Why older community-dwelling adults do not discuss urinary incontinence with their primary care physicians

Accessibility of Pelvic Floor Physiotherapy for Treating Urinary Incontinence in Older Women in Quebec: An Online Survey

Purpose

This cross-sectional descriptive study describes available pelvic floor physiotherapy (PT) services for older women with urinary incontinence (UI) in Quebec, Canada, and identifies possible affordability barriers.

Methods

From September to December 2019, Quebec physiotherapists practising pelvic floor PT were invited to complete a survey on their clinical practice and perceptions of the affordability of UI treatment for older women.

Results

Eighty-four of the 225 registered pelvic floor physiotherapists (37.3%) filled out the online survey. They worked a median of 32 hours/week in PT, with 15 of those hours (46.9%) in pelvic floor PT and three hours (9.8%) treating UI in older women. Only 13.0% of them offered group treatment, while 84.3% were interested in it. Most of the physiotherapists (92.2%) had met older women in their practice who had reported financial barriers to completing their pelvic floor PT treatment.

Conclusions

The accessibility of UI care in Quebec appears hampered by the limited availability of pelvic floor PT treatments, mainly in public settings, and potential financial constraints. Providing pelvic floor PT to groups could constitute a promising avenue to tackle both issues. Future studies should look at ways of implementing this option.

Comparative effectiveness of pelvic floor muscle training, mirabegron, and trospium among older women with urgency urinary incontinence and high fall risk: a feasibility randomized clinical study

BACKGROUND

Untreated, urgency urinary incontinence (UUI) and overactive bladder (OAB) can precipitate a vicious cycle of decreasing physical activity, social isolation, fear of falling, and falls. Structured behavioral interventions and medications are common initial treatment options, but they elicit their effects through very different mechanisms of action that may influence fall-related outcomes differently. This study will determine the feasibility of conducting a comparative effectiveness, three-arm, mixed methods, randomized clinical trial of a behaviorally based pelvic floor muscle training (PFMT) intervention versus two recent drug options in older women with UUI or OAB who are also at increased risk of falling.

METHODS

Forty-eight women 60 years and older with UUI or OAB who screen positive for increased fall risk will be recruited through the urogynacology and pelvic health clinics of our university health system. Participants will be randomly assigned to one of three 12-week treatment arms: (1) a course of behavioral and pelvic floor muscle training (PFMT) provided by physical therapists; (2) the beta-3 agonist, mirabegron; and (3) the antimuscarinic, trospium chloride. Study feasibility will be established through objective metrics of evaluability, adherence to the interventions, and attrition. We will also assess relevant measures of OAB symptom severity, quality of life, physical activity, incident falls, and concern about falling.

DISCUSSION

The proposed research seeks to ultimately determine if linkages between reduction in UI symptoms through treatment also reduce the risk of falling in this patient population.

TRIAL REGISTRATION

NCT05880862. Registered on 30 May 2023.

Prevalence and Influencing Factors of Help-Seeking Behavior Among Women with Urinary Incontinence: A Systematic Review and Meta-Analysis

Purpose: This systematic review and meta-analysis aimed to investigate the mean (weighted) prevalence of help-seeking behavior among women with urinary incontinence (UI) in relevant subgroups and the related influencing factors. Materials and Methods: Six English and four Chinese databases were systematically searched between 1996 and July 10, 2022. Two researchers independently screened the literature, extracted data, and evaluated the quality of the included studies. All statistical analyses were conducted using RevMan 5.4. Results: The mean (weighted) prevalence of help-seeking behavior based on the 41 included studies, including a total of 32,640 women with UI, was 28% (95% confidence interval [CI]: 22%-34%). We performed a subgroup analysis based on UI type, population, region, publication time, case definition of help-seeking, and use of validated tools to determine UI. The results of the subgroup analysis showed that the pooled prevalence of help-seeking behavior was 23% (95% CI: 14%-32%) among pregnant and maternity women, 27% (95% CI: 19%-35%) among menopausal women, 24% (95% CI: 14%-35%) among 20- to 50-year-old women, 31% (95% CI: 25%-36%) among those older than 50 years, 24% (95% CI: 17%-30%) in Asia, and 33% (95% CI: 22%-44%) in Europe. Meanwhile, the pooled odds ratio showed that education level, UI type, UI severity, and quality of life significantly influenced help-seeking behavior among women with UI. Conclusions: This systematic review revealed that the pooled prevalence of help-seeking behaviors among women with UI is 28%. These influencing factors have important implications for adapting to health care and social care systems.

Help-seeking behavior for nonsevere stress urinary incontinence among elderly women in communities, Beijing, China

INTRODUCTION AND HYPOTHESIS

Stress urinary incontinence (SUI) is a common health problem and influences women's quality of life significantly. In order to enhance health education according to a specific situation, it is essential to identify barriers to seeking help among elderly women with nonsevere SUI. The objectives were to investigate reasons for (not) seeking help for nonsevere SUI among women aged ≥60 years, and to analyze factors affecting help-seeking behavior.

METHODS

We enrolled 368 women aged ≥60 years with nonsevere SUI from communities. They were asked to filled out sociodemographic information, International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), Incontinence Quality of Life (I-QOL), and self-constructed questiones on help-seeking behavior. Mann-Whitney U tests were used to analyze the different factors between seeking group and nonseeking group.

RESULTS

Only 28 women (7.61%) had ever sought help from health professionals for SUI. The most frequent reason for seeking help was urine-soaked clothes (67.86%, 19 out of 28). The most frequent reason for not seeking help was that women thought it was normal (67.35%, 229 out of 340). Compared with the nonseeking group, the seeking group had higher total ICIQ-SF scores and lower total I-QOL scores.

CONCLUSION

Among elderly women with nonsevere SUI, the rate of seeking help was low. Lack of correct perception about the SUI kept women from doctor visits. Women who were bothered by more severe SUI and lower quality of life were more likely to seek help.

Preferences for Public Health Messaging Related to Bladder Health in Adolescent and Adult Women

Objective: The purpose of this analysis was to explore adolescent and adult women's preferences for the content and delivery of public health messaging around bladder health. Materials and Methods: This was a directed content analysis of focus group data from the Study of Habits, Attitudes, Realities, and Experiences, which explored adolescent and adult women's experiences, perceptions, beliefs, knowledge, and behaviors related to bladder health and function across the life course. This article reports an analysis of the "Public Health Messaging" code, which includes participants' views on what information is needed about bladder health, attributes of messaging, and preferred locations and delivery methods. Results: Forty-four focus groups were conducted with 360 participants (ages 11-93 years) organized into six age groups. Across age groups, participants wanted messaging on maintaining bladder health and preventing bladder problems. They offered suggestions for a wide variety of methods to deliver bladder health information. Ideas for delivery methods fell into three broad categories: (1) traditional in-person modes of delivery, which included individual communication with providers in clinical settings and group-based methods in schools and other community settings where adolescent and adult women naturally gather; (2) internet-based website and social media delivery methods; and (3) static (noninteractive) modes of delivery such as pamphlets. Participants recommended the development of multiple delivery methods to be tailored for specific audiences. Conclusions: These findings can inform development of broad ranging public health messaging tailored to audiences of all ages with a goal of engaging adolescent and adult women across the bladder health risk spectrum.

