Urinary incontinence in institutionalized elderly: prevalence and impact on quality of life

Roig, Javier Jerez; Souza, Dyego Leandro Bezerra de; Lima, Kenio Costa

doi:10.1590/0103-5150.028.003.AO17

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Original Article • Fisioter. Mov. 28 (3) • Jul-Sep 2015 • https://doi.org/10.1590/0103-5150.028.003.AO17 copy

Urinary incontinence in institutionalized elderly: prevalence and impact on quality of life

Incontinência urinária em idosos institucionalizados: prevalência e impacto na qualidade de vida

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Urinary incontinence is a geriatric syndrome that generates strong economic and social impacts as well as emotional changes and negative consequences for the health of the elderly.

Objective

The objective of this work was to identify the prevalence of urinary incontinence and its associated factors, as well as its impact on quality of life of institutionalized elderly.

Materials and methods

A cross-sectional study was conducted herein, with 10 long-term institutions for the elderly of the municipality of Natal (Northeast Brazil). The Minimum Data Set was completed by caregivers to determine the presence of incontinence, and the Short Form of the International Consultation on Incontinence Questionnaire was answered by the elderly, to assess the frequency and amount of urinary leakage, the impact on quality of life, and the type of incontinence. The chi-square test and Fisher’s exact test were applied in the bivariate analysis, and logistic regression was utilized for multivariate analysis.

Results

The prevalence of urinary incontinence was 42.7% (95% CI: 34.8–50.8). The impact of this condition on daily life was mild in 46.5% of cases, moderate for 29.3% of cases, and severe in 24.1% of cases. The condition was associated with functional impairment (p < 0.001; RP: 4.13).

Final considerations

The prevalence of urinary incontinence in this sample, which presented cognitive ability to answer questionnaires, was over 40% with a high degree of severity. Approximately half of the incontinents referred a moderate-severe impact of incontinence. Control measures for this geriatric syndrome within the institutions are important to delay the decline of health and improve the quality of life of the residents.

Cross-sectional studies; Elderly; Urinary incontinence; Institutionalization; Long-term institution for the elderly

	n	%
Age
60–69	24	16.8
70–79	40	28.0
80–89	68	47.5
90 or over	11	7.7
Color/race
White	84	58.7
Brown	42	29.4
Afro-American	15	10.5
Yellow	1	0.7
Indigenous	1	0.7
Education level
Iliterate	27	18.9
Literate/Primary education I	50	34.9
Primary education II	15	10.5
High school education	26	18.2
College education	16	11.2
DNK/DNA	9	6.3
Marital status
Single	63	44.1
Married	14	9.8
Divorced	19	13.3
Widow(er)	46	32.2
DNK/DNA	1	0.7
Reason for institutionalization
No caregiver	53	37.1
Lived alone	22	15.4
Several reasons	18	12.6
Disease	17	11.9
Other reasons	16	11.2
Own choice	11	7.7
No place to live	4	2.8
DNK/DNA	2	1.4
Money administration
Self administration	16	11.2
Relatives or other person	56	39.2
Institution	41	28.7
Institution and elderly	13	9.1
Institution and relatives	9	6.3
Not applicable (no income)	6	4.2
Body Mass Index
Low weight	42	29.4
Eutrophy	43	30.1
Overweight	49	34.3
Not known	9	6.3
Mobility
Bedridden	3	2.1
Wheelchair	19	13.3
Walks with aid	31	21.7
Walks without aid	90	62.9
Functional capacity
Independent	66	46.2
Slight dependency	20	14.0
Moderate dependency	27	18.9
Severe dependency	30	21.0
Cognitive state (Pfeiffer)
Intact	29	20.3
Slight cognitive decline	24	16.8
Moderate cognitive decline	64	44.8
Severe cognitive decline	26	18.2

	n	%
Frequency of urinary losses
Never	85	59.4
Once a week or less	6	4.2
Two or three times per week	6	4.2
Daily	12	8.4
Several times a day	32	22.4
Continuous	1	0.7
DNK/DNA	1	0.7
Amount of urinary losses
Never	85	59.4
Small	18	12.6
Moderate	17	11.9
Large	21	14.7
DNK/DNA	2	1.4
Predominant type of UI
Never	85	59.4
Urgency UI	13	9.1
Stress UI	6	4.2
Mixed UI	7	4.9
Nocturnal UI	14	9.8
Continuous UI	3	2.1
Indeterminate	9	6.3
DNK/DNA	6	4.2
Nocturia (times of nighttime urination)
0	28	19.6
1	28	19.6
2	26	18.2
3	19	13.3
4 or over	17	11.9
Not applicable (does not walk)	22	15.4
Unknown	4	2.8

