The quality of life of older adults with urinary incontinence: determining generic and condition-specific predictors

A multicenter cross-sectional study on the prevalence of overactive bladder and its impacts on the quality of life in gynecologic outpatients

Objective

The present study assessed the prevalence of overactive bladder (OAB) symptoms in gynecologic outpatients and the effects of OAB on a patient's quality of life.

Methods

The survey was completed by adult female patients who visited the gynecology clinic for examination or treatment of gynecologic conditions. The subjects who met the exclusion criteria were excluded. The survey included a questionnaire assessing general characteristics, the purpose of the visit, diagnosis, and the presence or absence of OAB. The subjects were asked whether they were under medical treatment for OAB symptoms, and the degree of discomfort in daily activities was evaluated.

Results

In total, 1,990 female subjects visiting the gynecology clinics of 4 different institutions were recruited. On OAB Symptom Score, 188 subjects responded with scores of ≥2 for question #3 (≥1 time(s) weekly). The severity of OAB symptoms was as follows: 345 subjects had mild OAB, 127 subjects had moderate OAB, and 12 subjects had severe OAB. The prevalence of OAB symptoms was 10.30%.

Conclusion

The present study confirmed that OAB symptoms are common, with a prevalence of 10.30%. Patients with OAB symptoms frequently neglect to seek medical intervention. Our findings will help inform patients to recognize their condition and seek medical assistance, especially in gynecologic outpatient clinics.

How does the onset of incontinence affect satisfaction with life among older women and men? Findings from a nationally representative longitudinal study (German Ageing Survey)

Background

There is a large body of evidence showing that incontinence is associated with decreased health-related quality of life (HRQoL). Moreover, while a few cross-sectional studies have shown that incontinence is associated with decreased life satisfaction, there is a lack of studies regarding whether the onset of incontinence influences life satisfaction of affected individuals longitudinally. Thus, the objective of this study is: (i) to investigate the impact of incontinence on life satisfaction and (ii) whether this effect differed between women and men using a large population-based sample longitudinally.

Methods

Longitudinal data from 2008 to 2014 were retrieved from a nationally representative sample (9869 observations in regression analysis) of community-dwelling individuals aged 40 years and over (German Ageing Survey, DEAS). Physician-diagnosed incontinence was reported by respondents. Life satisfaction was quantified using the well-established Satisfaction with Life Scale. Linear fixed-effects regressions were used.

Results

After adjusting for potential confounders (e.g., self-rated health or depression), regressions revealed that the onset of incontinence was associated with a decline in life satisfaction in men (β = −.25, p < .01), but not in the total sample and in women. These differences were significant (p < .05). In a further sensitivity analysis, individuals with cancer were excluded. However, in terms of significance and effect size, the impact of incontinence on life satisfaction in men remained almost the same in both models.

Conclusions

The onset of incontinence markedly reduces life satisfaction among men aged 40 and over. Interventional strategies to postpone incontinence may assist in maintaining life satisfaction in men.

Severity, not type, is the main predictor of decreased quality of life in elderly women with urinary incontinence: a population-based study as part of a randomized controlled trial in primary care

Background

Urinary incontinence negatively influences the lives of 25-50% of elderly women, mostly due to feelings of shame and being limited in activities and social interactions. This study explores whether differences exist between types of urinary incontinence (stress, urgency or mixed) and severity of the symptoms, with regard to their effects on generic and condition-specific quality of life.

Methods

This is a cross-sectional study among participants of a randomized controlled trial in primary care. A total of 225 women (aged ≥ 55 years) completed a questionnaire (on physical/emotional impact and limitations) and were interviewed for demographic characteristics and co-morbidity. Least squares regression analyses were conducted to estimate differences between types and severity of urinary incontinence with regard to their effect on quality of life.

Results

Most patients reported mixed urinary incontinence (50.7%) and a moderate severity of symptoms (48.9%). Stress urinary incontinence had a lower impact on the emotional domain of condition-specific quality of life compared with mixed urinary incontinence (r = −7.81). There were no significant associations between the types of urinary incontinence and generic quality of life. Severe symptoms affected both the generic (r = −0.10) and condition-specific (r = 17.17) quality of life.

Conclusions

The effects on condition-specific quality of life domains differ slightly between the types of incontinence. The level of severity affects both generic and condition-specific quality of life, indicating that it is not the type but rather the severity of urinary incontinence that is the main predictor of decreased quality of life.