Cumulative Effects of Comorbid Burden and Overactive Bladder Symptoms on Fall Risk Among Older Women Seeking Treatment for Urogynecologic Conditions

IMPORTANCE

Overactive bladder (OAB) syndrome and urinary incontinence, age, and comorbid burden are strong risk factors for falls in women. Less is known about their cumulative effects on fall risk in a urogynecologic population.

OBJECTIVE

The purpose of this study was to investigate the effects of coexisting OAB, older age, and comorbidities on risk of falling among treatment seeking women with pelvic floor disorders.

STUDY DESIGN

We conducted a retrospective medical records review of 348 consecutive women presenting to a urogynecology clinic over 6 months. Fall risk was determined by the Centers for Disease Control and Prevention's, Stopping Elderly Accidents, Deaths, and Injuries screening tool. Clinical and sociodemographic measures were abstracted from the electronic medical record. Odds of screening positive for high fall risk based on different patient profiles were calculated. We then used a classification and regression tree analysis to determine the relative importance of the different variables on fall risk within the homogeneous subgroups.

RESULTS

Of the 348 women (mean age, 58.7 ± 15.8 years) who completed the fall risk screen, 124 (36%) screened positive for increased fall risk. Overactive bladder symptoms increased the likelihood of a positive fall risk screen across all combinations of age and comorbid burden. The patient profile of ≥3 OAB symptoms, ≥4 comorbid conditions, and age 65 years or older increased the odds of screening positive for high fall risk more than 6-fold (odds ratio, 6.4; 95% confidence interval, 3.1-12.9). In the following order of importance, the combination of high comorbid burden, OAB, and older age identified approximately 3 in 4 patients (73.3%) at high risk of falling.

CONCLUSION

The presence of 3 easily identifiable patient characteristics is strongly associated with a risk of falls in women seeking care for pelvic floor disorders.

Comorbidities of community-dwelling older adults with urinary incontinence: A scoping review

BACKGROUND

Identifying comorbidities is a critical first step to building clinical phenotypes to improve assessment, management, and outcomes.

OBJECTIVES

1) Identify relevant comorbidities of community-dwelling older adults with urinary incontinence, 2) provide insights about relationships between conditions.

METHODS

PubMed, Cumulative Index of Nursing and Allied Health Literature, and Embase were searched. Eligible studies had quantitative designs that analyzed urinary incontinence as the exposure or outcome variable. Critical appraisal was performed using the Joanna Briggs Institute Critical Appraisal Checklists.

RESULTS

Ten studies were included. Most studies had methodological weaknesses in the measurement of conditions. Comorbidities affecting the neurologic, cardiovascular, psychologic, respiratory, endocrine, genitourinary, and musculoskeletal systems were found to be associated with urinary incontinence.

CONCLUSION

Existing literature suggests that comorbidities and urinary incontinence are interrelated. Further research is needed to examine symptoms, shared mechanisms, and directionality of relationships to generate clinical phenotypes, evidence-based holistic care guidelines, and improve outcomes.

Predictors of help-seeking behaviors in women with urinary incontinence: Based on Iranian women's lens

Urinary incontinence has an undeniable impact on the quality of life of affected women; however, talking about incontinence is not comfortable for many women, and they often hide it and do not seek treatment. Predictors affecting women's decisions to seek treatment in communities can be different. This study was designed to identify predictors of help-seeking behaviors among Iranian women with urinary incontinence.

METHODS

This cross-sectional, analytical study was conducted on 199 women with urinary incontinence who met the inclusion criteria by convenience sampling from the beginning of 2020 to the middle of 2021. The Incontinence Severity Index, Bradley's Questionnaire for Urinary Incontinence Diagnosis, Medical Embarrassment Questionnaires, Brief-Illness Perception Questionnaire, Incontinence Quality of Life Questionnaire, Barrier to Incontinence Care Seeking Questionnaire, Medical Help Seeking Scale, and Medical Outcomes Study Social Support Survey were all self-administered data collection tools used in this study. Multiple linear regression was used to investigate the relationship and prediction of help-seeking behaviors by other variables. To analyze the data, SPSS software version 20 was used.

RESULTS

The variables of shame, barriers to care, social support, quality of life, and age were found to be predictors of help-seeking behavior in the research population of women with urinary incontinence. Help-seeking had a direct relationship with quality of life and an inverse relationship with other factors. Among these factors, shame has the greatest impact (P = 0/001, β = - 0/37).

CONCLUSIONS

The extracted predictors, especially the variable of "shame" as the most important negative factor related to the treatment decisions of women with urinary incontinence, will help to health service providers to take into account these factors in the regular service provision programs that promote women's health, which are effective in facilitating the help-seeking of sufferers and correct guidance towards treatment or rehabilitation.

Exploring support, experiences and needs of older women and health professionals to inform a self-management package for urinary incontinence: a qualitative study

OBJECTIVES

Many women attempt to manage urinary incontinence (UI) independently with variable success while health professionals may be unaware of their needs. This study aimed to (1) understand older women's experiences of UI, their self-management strategies and support needs; (2) explore health professionals' experiences of supporting women and providing relevant services and (3) combine their experiences contribute to development of a theory-based and evidence-based self-management package for UI.

DESIGN

Qualitative semi-structured interviews were conducted with 11 older women with UI and 11 specialist health professionals. Data were analysed independently using the framework approach, then synthesised in a triangulation matrix to identify implications for content and delivery of the self-management package.

SETTING

Community centres, community continence clinic and urogynaecology centre of a local teaching hospital in northern England.

PARTICIPANTS

Women aged 55 years and over who self-reported symptoms of UI and health professionals delivering UI services.

RESULTS

Three overarching themes emerged. Older women see UI as a 'fact of life' but many struggle with it: women typically considered UI as part of ageing yet expressed annoyance, distress, embarrassment and had made significant lifestyle changes. Access to information and limited high-quality professional support: health professionals provided specialist UI care and information. Yet less than half of women accessed specialist services, those who had, highly valued these services. 'Trial and error' with different self-management strategies: women had tried or were using different strategies (continence pads, pelvic floor exercises, bladder management and training, fluid management and medication), with mixed success. Health professionals provided evidence-based, personalised support and motivation.