	UI

	Yes		No
	n	%	n	%	p	PR (CI: 95%)
Sex
Female	44	38.9	69	61.1	0.081	1.00
Male	17	56.7	13	43.3		1.45 (0.99–2.15)
Retired
Yes	59	45.0	72	55.0	0.115^b	1.00
No	2	18.2	9	81.8		0.40 (0.11–1.43)
Lived alone
No	54	45.4	65	54.6	0.115	1.00
Yes	6	27.3	16	72.7		0.60 (0.29–1.22)
Several reasons
No	48	39.0	75	61.0	0.027*	1.00
Yes	12	66.7	6	33.3		1.71 (1.15–2.53)
Occupation
Yes	29	37.7	48	62.3	0.192	1.00
No	32	48.5	34	51.5		1.29 (0.88–1.88)
Craft activities
Yes	4	16.0	21	84.0	0.003*	1.00
No	57	48.3	61	51.7		3.02 (1.21–7.56)
Other activities
Yes	18	58.1	13	41.9	0.050	1.00
No	43	38.4	69	61.6		0.66 (0.45–0.97)
Smoker
No	58	45.0	71	55.0	0.129	1.00
Yes	3	23.1	10	76.9		0.51 (0.19–1.41)
Use of medicine
No	0	0	4	100.0	0.136^b	1.00
Yes	61	43.9	78	56.1		/
Dyslipidemia
No	51	46.8	58	53.2	0.074	1.00
Yes	10	29.4	24	70.6		0.63 (0.36–1.10)
Osteoporosis
No	47	39.2	73	60.8	0.054	1.00
Yes	14	60.9	9	39.1		1.55 (1.05–2.31)
Cardiovascular disease
No	56	44.8	69	55.2	0.172	1.00
Yes	5	27.8	13	72.2		0.62 (0.29–1.34)
Pulmonary disease
No	55	41.0	79	59.0	0.171^b	1.00
Yes	6	66.7	3	33.3		1.62 (0.98–2.69)
Renal insufficiency
No	56	41.2	80	58.8	0.137^b	1.00
Yes	5	71.4	2	28.6		1.73 (1.04–2.89)
Urinary infection
No	54	40.6	79	59.4	0.039^b.*	1.00
Yes	7	77.8	2	22.2		1.92 (1.28–2.87)
Falls
No	59	44.4	74	55.6	0.189^b	1.00
Yes	2	20.0	8	80.0		0.45 (0.13–1.58)
Fecal incontinence
No	39	32.2	82	67.8	< 0.001*	1.00
Yes	22	100.0	0	0		3.10 (2.40–4.02)
Constipation
No	47	39.5	72	60.5	0.018*	1.00
Yes	13	68.4	6	31.6		1.73 (1.19–2.53)
Mobility
Walks without aid	22	24.4	68	75.6	< 0.001*	1.00
Mobility restrictions	39	73.6	14	26.4		3.01 (2.02–4.48)
Depressive symptoms (GDS-15)
No	27	35.1	50	64.9	0.039*	1.00
Yes	34	52.3	31	47.7		1.49 (1.02–2.19)
Weight loss
No	35	35.7	63	64.3	0.036*	1.00
Yes	23	54.8	19	45.2		1.53 (1.05–2.25)

	UI

	Yes		No
	n	%	n	%	p	PR (CI: 95%)	p	Adjusted PR (CI: 95%)
Functional incapacity
No	10	15.2	56	84.8	< 0.001*	1.00	< 0.001*	1.00
Yes	51	66.2	26	33.8		4.37 (2.42–7.91)		4.13 (2.33–7.34)
Parkinson’s disease
No	59	44.4	74	55.6	0.189^b	1.00	0.042*	1.00
Yes	2	20.0	8	80.0		0.45 (0.13–1.58)		0.23 (0.06–0.95)
Cerebrovascular accident
No	49	37.7	81	62.3	< 0.001*	1.00	0.072	1.00
Yes	12	92.3	1	7.7		2.45 (1.87–3.21)		2.18 (0.93–5.07)
Low weight
No	34	37.0	58	63.0	0.015*	1.00	0.250	1.00
Yes	25	59.5	17	40.5				1.35 (0.81–2.27)
Age
60-80	31	44.3	39	55.7	0.700	1.00	0.346	1.00
81 and over	30	41.1	43	58.9		0.93 (0.63–1.36)		0.78 (0.46–1.31)

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[1] *JJR: MSc, e-mail:javijerez81@hotmail.com DLBS: PhD, e-mail:dysouz@yahoo.com.br KCL: PhD, e-mail:limke@uol.com.br