Abstract
This study aims to evaluate the impact of urinary incontinence on the quality of life in those receiving home care services and the factors that influence this. This cross-descriptive study was performed in 180 patients who were served from Home Care Services between 01 and 28 February 2018. An International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF) was implemented in person to those who gave their informed consent with orientation and cooperation. The mean age of a 180 patients was 74.40 ± 7.80 years (min = 18, max = 104), of which 55.2% were women. The mean ICIQ-SF score was found to be 12.42 ± 4.83 (min = 0, max = 21). The lowest points were given as responses to the question, “In your opinion, what amount of leakage do you experience?” The highest points, however, were given to the question of “How much does urinary leakage interfere with your everyday life?” It was seen that when quality of life is assessed with a visual analog scale within the ICIQ-SF, the quality of life for 66.6% of elderly individuals was affected moderately or significantly. The mean ICIQ-SF scores were higher in those with chronic diseases (p < .005). Urinary Incontinence negatively affects quality of life to a moderate and significant degree in those receiving home care. The quality of life for those who have chronic diseases was worse. In this respect, there is a need to support patients in those receiving home care services.
Introduction
Urinary Incontinence (UI) is a problem frequently seen in society that negatively affects quality of life, is distressing, and can lead to. 1 The International Continence Association defines UI as the “grievance of unintentional urinary leakage.” 2 They believe that the incontinence among elderly patients is a normal result of aging and that it has no treatment besides surgery. For this reason, UI cannot be vocalized as a grievance as long as physicians are not asked. 3 Only one-third of patients with UI seek out medical treatment. 4 The UI frequency in geriatric cases in our country is 44.2%. It was found to be 21.5% in males and 57% in females. However, if this case is not asked in detail, only one in 10 patients specify this complaint. 5 Another study reported that the prevalence of UI in our country varies from 9.6% to 25.8%. 6
The most important cause that triggers UI in the elderly is urinary tract infections. In addition to this, advanced age, the female sex, comorbidity, cognitive condition, and medications taken (lithium, tricyclic antidepressants, glitazones, alcohol, alpha blockers, diuretics, anticholinergics, cholinesterase inhibitors, narcotic analgesics, NSAIDs, calcium canal blockers, etc.) are among the prime risk factors for UI. Decreases in the level of estrogen hormones after menopause, decrease in urethral pressure, urethral hypermobility, prostate hypertrophy, urethral stricture, changes in bladder function, changes in immune function, neurologic and metabolic changes like diabetes mellitus, and changes in renal functions play a role in the etiology. 7
UI physically can lead to recurring urinary system infections, similarly to how it can lead to a wide array of skin lesions varying from symptoms of maceration and irritation in the skin to pressure injuries. 8 In terms of the psychosocial, individuals deplete their own confidence, see themselves as dependent on others, and place limitations on their social lives. 9 Acute onset and/or temporary UI is an incontinence that lasts for 6 months or shorter, develops spontaneously, generally secondary to an acute disease and is treatable. 10 Temporary UI is seen in one-third of patients laying in hospital beds and in 50% of patients being treated in outpatient care. 11 Confusion or delirium developed secondary to an acute illness arise for reasons such as the increase in the production of urine in connection with metabolic conditions like infection, atrophic urethritis or vaginitis, hyperglycemia, hypercalcemia, or Paget’s disease; the pressing of firm stool against the urethra; and the restriction of movement. 12 Chronic or persistent UI can be assessed as permanent if UI continues after the conditions that lead to acute or temporary UI are excluded. 13 Stress-type UI is diagnosed with symptoms of the “complaint of the unintended loss of urine experienced while coughing, sneezing, the exertion of effort or physical exercise,” and the root cause is the deterioration of the support of the pelvic floor, which supports the bladder and/or urethra. Urge-type UI has been defined as the “complaint of the unintended loss of urine that arises together with, or immediately after, feelings of urgency.” The extreme neurogenic or idiopathic activity of the detrusor muscle plays a role in urge-type UI. Mixed-type UI is the condition in which complaints of stress and urge-type UI are seen together. 14
Medical history, physical examination, and urinary analysis are generally sufficient for the elucidation of the etiology and the regulation of initial treatment. Additionally, our primary goals in diagnosis should be to reveal present UI type and the potentially revertible causes for a suitable treatment plan and to direct these by specifying cases that make future examination or urological or gynecological assessment necessary. 15
Despite being treatable, UI continues to be a major problem in society in terms of its physical, psychosocial, and economic effects, and most of the time confronts us as situations in which referrals to health institutions and treatment are delayed. Various medical conditions (cardiovascular diseases, depression, cerebrovascular diseases, etc.), including neurological diseases, are found to be correlated to UI. 16
Home care services are the specification of the treatment needs of individuals who are bedridden or semidependent by visiting them at home. 17 UI is frequently seen in those receiving home care. In previously conducted studies, the prevalence of UI in individuals above the age of 65 who are receiving home care is approximately 50%. 18
Our objective in this study evaluates the impact on quality of life of UI in those who are receiving home care services.