CONCLUSIONS

Findings informed the content of the self-management package that focused on providing facts, acknowledging challenges of living with/self-managing UI, sharing others' experiences, using motivational strategies and self-management tools. Delivery preferences were independent use by women or working through the package with a health professional.

Group-Based Pelvic Floor Telerehabilitation to Treat Urinary Incontinence in Older Women: A Feasibility Study

Less than half of women with urinary incontinence (UI) receive treatment, despite the high prevalence and negative impact of UI and the evidence supporting the efficacy of pelvic floor muscle training (PFMT). A non-inferiority randomized controlled trial aiming to support healthcare systems in delivering continence care showed that group-based PFMT was non-inferior and more cost-effective than individual PFMT to treat UI in older women. Recently, the COVID-19 pandemic highlighted the importance of providing online treatment options. Therefore, this pilot study aimed to assess the feasibility of an online group-based PFMT program for UI in older women. Thirty-four older women took part in the program. Feasibility was assessed from both participant and clinician perspectives. One woman dropped out. Participants attended 95.2% of all scheduled sessions, and the majority (32/33, 97.0%) completed their home exercises 4 to 5 times per week. Most women (71.9%) were completely satisfied with the program's effects on their UI symptoms after completion. Only 3 women (9.1%) reported that they would like to receive additional treatment. Physiotherapists reported high acceptability. The fidelity to the original program guidelines was also good. An online group-based PFMT program appears feasible for the treatment of UI in older women, from both participant and clinician perspectives.

Need for Public Health Messaging Related to Bladder Health from Adolescence to Advanced Age

Objective: The purpose of this analysis was to explore adolescent and adult women's interest in public health messaging around bladder health and perceptions of its usefulness. Materials and Methods: Directed content analysis of focus group data from the Study of Habits, Attitudes, Realities, and Experiences, which explored adolescent and adult women's experiences, perceptions, beliefs, knowledge, and behaviors related to bladder health across the life course. This article reports an analysis of the "Public Health Messaging" code, which included participants' desire or need for information about bladder health and recommendations for appropriate priority audiences. Results: Forty-four focus groups were conducted with 360 participants organized into six age groups (11-93 years). There was consensus across age groups that more information about the bladder is wanted and needed throughout the life course, as there is currently a lack of reliable educational resources. Information on bladder health was seen as useful and important because it enables people to anticipate negative changes in bladder health and act to prevent these. Several priority audiences were identified based on their risk of developing symptoms, but participants also saw value in educating the general public regardless of risk status. They also recommended education for parents and teachers who are in positions to control bathroom access. Conclusions: Results indicate a uniform desire for information on women's bladder health and a need for more research to develop individual prevention strategies and public health messaging for women of all ages, as well as guidance for organizations with a role in supporting bladder health.

Feasibility, acceptability and effects of a group pelvic floor muscle telerehabilitation program to treat urinary incontinence in older women

INTRODUCTION

Urinary incontinence (UI) is one of the most prevalent health concerns in women age 65 and over. The recommended first-line treatment for UI is individual pelvic floor muscle training (PFMT). However, healthcare systems worldwide are unable to meet the demand for this resource-intensive approach. Recently, the Group Rehabilitation Or IndividUal Physiotherapy (GROUP) trial showed that group-based PFMT was not inferior to individual PFMT to treat UI in older women, despite using fewer resources. This study aims to assess the feasibility, acceptability and effects on UI-related symptoms and associated quality of life (QoL) of an online adaptation of the GROUP program (teleGROUP) for UI in older women.

METHODS AND ANALYSIS

This pilot study will involve the recruitment of 32 older women with UI. Participants' attendance to online sessions, adherence to weekly home exercises, and side effects, in addition to the physiotherapist's fidelity to the program delivery will be collected to evaluate the program's feasibility. Participants' dropout rates, reasons for dropout, satisfaction and usability scores will be collected to evaluate the program's acceptability for participants. A survey will evaluate the program's acceptability for the physiotherapists. Additionally, at the end of the study, qualitative semi-structured interviews and focus groups will investigate further feasibility and acceptability. To measure the effects of teleGROUP, number of weekly leakages and percentage reduction will be the primary outcomes.

The role of intermediaries in connecting community-dwelling adults to local physical activity and exercise: A scoping review protocol

Introduction: Physical inactivity is a major global issue affecting health. Promoting, supporting and encouraging physical activity amongst community-dwelling adults is essential. An intermediary is a clinical or non-clinical professional based in primary care, community or voluntary settings. They support individuals referred to them to connect with appropriate community services with the goal of improving health and wellbeing. This may be a promising method to establish a connection to local physical activity and exercise; however the process has been poorly described to date. Objective: The objectives of this scoping review will be to identify and summarise the literature describing the process of connecting community-dwelling adults to an intermediary, the characteristics of these adults, the processes (role, practice and procedure) of an intermediary in connecting these adults to local physical activity and exercise opportunities, and to map these processes of connection to outcomes. Methods: This scoping review will be conducted in accordance with the scoping review methodology of the Joanna Briggs Institute. A comprehensive search strategy will identify relevant studies in Embase, Medline, Web of Science and CINAHL, along with a structured grey literature search. Studies which describe an intermediary connecting community-dwelling adults (aged ≥18 years) to local physical activity and exercise will be included. Data will be charted and narratively summarised. Intermediary processes will be mapped to outcomes related to physical activity, and the PAGER (patterns, advances, gaps, evidence for practice and research recommendations) framework will be used to identify evidence gaps and research recommendations. Conclusions: This scoping review will be the first to describe the process of an intermediary connecting community dwelling adults to local physical activity and exercise. This review will identify, map and summarise the existing research on the processes and outcomes. The results will also identify any evidence gaps and will guide future research.

Perceptions and help-seeking behaviours among community-dwelling older people with urinary incontinence: A systematic integrative review

AIM

To synthesize research evidence on perceptions and help-seeking behaviours in community-dwelling older people with urinary incontinence based on the Capability-Opportunity-Motivation-Behaviours model.

BACKGROUND

Urinary incontinence is highly prevalent in community-dwelling older people, yet only a small proportion seek help from health professionals. Untreated urinary incontinence has a detrimental impact on older people's quality of life and distresses their caregivers.

DESIGN

Systematic integrative review.