The effects of severity of urine leakage on quality of life in Hispanic, white, and black men and women: the Boston community health survey

OBJECTIVES

To investigate the relationship between the severity of urine leakage and quality of life (QOL) in men and women of different race/ethnicity.

METHODS

An epidemiologic survey was conducted with a population-based random sample of 3202 women and 2301 men (1767 black, 1877 Hispanic, 1859 white) aged 30-79 years in Boston, MA. Severity of leakage was based on frequency and amount by the Sandvik Severity Scale. QOL was measured with physical and mental component summaries of Medical Outcomes Study Short Form-12. Covariates included race/ethnicity, age, socioeconomic status, urinary incontinence risk factors, and comorbidities. Analysis included multivariate linear regression modeling by gender.

RESULTS

Urine leakage, most of which was mild or moderate, was reported in 30% of women and 18% of men. Women (5.1%) were more likely than men (0.9%) to report severe leakage. In multivariate analysis, as severity of leakage increased, both components of QOL declined, with decreases in scores of 7-8 points for men (P < or = .001 for each) and 4-6 points (P < .05 and P = .001, respectively) for women. Severe leakage was associated with a greater decline in QOL than that observed for most other comorbidities considered. The effect of urine leakage on QOL was similar among racial and ethnic groups.

CONCLUSIONS

Urine leakage impairs QOL for both men and women, with no evidence of different effects by racial/ethnic group. Leakage has clinically significant effects on physical health-related QOL for men and on mental health QOL for both men and women.

Health-related Quality of Life among hospitalized older people awaiting residential aged care

Background

Health related quality of life (HRQoL) in very late life is not well understood. The aim of the present study was to assess HRQoL and health outcomes at four months follow-up in a group of older people awaiting transfer to residential aged care.

Methods

Secondary analysis of data from a randomized controlled trial conducted in three public hospitals in Adelaide. A total of 320 patients in hospital beds awaiting a residential aged care bed participated. Outcome measurements included HRQoL (Assessment of Quality of Life; AQoL), functional level (Modified Barthel Index), hospital readmission rates, survival, and place of residence at four months follow-up.

Results

In this frail group the median AQoL was poor at baseline (median 0.02; 95%CI -0.01 – 0.04) and at follow-up (0.05; 95%CI 0.03 – 0.06). On leaving hospital, more than one third of participants who were moving for the first time into nursing home care rated themselves in a state worse than death (AQoL ≤ 0.0). Poor HRQoL at discharge from hospital (AQoL ≤ 0.0) was a significant predictor of mortality (HR 1.7; 95%CI 1.2 – 2.7), but not hospital readmission nor place of residence at four months follow-up. Improved function was a predictor of improved HRQoL among the surviving cohort.

Conclusion

People making the transition to residential aged care from hospital have very poor HRQoL, but small gains in function seem to be related to improvement. While functional gains are unlikely to change discharge destination in this frail group, they can contribute to improvements in HRQoL. These gains may be of great significance for individuals nearing the end of life and should be taken into account in resource allocation.

Differences between older Chinese men and women from Hong Kong in the impact of urinary incontinence on their lives

This study reports the epidemiology of urinary incontinence (UI) and its impact on the social lives of older Chinese people in Hong Kong, a modern city in China. It also examines the relationship between sex and this impact, as well as the extent of UI in a convenience sample of 101 sufferers aged 60 or older. This study was cross-sectional and used face-to-face interviews with a structured questionnaire. A number of findings concur with studies conducted in Western countries. Prevalence of UI increased with adult age, and it affected women more than men. UI had a negative impact on 86.1% of the incontinent respondents. There were no significant differences between men and women in the duration of UI, the level of UI, or health status. Out of the nine impacts on social lives, only one showed a significant difference between older men and women: "restriction on opportunities to participate in social activities." Statistically, men tended to report more negative impacts than women. More than 80% of the respondents were affected by their UI. The impact of UI on social lives was basically the same for men and women, though men reported significantly more social impacts than did women. However, this study does not support the claim that the social life of those who reported more social impacts was worse than that of those who reported fewer.

Race and ethnicity do not contribute to differences in preoperative urinary incontinence severity or symptom bother in women who undergo stress incontinence surgery

OBJECTIVE

The purpose of this study was to determine whether race/ethnicity affects urinary incontinence (UI) severity and bother in women who undergo surgery for stress incontinence.