Materials and Methods
This descriptive, cross-sectional type study was conducted between the 01 and 28 February 2018 in Samsun province. Upon receiving the informed consent of patients with UI who were oriented and cooperative, a survey form containing sociodemographic information and the International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF) was implemented during a face-to-face interview. Sociodemographic data were recorded based on the files of patients recorded in the Home Care Service. Age, gender, marital status, social security status, educational status, pain and nourishment status, the presence of bedsores, history of falling, and the presence of chronic diseases were inquired. The informed consent forms for those who are illiterate or who have aphasia were filled out by one of the patient’s relatives.
The Turkish validity and reliability of the ICIQ-SF was made by Cetinel (Cronbach’s α = 0.91). This form asks about the quality of life because it assesses incontinence type, degree, and psychosocial effects. The form also inquires into the impact of UI on quality of life in elderly individuals with a visual, analog scale. In responses given to the question of “How frequently do you experience leakage?”, 0 points are given for “never,” 1 point is given for “about once a week or less,” 2 points are given for “two or three times a week,” 3 points are given for “about once a day,” 4 points are given for “a couple times a day,” and 5 points are given for “always.” 0 points are given to those who gave no response to the question, “In your opinion, what amount of leakage do you experience?”, 2 points to those who said a small amount, 4 points to those who said a moderate amount, and 6 points to those who said a large amount. Points are given between 0 (“not at all”), 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 (“significantly”), to the question of “How much does urinary leakage impact your daily life?” The IQO-L is calculated by gathering the points from these three questions. 19
Health Sciences University Samsun Educational and Research Hospital Clinical Research Ethical Committee approval was granted for the study. The Mann–Whitney U and Kruskal–Wallis tests were implemented in the statistical analysis. The data were evaluated using the SPSS 20.00 package program. Statistical significance was accepted p < .05.
Results
The mean age of the patients was 74.40 ± 7.80 years (min = 18, max =104). Around 56.11% (n = 101) of those receiving home care were female, 61.11% (n = 110) of patients were married, and 42.78% (n = 77) of the individuals graduated from primary school. Of the 180 individuals, 49.44% (n = 89) of patients income is equal to expenses. The most frequent group (32.22%, n = 58) was neurological diseases (cerebrovascular disease, Parkinson’s, etc.). About 36.12% (n =) of the patients had a chronic disease and 98.89% (n = 178) of the patients had social insurance (Table 1).
Descriptive Characteristics of Patients (n = 180).
While responses of “I experience leakage while coughing, sneezing” and “I experience leakage while moving about or exercising” are defined as stress-type incontinence in the ICIQ-SF scale, “I experience leakage while finishing urinating and getting dressed” was defined as urge-type incontinence. It was diagnosed as mixed-type UI when stress and urge incontinence were seen together. Based on this, stress-type incontinence was identified in 25% of our patients, and urge-type incontinence was identified in 24% of our patients (Table 2).
International Incontinence Questionnaire–Short Form (n = 180).
The ICIQ-SF (n = 180) score was found to be 12.42 ± 4.80 (min = 0, max = 21; Table 2). The lowest points (1.43 ± 0.61) were given as responses to the question, “In your opinion, what amount of leakage do you experience?” The highest points (6.21 ± 1.62) were given to the question of “How much does urinary leakage interfere with your everyday life?”