DATA SOURCES

Ten databases were searched systematically between 9 November 2020 and 17 December 2020 including Medline (PubMed), CINAHL, Ageline, Web of Science, Scopus, ProQuest, Psyclnfo, CNKI, Wanfang and Vip.

REVIEW METHODS

Quality appraisal was applied to assess the quality of selected articles. Data relevant to the review aim were extracted from included articles for analysis. Convergent qualitative synthesis was used to synthesize findings.

RESULTS

Twenty articles were included and two main themes with six sub-themes were identified. Theme one described three common perceptions including urinary incontinence as a part of normal ageing, a stigma and a health problem. Each perception had a profound impact on older people's motivation to self-report the problem to health professionals. Theme two revealed three main help-seeking approaches comprising self-help, help from friends and help from health professionals. Of these, self-help was the dominant approach used to conceal urinary incontinence and contributed to social isolation.

CONCLUSION

Improving urinary incontinence management in community-dwelling older people requires the development of their capability and motivation, and increased opportunities to access and gain help from skilled health professionals.

IMPACT

Findings can facilitate resource development to improve health literacy for the general public pertinent to urinary incontinence and associated stigma. Moreover, findings can inform a user-friendly reporting and referral system for the problem. In addition, findings can inform education and skill training for health professionals, older people and their caregivers to effectively manage the problem.

Urinary Incontinence and Depressive Symptoms: The Mediating Role of Physical Activity and Social Engagement

OBJECTIVES

This study investigates longitudinal within-person associations between urinary incontinence (UI) and depressive symptoms among older women. Drawing on activity theory, this study also adds to limited knowledge about the mediating role of physical activity and social engagement in the association between UI and depressive symptoms.

METHOD

Using six waves of a nationally representative longitudinal study of older adults in Korea between 2008 and 2018, this study examined the relationship between UI and depressive symptoms among women aged 70 and over. Fixed effects models were estimated to account for unobserved time-invariant confounding factors. Sobel mediation tests were conducted to formally test for mediation.

RESULTS

Fixed effects estimates showed that, after adjusting for a wide array of time-varying covariates, having UI is positively associated with depressive symptoms among older women (b = 0.238, p < 0.05). Results revealed that individuals who begin to experience UI tend to have less frequent social interactions and participate in fewer social activities. UI, however, is only marginally associated with a decrease in physical activity. Reductions in physical activity, social connections, and social activities jointly explain about 22% of the association between UI and depressive symptoms, rendering it statistically insignificant.

DISCUSSION

UI poses a threat to psychological well-being among older women. This is partly explained by a decrease in physical activity and disruption in social engagement. This study reaffirms the significance of the programs that promote physical and social activity among older adults.

Effect of Case-Based Small-Group Learning on Care Workers' Emergency Coping Abilities

This study aimed to develop and implement an emergency coping education program using a case-based small-group learning method and verify its effect on care workers’ emergency coping abilities. The study was conducted with 72 care workers in older adult care facilities and home care centers. Using a nonequivalent control group pretest–posttest design, 36 participants were assigned to each group (i.e., experimental and control groups). The collected data were analyzed through χ^²-test and independent t-test using SPSS for Windows, version 25.0. Compared to the control group, a statistically significant increase in knowledge and performance levels in emergencies, emergency coping abilities, self-efficacy in coping with emergencies, and confidence in communication was observed in the experimental group. This study was able to verify the effectiveness of the emergency coping education program in care workers and recommends its use. To maximize the learning effects of educational programs, future research should develop and apply programs that incorporate simulation education.

Patient-Provider Discussions About Urinary Incontinence Among Older Women

BACKGROUND

Urinary incontinence (UI) is prevalent in women and has been associated with decreased quality of life and institutionalization. Despite this, and the fact that several treatment options exist, few women discuss UI with clinicians. The aim of this study was to examine the proportion of middle aged and older women with urinary incontinence who have discussed UI with clinicians, focusing on female health professionals as a way to examine this question outside of issues of health care access.

METHODS

Data are from the Nurses Health Studies (NHS), two ongoing observational, prospective, cohort studies. The surveys collected detailed information about UI, including frequency, amount and type. Women were also asked if they had discussed UI with a clinician. We used multivariable-adjusted logistic regression to estimate odds ratios (OR) of participants reporting discussion about UI.

RESULTS

94,692 women with UI aged 49-91 years old were included in this study. Of these, 34% reported that they had discussed their incontinence with a clinician. Women with daily UI had 4.4 times greater odds of discussing it with clinicians when compared to those with monthly UI (OR = 4.36, 95% confidence interval [CI] 4.06-4.69). When controlling for severity of symptoms, the oldest women, greater than eighty years, were 20% less likely to have discussed UI with their clinician, compared to the youngest women (OR = 0.81, 95% CI 0.73-0.89).

CONCLUSIONS

A minority of women with UI, even among health professionals, discuss their symptoms with clinicians. Oldest women were the least likely to discuss their UI with a provider.

Explaining factors affecting help-seeking behaviors in women with urinary incontinence: a qualitative study

BACKGROUND

Urinary incontinence is widely accepted to be among the most important issues in the global health system. However, only a limited number of women are referred for treatment because different factors complicate help-seeking behaviors. The aim of this study was to explain the factors affecting help-seeking behaviors in women suffering from urinary incontinence.

METHODS

This study was a qualitative study using the conventional content analysis approach. The study was conducted from December 2018 and August 2019 in Tehran, Iran. The participants were 34 women with urinary incontinence selected using a purposive sampling method. The content analysis approach was based on the Graneheim and Lundman method, and qualitative data management software was used for analysis.

RESULTS

Data analysis illustrates two themes; " facilitator " and " inhibitor "; the categories "not perceiving disease", "shame", " negative support of important others", and "non-optimal health care system" were among the inhibitors and the categories " reduced quality of life " and " positive support of important others" were found to be facilitators of help-seeking behaviors.

CONCLUSIONS

The findings of the present study highlight the need for understanding the underlying facilitators and inhibitors of help-seeking behaviors in women with urinary incontinence. We suggest that healthcare providers consider an open dialogue with patients and consider their subjective beliefs and life context during routine visits to facilitate early diagnosis of the disease and ultimately lead to an improvement in the woman's quality of life.

No date for the PROM: the association between patient-reported health events and clinical coding in primary care

OBJECTIVE

It is unclear whether data from patient-reported outcome measures (PROMs) are captured and used by clinicians despite policy initiatives. We examined the extent to which fall risk and urinary incontinence (UI) reported on PROMS and provided to clinicians prior to a patient visit are subsequently captured in the electronic medical record (EMR). Additionally, we aimed to determine whether the use of PROMs and EMR documentation is higher for visits where PROM data was provided to clinicians.

