary incontinence are offered. Among these are that it be adequately introduced within survey interviews, and that survey questions reflect respondents' experiential knowledge of the condition.

Gender differences in affiliation and instrumentality across adulthood.

This secondary data analysis tests the hypothesis that gender differences decline across adulthood. Six measures tapping 3 dimensions of affiliation and instrumentality were selected from the cross-sectional sample surveys of The Quality of American Life (1971) and Americans View Their Mental Health (1976). In both studies, approximately 2,200 adults who had been selected from probability samples of households in the continental United States were interviewed. For each measure, the variance explained by age, sex, and Age x Sex interaction terms was compared with the variance explained by age and sex alone. The addition of the interaction terms does not significantly increase the R2 for any of the measures, arguing against a late-life convergence of men's and women's orientations. Although the release from active parenting has been proposed as a basis for declining gender differentiation, limiting the analyses to respondents with children does not change this conclusion.

Methods used to manage urinary incontinence by older adults in the community.

This paper addresses the ways that noninstitutionalized older adults deal with involuntary urine loss. The data come from a 1983-1984 sample survey of Washtenaw County, Michigan residents aged 60 and over. Five hundred twelve self-reported incontinent respondents are included in the analyses. About a quarter of the incontinent respondents had discussed their condition with a doctor in the previous year, while 66% used one or more methods to control urine loss. Respondents preferred using absorbent products (47% of those who used some method) and locating a toilet upon reaching a destination (42%). Fewer respondents manipulated their voiding patterns (29%) or diet and fluid intake (17%), or did pelvic muscle exercises (10%). Only 7% were taking medication for their incontinence. Logistic regression analyses were performed to identify factors associated with the choice of actions. Predictors were taken from theoretical models of health service utilization and health behavior, and included predisposing characteristics, health beliefs, enabling factors, and illness variables. Illness variables, particularly severity and type of incontinence, were the best predictors of consultation with a doctor and use of any urine control method. The predictors were less useful for understanding the choice of a specific method.

Urinary incontinence: medical and psychosocial aspects.

Recognition has been growing over the past two decades that urinary incontinence is a rather widespread condition among older adults. Prevalence rates of about 30% for any incontinence and about 5% for severe incontinence among older adults were suggested by several European studies and have recently been confirmed by American studies. The rates are typically higher among women than men. Despite these findings, much about the true distribution of urinary incontinence remains to be firmly established. The proportion of different types and the differences between sexes, ages, and races need to be confirmed using representative population samples and valid measures of incontinence. These distributions cannot be accurately described using clinical populations. Perhaps because urinary incontinence is viewed as highly embarrassing, it has not been a focus of media coverage or public discussion. More attention by the media and by health-care professionals would build public awareness of the condition. Older adults and their caregivers need to know that urinary incontinence is common and treatable, so that they will identify it promptly and bring it to their physicians' attention. Health-care providers and social workers must also be alert to the possibility of incontinence among their clients. They should be prepared to ask older patients directly, because many patients may disregard urine loss or be too embarrassed to mention it. Currently, much of the management of urinary incontinence appears to be self-devised. Many incontinent persons have not talked to a physician about their problem. The largest proportion of those who attempt to control their urine loss use absorbent products or try to avoid loss by awareness of toilet locations and frequent toileting. Reliance on these methods is unfortunate because much progress has been made in developing diagnostic and treatment procedures for urinary incontinence. For example, surgical procedures to rectify an incompetent sphincter have been shown to be effective and are generally accepted. There are a number of medications effective for controlling detrusor instability. Further, various behavioral techniques appear to be promising as noninvasive initial interventions for many patients. We are on weaker ground regarding the prevention of and early intervention in urinary incontinence. The existing epidemiological data on the development of incontinence are poor. We do not know the proportion of urinary incontinence that is transient and the proportion that is chronic or established. Nor do we know the risk factors for onset and progression of the condition.(ABSTRACT TRUNCATED AT 400 WORDS)

Urinary incontinence and psychological distress among older adults.

We examined the relationship between urinary incontinence and psychological distress in a sample of community-dwelling older adults. The data are from a probability sample of Washtenaw County, Michigan residents ages 60 years and older, who were interviewed in 1983 and 1984. A total of 747 women and 541 men were included in the analyses. Experiencing urinary incontinence, particularly in a severe form, was weakly related to depression, negative affect, and low life satisfaction. These relationships are partly explained by the fact that incontinent respondents are less healthy than are continent respondents.