When the frequency of urinary leakage in elderly individuals evaluated with the ICIQ-SF is examined, 28.4% (n = 51) reported that they experienced leakage a couple times a day, 25.6% (n = 46) reported that they experience leakage two or three times a week, 21.5% (n = 39) reported that they experience leakage once or fewer times a week, and 18.8% (n = 44) reported that they always experience urinary leakage. It was seen that when quality of life is assessed with a visual analog scale within the ICIQ-SF, the quality of life for 66.6% (n = 120) of elderly individuals was affected moderately or significantly (Table 2).
No significant relationship between gender, social insurance, income status, and pressure injuries was detected. The ICIQ-SF scores were found to be higher in those with chronic diseases (Table 3; p < .005).
The Relationship Between International Incontinence Questionnaire–Short Form and Sex, Social Insurance, Income Status, Pressure Sore, and Chronic Diseases (n = 180).
Mann–Whitney U test.
Kruskal–Wallis test. Note: Bold values are scientificly significant.
Discussion
During the home visits, it was seen that the patients considered UI a natural part of old age and did not refer to a physician for this reason. UI is not being a pathological condition. Treatment of UI is possible.
The mean age of the patients in our study was 74.40 ± 7.80 years. The mean age in Akdemir et al’s study was 67.9. 20 Totally, 68.9% of the patients in our study were above the age of 66 years. Of the patients in the study that Tasdelen and Ates conducted, 59.3% were above the age of 76 years. 17
About 56.11% of the patients in our study receiving home care services were female. Of those receiving home care in the study John et al conducted, 80.8% were women. 21
In our study, 42.78% of patients were primary school graduates. Of those receiving home care in the study Isik et al conducted, 43.9% were primary school graduates. 22
Of the patients in our study, 36.12% had any kind of chronic disease. Of the patients in Söylemezo et al’s study, 19.2% had any kind of chronic disease. 23 The prevalence of chronic disease increases each year. For this reason, the frequency of chronic diseases may have been high in our study.
Of the patients with UI in our study, 24.44% had cerebrovascular disease. In the study that Roe et al conducted, 45.0% of patients receiving home care have a neurological disease. 24 Of those receiving home care in Limnili and Ozcakar study, 25.0% had dementia and 21.4% had cerebrovascular disease. 25 In the study that Cayir et al conducted, half of those receiving home care had cerebrovascular disease and Alzheimer’s .Neurological patients compose the majority of patients receiving home care services.
Around 34.4% of the patients in our study had pressure injuries (stages I-II). In Cayir et al’s study, 42.1% of those receiving home care services pressure injuries. 26
Stress incontinence was seen in 25% of the patients in our study. In the study that Kikuchi et al conducted, 36.1% of the patients were seen to have stress incontinence. 27
We determined in our study that the quality of life for 65.5% of the patients evaluated with the ICIQ-SF was moderately or significantly affected. In the study that Ilce and Ayhan conducted, the quality of life for 66.6% of the patients whose UI was evaluated with the ICIQ-SF was moderately or significantly affected. It was determined in Simeonova et al’s study that those with incontinence had a worse quality of life. 28
While the mean ICIQ-SF score in those with UI was 12.7 ± 3.6 in Padros et al’s study. 29 In our study ICIQ-SF score was 12.42 ± 4.80. The mean ICIQ-SF score in those with UI in the study that Ergin et al conducted was calculated as 5.49 ± 8.53 (min = 0, max = 21). 30 The ICIQ-SF points ended up being lower compared with our study. The reason for this was that our patients who were completely bedridden may have been higher when compared with Ergin et al’s study.
There are not many studies on this area. To obtain better results in this area, it is necessary to carry out large-scale studies.
Conclusion
UI is common in our patients receiving home care. It was determined that UI evaluated with the ICIQ-SF scale in those receiving home care negatively affected their quality of life. The mean ICIQ-SF scores were higher in those with chronic diseases. Disorders seen frequently in old age like UI are gradually increasing in prevalence with the extension of the life expectancy at birth in recent years. However, UI is not a natural result of aging. UI is a treatable condition. Knowledge and education should be provided on this topic to our patients who are receiving home care services and their relatives.
Footnotes
Ethical Approval
Health Sciences University Samsun Education and Research Hospital Clinical Research Ethical Committee approval was granted for the study.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