DESIGN

We conducted a cross-sectional patient-reported risk assessment survey and semi-structured interviews with clinicians to identify themes related to the use of PROMs.

SETTING

Fourteen primary care clinics in the US (eight intervention and six control clinics), between October 2013 and May 2015.

PARTICIPANTS

Primary care clinicians and older adult (≥66 years) patients completing a 46-item health risk assessment, including PROMs for fall risk and UI.

INTERVENTION

Risk assessment results provided to the clinician or nurse practitioners prior to the clinic visit in intervention clinics; data was not provided in control clinics.

MAIN OUTCOME

1) Agreement between ICD-9 codes of fall risk or UI in the EMR and patient-reports, and 2) clinician experience of PROMs use and impact on coding.

RESULTS

A total of 505 older adult patients were included in the study, 176 at control clinics and 329 at intervention clinics. While patient reports of fall risk and UI were readily captured by PROMs, this information was only coded in the EMR between 3% - 14% of the time (poor Kappa agreement). Intervention clinics performed slightly better than control clinics. Clinician interviews (n = 16) revealed low use of PROMs data with multiple barriers cited including poor access to data, high quantity of data, interruption to workflow, and a lack of training on PROMs.

CONCLUSIONS

Current strategies of providing PROMs data prior to clinic visits may not be an effective way of communicating important health information to busy clinicians; ultimately resulting in underuse. Better systems of presenting PROMs data, and clinician training on the importance of PROMs and their use, is needed.

Urinary incontinence and chronic conditions in the US population age 50 years and older

INTRODUCTION AND HYPOTHESIS

Urinary incontinence is common among older adults with chronic conditions. The purpose of this study is to examine the association of urinary incontinence with chronic conditions in the US population.

METHODS

We used data from the 2001-2014 National Health and Nutrition Examination Survey; 7226 women and 7239 men age > 50 years answered questions regarding urinary symptoms. The analysis accounted for the complex survey design, and prevalence reflects estimates within the non-institutionalized US population.

RESULTS

The mean age was 64.2 years [standard error (SE) 0.2] among women and 62.9 (SE 0.1) years among men. Bothersome stress, urgency and mixed incontinence were reported by 6.7% (SE 0.4), 4.8% (SE 0.4) and 19.3% (SE 0.59) of women, respectively, and 0.6% (SE 0.1), 3.5% (SE 0.2) and 1.9% (SE 0.2) of men, respectively. Among chronic conditions, heart failure was associated with higher prevalence of mixed incontinence in women and urgency incontinence in men. Among women, heart failure was associated with significantly increased odds of bothersome mixed incontinence (OR 2.35; 95% CI 1.62, 3.42) and lower odds of stress (OR 0.50; 95% CI 0.3, 0.9) or urgency incontinence (OR 0.43; 95% CI 0.19, 0.98) after adjustment for covariates. Among men, heart failure was associated with higher odds of stress (OR 1.99; 95% CI 0.39, 10.22), urgency (1.65; 95% CI 0.91, 2.99) and mixed incontinence (OR 1.54; 95% CI 0.91, 2.62) but associations were not statistically significant.

CONCLUSIONS

Heart failure is associated with higher odds of bothersome incontinence, especially among women.

Chronic Condition Measurement Requires Engagement, Not Measurement Alone

Patient-reported outcome measures (PROMs) have great promise, but evidence of success is mixed. This study uses data from Dartmouth-Hitchcock Medical Center and Kaiser-Permanente Colorado to evaluate providing PROMs directly to the primary care physician. We compared changes over time in urinary incontinence, falls, and mental and physical health between clinics providing augmented PROMs (N = 202 patients) and control clinics (N = 102 patients). Both the control and treatment groups exhibited improvements, but there was no significant difference in outcomes over time. These results suggest that measuring and printing out PROMs for primary care physicians will not result in better patient outcomes without physician clinical engagement.

Multifaceted self-management interventions for older women with urinary incontinence: a systematic review and narrative synthesis

OBJECTIVE

To synthesise the evidence for the multifaceted self-management interventions for older women with urinary incontinence (UI) and to understand the outcomes associated with these interventions.

DESIGN

A systematic review and narrative synthesis to identify randomised controlled trials that investigated the effect of multifaceted self-management interventions for older women with UI.

METHODS

MEDLINE, PsycINFO, EMBASE, The Cochrane Library, CINAHL and Applied Social Sciences Index and Abstracts databases were searched (January 1990 to May 2019) using a systematic search strategy, complemented by manually screening the reference lists and citation indexes. Study selection, data extraction and risk of bias assessment were undertaken independently. A narrative synthesis was undertaken in which studies, interventions and outcomes were examined based on the intervention components. The effect size and 95% CI were estimated from each study.

RESULTS

A total of 13 147 citations were identified and 16 studies were included. There was no study rated as of high quality. Three types of multifaceted interventions were found: those that had an element of pelvic floor muscle exercises (PFME), those with bladder retraining and some with combination behavioural interventions. Outcome measures varied across studies. A statistically significant improvement in incontinence symptoms was reported in the intervention group compared with the control in 15 studies.

CONCLUSION

Multifaceted interventions that included PFME, bladder retraining or combination behavioural techniques appear to be useful in some settings for UI management in older women, but the quality of the evidence was poor and unclear. There was insufficient evidence to determine whether any of the combination of components is superior to others in improving UI symptoms. There is a need for high-quality studies to confirm the effectiveness of these interventions and to identify comparative effectiveness.

PROSPERO REGISTRATION NUMBER

CRD42018104010.

Identifying the most reliable and valid bladder health screening tool: a systematic review

Purpose: Lower urinary tract symptoms are common in advancing age and a major cause of disability through avoidance of activity and social engagement. This systematic review aimed to identify the most valid and reliable brief screening tool for these symptoms or bladder problems, to incorporate into a health promotion programme for older adults to facilitate discussion about self-management.Method: Review eligibility criteria included studies published between 1990 and November 2018, reporting the validity, reliability and/or acceptability of bladder health screening tools. Six electronic databases were searched.Results: Twenty-two studies were included. Three screening tools met the criteria: International Prostate Symptom Score (IPSS); International Consultation on Incontinence Questionnaire Urinary Incontinence Short-Form; Bladder Control Self-Assessment Questionnaire (B-SAQ). Test-retest reliability for total scores of the IPSS and International Consultation on Incontinence Questionnaire Urinary Incontinence Short-Form was acceptable. All three questionnaires showed evidence of acceptable levels of internal consistency and of convergent validity.Conclusion: Having favourable psychometric scores compared to the B-SAQ and for ease of use and trustworthiness of a simple questionnaire, the IPSS and International Consultation on Incontinence Questionnaire Urinary Incontinence Short-Form met the criteria for recommendation for raising awareness and bladder health promoting interventions to reduce associated disability.Implications for RehabilitationLower urinary tract symptoms are common in advancing age and a major cause of disability through avoidance of activity and social engagement.Lower urinary tract symptoms can be prevented or improved through self-management strategies.Help-seeking levels for lower urinary tract symptoms is low but could be improved through continence promotion interventions.The International Prostate Symptom Score and the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form are bladder health screening questionnaires which would be appropriate to use as part of a continence promotion intervention to help prompt discussions and raise awareness and subsequently improve symptoms and associated disability.