STUDY DESIGN

We used baseline data from participants in the Stress Incontinence Surgical Treatment Efficacy trial. UI severity was measured by the number of leakage episodes during a 3-day urinary diary and by urodynamic evaluation. UI bother was measured with the Urogenital Distress Inventory. Race/ethnicity classification was based on self-report.

RESULTS

Of the 654 women, 72 women (11%) were Hispanic; 480 women (73%) were non-Hispanic white; 44 women (6.7%) were non-Hispanic black, and 58 women (8.9%) were of other race/ethnicity. No differences were seen in any UI severity measures. Non-Hispanic white women had the lowest Urogenital Distress Inventory scores on bivariate analysis, which was explained by socioeconomic status, body mass index, and age on multivariate analysis.

CONCLUSION

Factors other than racial/ethnic differences underlie variations in UI symptoms and bother in this group of women who sought surgery for stress incontinence.

Quality of life in women with stress urinary incontinence

The objective of this study was to identify clinical and demographic factors associated with incontinence-related quality of life (QoL) in 655 women with stress urinary incontinence who elected surgical treatment. The following factors were examined for their association with QoL as measured with the Incontinence Impact Questionnaire (IIQ): number of incontinence (UI) episodes/day; self-reported type of UI symptoms (stress and urge); sexual function as measured by the Prolapse/Urinary Incontinence Sexual Questionnaire; symptom bother as measured by the Urogenital Distress Inventory; as well as other clinical and sociodemographic factors. A stepwise least-squares regression analysis was used to identify factors significantly associated with QoL. Lower QoL was related to the greater frequency of stress UI symptoms, increasing severity, greater symptom bother, prior UI surgery or treatment, and sexual dysfunction (if sexually active). Health and sociodemographic factors associated with lower incontinence-related QoL included current tobacco use, younger age, lower socioeconomic status, and Hispanic ethnicity.

A review of quality-of-life questionnaires for urinary incontinence and overactive bladder: which ones to use and why?

Overactive bladder (OAB) and stress urinary incontinence have a profound impact on patients' health-related quality of life (HRQL). The purpose of this article is to identify and describe condition-specific HRQL measures validated among patients with symptoms of OAB or stress urinary incontinence. A Medline literature search was performed to identify published articles or abstracts focusing on the development and psychometric validation of relevant instruments. Target populations and psychometric properties (reliability, validity, responsiveness to change) of 16 questionnaires are reviewed. A range of well-validated, condition-specific HRQL measures are available. Recommendations are provided regarding which measures to use in different situations. When choosing among instruments, psychometric evidence and the match of an instrument to the study population should be considered.

Quality of life impact and treatment seeking of Chinese women with urinary incontinence

The objective of this study was to investigate the quality of life (QOL) impact of urinary incontinence (UI) and to examine its relationship with treatment seeking in adult Taiwanese women. We conducted a cross-section in-person questionnaire interview of 1608 adult women living in the Taipei area. The characteristics and incontinence status were recorded. A short form incontinence impact questionnaire (IIQ-7) was used to evaluate the QOL impact of UI. Multiple logistic regression analysis was used to assess the determinative factors for treatment seeking. The mean IIQ-7 score of the 205 (12.7%) women who reported urinary leakage more than once per month in the preceding 12 months was 5.0 (range: 0-19), which showed a significant correlation with the severity of incontinence (r = 0.59, p < 0.001). Women with mixed type UI had a higher IIQ-7 score compared to those with stress or urge UI. Fifty-five (26.8%) incontinent women had sought medical help. Treatment seeking was highly related to IIQ-7 scores as 75% of incontinent women with an IIQ-7 score > 10 in contrast to 5% of those with an IIQ-7 score < or = 3 (p < 0.001) had sought medical care. On multiple logistic regression analysis, perceiving UI as a disease and a higher IIQ-7 score were independent factors predicting treatment seeking. We concluded that UI is a common problem that brings substantial QOL impact to Taiwanese women. The IIQ-7 questionnaire may provide a useful measurement to quantitate the degree of QOL impact, which is largely affected by the severity and type of incontinence. Women who perceive UI as a disease and those with a higher degree of QOL impact are more likely to seek medical help. Furthermore, treatment seeking in Taiwanese women with significant UI may be more common than thought as a great majority of women with higher IIQ-7 scores had sought medical help.