A group-based yoga program for urinary incontinence in ambulatory women: feasibility, tolerability, and change in incontinence frequency over 3 months in a single-center randomized trial

BACKGROUND

Because of the limitations of existing clinical treatments for urinary incontinence, many women with incontinence are interested in complementary strategies for managing their symptoms. Yoga has been recommended as a behavioral self-management strategy for incontinence, but evidence of its feasibility, tolerability, and efficacy is lacking.

OBJECTIVE

To evaluate the feasibility and tolerability of a group-based therapeutic yoga program for ambulatory middle-aged and older women with incontinence, and to examine preliminary changes in incontinence frequency as the primary efficacy outcome after 3 months.

MATERIALS AND METHODS

Ambulatory women aged 50 years or older who reported at least daily stress-, urgency-, or mixed-type incontinence, were not already engaged in yoga, and were willing to temporarily forgo clinical incontinence treatments were recruited into a randomized trial in the San Francisco Bay area. Women were randomly assigned to take part in a program of twice-weekly group classes and once-weekly home practice focused on Iyengar-based yoga techniques selected by an expert yoga panel (yoga group), or a nonspecific muscle stretching and strengthening program designed to provide a rigorous time-and-attention control (control group) for 3 months. All participants also received written, evidence-based information about behavioral incontinence self-management techniques (pelvic floor exercises, bladder training) consistent with usual first-line care. Incontinence frequency and type were assessed by validated voiding diaries. Analysis of covariance models examined within- and between-group changes in incontinence frequency as the primary efficacy outcome over 3 months.

RESULTS

Of the 56 women randomized (28 to yoga, 28 to control), the mean age was 65.4 (±8.1) years (range, 55-83 years), the mean baseline incontinence frequency was 3.5 (±2.0) episodes/d, and 37 women (66%) had urgency-predominant incontinence. A total of 50 women completed their assigned 3-month intervention program (89%), including 27 in the yoga and 23 in the control group (P = .19). Of those, 24 (89%) in the yoga and 20 (87%) in the control group attended at least 80% of group classes. Over 3 months, total incontinence frequency decreased by an average of 76% from baseline in the yoga and 56% in the control group (P = .07 for between-group difference). Stress incontinence frequency also decreased by an average of 61% in the yoga group and 35% in controls (P = .045 for between-group difference), but changes in urgency incontinence frequency did not differ significantly between groups. A total of 48 nonserious adverse events were reported, including 23 in the yoga and 25 in the control group, but none were directly attributable to yoga or control program practice.

CONCLUSION

Findings demonstrate the feasibility of recruiting and retaining incontinent women across the aging spectrum into a therapeutic yoga program, and provide preliminary evidence of reduction in total and stress-type incontinence frequency after 3 months of yoga practice. When taught with attention to women's clinical needs, yoga may offer a potential community-based behavioral self-management strategy for incontinence to enhance clinical treatment, although future research should assess whether yoga offers unique benefits for incontinence above and beyond other physical activity-based interventions.

Knowledge of Pelvic Floor Disorders in Obstetrics

OBJECTIVES

The aim of this study was to investigate knowledge and demographic factors associated with a lack of knowledge proficiency about urinary incontinence (UI) and pelvic organ prolapse (POP) among pregnant and postpartum women.

METHODS

This was a cross-sectional survey of women receiving antepartum and postpartum care at 9 Connecticut sites. Knowledge was assessed using the validated Prolapse and Incontinence Knowledge Questionnaire. Lack of knowledge proficiency was defined as less than 80% and less than 50% correct responses on the Prolapse and Incontinence Knowledge Questionnaire UI and POP subscales. Logistic regression was used to evaluate unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs). P < 0.05 was considered statistically significant.

RESULTS

Surveys from 399 diverse pregnant and postpartum women were analyzed. Three quarters showed a lack of knowledge proficiency about UI and POP (74.2%, 70.6%). After adjustment, increased odds of lacking UI knowledge proficiency were associated with primiparity versus nulliparity (OR, 4.73; 95% CI, 2.24-9.98), Hispanic versus white race (OR, 2.72; 95% CI, 1.18-6.01), and having a high school diploma/General Education Development/less (OR, 3.17; 95% CI, 1.34-7.48) or some college (OR, 2.55; 95% CI, 1.08-6.01) versus bachelor's degree; greater lack of POP knowledge proficiency was associated with having a high school diploma/General Education Development versus bachelor's degree (OR, 2.11; 95% CI, 1.05-4.26) and never seeing a urologist/urogynecologist versus those who had (OR, 0.30; 95% CI, 0.12-0.77). Women working in a medical field versus those who did not demonstrated decreased odds of lacking UI and POP knowledge proficiency (ORs, 0.26 [95% CI, 0.13-0.52] and 0.38 [95% CI, 0.21-0.70]).

CONCLUSIONS

Pregnant and postpartum women lack knowledge about UI and POP. Preconceptional counseling provides an opportunity for educational intervention.

Pelvic Floor Morphometric Differences in Elderly Women with or without Urinary Incontinence

Purpose: Urinary incontinence (UI) affects as many as 50% of women aged 60 years and older, but UI pathophysiology, specifically in elderly women, remains unclear. A better understanding of morphometric differences between continent and urinary incontinent elderly women is needed to improve the effectiveness of conservative treatment approaches. We hypothesized that morphometric differences in the pelvic floor muscles (PFM) among elderly women with and without UI could be observed using three- and four-dimensional (3D/4D) transperineal ultrasound (TPU) imaging. Method: A total of 40 elderly women (20 women with and 20 women without UI), with a mean age of 67.10 (SD 4.94) years, participated in the study. This was a case-control study in which TPU images were taken under three conditions: rest, maximal voluntary contraction (MVC), and Valsalva. Independent t-tests were conducted to compare measurements between the groups. Results: The study revealed statistically significant differences between the groups. At rest, the levator hiatal area and transverse diameter were bigger, and the PFM position was lower in the incontinent group. During MVC, all axial plane parameters were bigger in the incontinent group. In the sagittal plane, PFM position was again lower in the incontinent group. During Valsalva, the anorectal angle was wider in the women with incontinence. Conclusion: PFM morphometric differences were present and were observed using 3D/4D TPU imaging in elderly women with and without UI.

Understanding help-seeking in older people with urinary incontinence: an interview study

The prevalence of urinary incontinence (UI) increases with age and can negatively affect quality of life. However, relatively few older people with UI seek treatment. The aim of this study was to explore the views of older people with UI on the process of seeking help. Older people with UI were recruited to the study from three continence services in the north of England: a geriatrician-led hospital outpatient clinic (n = 18), a community-based nurse-led service (n = 22) and a consultant gynaecologist-led service specialising in surgical treatment (n = 10). Participants took part in semi-structured interviews, which were transcribed and underwent thematic content analysis. Three main themes emerged: Being brushed aside, in which participants expressed the feeling that general practitioners did not prioritise or recognise their concerns; Putting up with it, in which participants delayed seeking help for their UI due to various reasons including embarrassment, the development of coping mechanisms, perceiving UI as a normal part of the ageing process, or being unaware that help was available; and Something has to be done, in which help-seeking was prompted by the recognition that their UI was a serious problem, whether as a result of experiencing UI in public, the remark of a relative, the belief that they had a serious illness or the detection of UI during comprehensive geriatric assessment. Greater awareness that UI is a treatable condition and not a normal part of ageing is needed in the population and among health professionals. Comprehensive geriatric assessment appeared an important trigger for referral and treatment in our participants. Screening questions by healthcare professionals could be a means to identify, assess and treat older people with UI.

Bridging the gap: determinants of undiagnosed or untreated urinary incontinence in women

BACKGROUND

More than a third of middle-aged or older women suffer from urinary incontinence, but less than half undergo evaluation or treatment for this burdensome condition. With national organizations now including an assessment of incontinence as a quality performance measure, providers and health care organizations have a growing incentive to identify and engage these women who are undiagnosed and untreated.

OBJECTIVE

We sought to identify clinical and sociodemographic determinants of patient-provider discussion and treatment of incontinence among ethnically diverse, community-dwelling women.

STUDY DESIGN

We conducted an observational cohort study from 2003 through 2012 of 969 women aged 40 years and older enrolled in a Northern California integrated health care delivery system who reported at least weekly incontinence. Clinical severity, type, treatment, and discussion of incontinence were assessed by structured questionnaires. Multivariable regression evaluated predictors of discussion and treatment.

RESULTS

Mean age of the 969 participants was 59.9 (±9.7) years, and 55% were racial/ethnic minorities (171 black, 233 Latina, 133 Asian or Native American). Fifty-five percent reported discussing their incontinence with a health care provider, 36% within 1 year of symptom onset, and with only 3% indicating that their provider initiated the discussion. More than half (52%) reported being at least moderately bothered by their incontinence. Of these women, 324 (65%) discussed their incontinence with a clinician, with 200 (40%) doing so within 1 year of symptom onset. In a multivariable analysis, women were less likely to have discussed their incontinence if they had a household income < $30,000/y vs ≥ $120,000/y (adjusted odds ratio [AOR], 0.49, 95% confidence interval [CI], 0.28-0.86) or were diabetic (AOR, 0.71, 95% CI, 0.51-0.99). They were more likely to have discussed incontinence if they had clinically severe incontinence (AOR, 3.09, 95% CI, 1.89-5.07), depression (AOR, 1.71, 95% CI, 1.20-2.44), pelvic organ prolapse (AOR, 1.98, 95% CI, 1.13-3.46), or arthritis (AOR, 1.44, 95% CI, 1.06-1.95). Among the subset of women reporting at least moderate subjective bother from incontinence, black race (AOR, 0.45, 95% CI, 0.25-0.81, vs white race) and income < $30,000/y (AOR, 0.37, 95% CI, 0.17-0.81, vs ≥ $120,000/y) were associated with a reduced likelihood of discussing incontinence. Those with clinically severe incontinence (AOR, 2.93, 95% CI, 1.53-5.61, vs low to moderate incontinence by the Sandvik scale) were more likely to discuss it with a clinician.

CONCLUSION

Even in an integrated health care system, lower income was associated with decreased rates of patient-provider discussion of incontinence among women with at least weekly incontinence. Despite being at increased risk of incontinence, diabetic women were also less likely to have discussed incontinence or received care. Findings provide support for systematic screening of women to overcome barriers to evaluation and treatment.

Continence Across Continents To Upend Stigma and Dependency (CACTUS-D): study protocol for a cluster randomized controlled trial

Background

Urinary incontinence occurs in 40 % of women aged 65 years and over; however, only 15 % seek care and many delay healthcare seeking for years. Incontinence is associated with depression, social isolation, reduced quality of life, falls and other comorbidities. It is accompanied by an enormous cost to the individual and society. Despite the substantial implications of urinary incontinence on social, psychological and physical well-being of older women, the impact of continence promotion on urinary symptom improvement and subsequent effects on falls, quality of life, stigma, social participation and the cost of care remains unknown.

Methods

This study is a mixed methods multi-national open-label 2-arm parallel cluster randomized controlled trial aiming to recruit 1000 community-dwelling incontinent women aged 65 years and older across Quebec, Western Canada, France and United Kingdom. Participants will be recruited through community organizations. Data will be collected at 6 time points: baseline and 1 week, 3 months, 6 months, 9 months and 12 months after baseline. One of the primary objectives is to evaluate whether the continence promotion intervention improves incontinence symptoms (measured with the Patient Global Impression of Improvement questionnaire, PGI-I) at 12 months post intervention compared to the control group. Other co-primary outcomes include changes in incontinence-related stigma, fall reduction, and incremental cost-effectiveness ratio and quality-adjusted life years. Data analysis will account for correlation of outcomes (clustering) within community organizations. A qualitative sub-study will explore stigma reduction.

Discussion

Community-based continence promotion programs may be a cost-effective strategy to reduce urinary incontinence, stigma and falls among older women with untreated incontinence, and simultaneously improve quality of life and healthy active life expectancy.

Trial registration

ClinicalTrials.gov: NCT01858493, registered 13 May 2013

Prevalence, management and outcomes of medically complex vulnerable elderly patients with urinary incontinence in the United States

OBJECTIVES

To assess the prevalence, patient-physician communication, treatment and health outcomes associated with urinary incontinence (UI) among the medically complex vulnerable elderly (MCVE) in the United States (US).

METHODS

Data from the 2006 to 2012 Medicare Health Outcomes Survey (HOS) were used. MCVE patients were aged 65+ years with a HOS VE score ≥ 3. UI was reported as a small, big or no problem. Descriptive statistics were used to assess patient-physician communication and treatment. Multivariable regression analyses were performed to assess the association of small or big UI problems with various outcomes.

RESULTS

The annual UI prevalence increased among MCVE [from 35.8% (2006) to 38.6% (2012)]. MCVE with big UI problems communicated with their physicians more often than those with small UI problems (77.9% and 49.6%, respectively); however, treatment of UI remained low (48.5% and 29.1%, respectively). Physical component summary (PCS) and mental component summary (MCS) scores were lower among MCVE with small or big UI problems compared with those with no UI problems, respectively. The decrements in PCS and MCS scores associated with big UI problems were greater than the decrements associated with any of the other assessed conditions. MCVE with small or big UI problems, respectively, were more likely to report past falls, depression and activity daily living limitations vs. those without UI. The odds of having experienced these outcomes were greater for those with big UI vs. small UI problems.

CONCLUSIONS

Urinary incontinence prevalence in the USA increased among MCVE from 2006 to 2012, although treatment of UI remained low. UI problems, particularly big UI problems, adversely impact health outcomes. Efforts to better identify and manage UI among the MCVE are needed.

A group-based yoga therapy intervention for urinary incontinence in women: a pilot randomized trial

OBJECTIVE

The aim of this study is to examine the feasibility, efficacy, and safety of a group-based yoga therapy intervention for middle-aged and older women with urinary incontinence.

METHODS

We conducted a pilot randomized trial of ambulatory women aged 40 years and older with stress, urgency, or mixed-type incontinence. Women were randomized to a 6-week yoga therapy program (n = 10) consisting of twice weekly group classes and once weekly home practice or a wait-list control group (n = 9). All participants also received written pamphlets about standard behavioral self-management strategies for incontinence. Changes in incontinence were assessed with 7-day voiding diaries.

RESULTS

The mean (SD) age was 61.4 (8.2) years, and the mean baseline frequency of incontinence was 2.5 (1.3) episodes/d. After 6 weeks, the total incontinence frequency decreased by 70% (1.8 [0.9] fewer episodes/d) in the yoga therapy versus 13% (0.3 [1.7] fewer episodes/d) in the control group (P = 0.049). Participants in the yoga therapy group also reported an average of 71% decrease in stress incontinence frequency (0.7 [0.8] fewer episodes/d) compared with a 25% increase in controls (0.2 [1.1] more episodes/d) (P = 0.039). No significant differences in reduction in urgency incontinence were detected between the yoga therapy versus control groups (1.0 [1.0] versus 0.5 [0.5] fewer episodes/d; P = 0.20). All women starting the yoga therapy program completed at least 90% of the group classes and practice sessions. Two participants in each group reported adverse events unrelated to the intervention.

CONCLUSIONS

Findings provide preliminary evidence to support the feasibility, efficacy, and safety of a group-based yoga therapy intervention to improve urinary incontinence in women.

Urinary incontinence and poor functional status in fragility fracture patients: an underrecognized and underappreciated association

PURPOSE/INTRODUCTION

Urinary incontinence (UI) affects some 20 % of community-dwelling older people and 30-60 % of people in institutional care. UI is known as an independent predictor of falls, and likely impacts fracture rates. The aim of the study was to measure the prevalence of UI in a typical fragility fracture population, to evaluate the relationship of UI with functional disability in the post-acute setting.

METHODS

Our study is a retrospective cross-sectional study of patients admitted to rehabilitation setting after inpatient hospital management for a fragility fracture. We included all consecutively admitted fragility fracture patients aged over 65. All patients underwent standard clinical examination and Geriatric Assessment. We assessed UI using a two-stage process with a six-item UI screening questionnaire followed by an interview.

RESULTS

1,857 (80.7 % female) patients were available for analysis, mean age was 81.7 years. UI was identified in 59.2 % of all fragility fracture patients, and was more prevalent in females. Patients suffering from UI differed significantly in almost all measured functional and cognitive tests, with increased dependency/lower ADL scores, increased rates of immobility, and higher rates of cognitive dysfunction and depression.

CONCLUSION

This study confirms the high prevalence of UI in older fragility fracture patients, and the association between UI and functional impairments. The diagnostic work-up and treatment of patients should be focused on the special needs of these older patients. More efforts are needed to increase awareness about prevalence and consequences of UI among older fragility fracture patients.

How large is the gap between self-report and assessed mental health and does it impact older adult mental health service utilization?

We examined the relationship between self-reported and assessed mental health status and service use, using data from the Health and Retirement Study (N = 9,547). Twelve percent and thirty percent had inaccurate perceptions of their mood and memory status, respectively. No significant difference was found in the likelihood of service use between older adults who were unaware of current depressive symptoms and those who self-reported problems but had no assessed symptoms. Older adults who scored low in cognitive test were more likely to use services, regardless of self-reported memory status. Discrepancies between self-reported and assessed status may contribute to service utilization.

Experiences and treatment patterns of hypogonadal men in a U.S. health system

OBJECTIVE

To examine self-reported experiences with hypogonadism (HG) and patterns of testosterone replacement therapy (TRT) in men seeking care in a U.S. healthcare system.

METHODS

Men ≥ 18 years old with HG were identified from the 2008-2010 Reliant electronic medical records database. Surveys, including validated instruments for measuring symptoms of HG, were collected and evaluated for demographic and behavioural data.

RESULTS

Surveys were mailed to 133 men with HG in 2012. Of the 107 surveys returned, 95 were included in the final analysis. Most respondents were Caucasian (90.5%). Men reported developing symptoms of HG, as well as being diagnosed, at a median age of 50 years. The most common symptoms reported as reasons for seeking treatment were erectile dysfunction (66.3%), fatigue (59.0%) and decreased sex drive (57.9%). These continued to be the most bothersome symptoms at the time of the survey regardless of whether the patient received treatment, although men who were currently taking TRT reported less severe symptoms. Approximately 88% of men reported taking TRT at some point, with 61.9% on therapy at the time of the survey.

CONCLUSIONS

This study examined men's experiences with HG, including symptoms, quality of life, and treatments. Some symptoms continued despite treatment, and therapy was discontinued at a high rate, which men generally attributed to cost and perceptions of efficacy. In light of this lack of adherence, patients may benefit from appropriate expectation setting regarding reasonable timelines for symptom improvement, the strengths and challenges of various TRT formulations, the importance of adherence and the benefits and risks of TRT.