Urinary incontinence in Norwegian nursing home residents

Abstract

Urinary incontinence is a multi-factorial condition that has a high impact on older persons living in nursing homes. While urinary incontinence is common, only a small percentage of nursing home residents have an official diagnosis. Factors influencing urinary incontinence in this population are poorly understood. The aim of this study was to evaluate the prevalence of urinary incontinence in Norwegian nursing home residents and to study the factors associated with urinary incontinence in this population. Residents from six different nursing homes were included in this study. Data on sex, age, medication, comorbid illnesses, urinary incontinence and the use of absorbent pads was collected. Barthel`s Index of Activities of Daily Living (ADL) was used to estimate residents’ functional levels. Post-voiding residual urine was measured by means of a portable ultrasound. A questionnaire was completed by the nursing staff for each of the residents. In total, 173 residents participated in the study. One hundred and twenty-two residents (69%) were incontinent for urine and 144 used absorbent pads (83%). Fourteen percent of residents used absorbent pads ‘just to make sure’. They did not have a history of urinary incontinence. Low ADL score, dementia and urinary tract infection were significantly associated with incontinence for urine. The prevalence of urinary incontinence in Norwegian nursing homes is high. Absorbent products are frequently used without a history of urinary incontinence. Physical impairment, dementia and urinary tract infections are significantly associated with urinary incontinence.

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Skotnes, L. , Omli, R. , Romild, U. , Hellzèn, O. and Kuhry, E. (2012) Urinary incontinence in Norwegian nursing home residents. Open Journal of Nursing, 2, 116-122. doi: 10.4236/ojn.2012.22018.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Aggazotti, G., Pesce, F., Grassi, D., Fantuzzi, G., Righi, E., De Vita, D., Santacroce, S. and Artibani, W. (2000) Prevalence of urinary incontinence among institutionalized patients: A cross-sectional epidemiologic study in a midsized city in northern Italy. Urology, 56, 245-249. doi:10.1016/S0090-4295(00)00643-9
[2] Hunskaar, S. and Vinsnes, A. (1992) The quality of life in women with urinary incontinence as measured by the sickness impact profile. Journal of American Geriatrics Society, 40, 976-977.
[3] Wilson, L., Brown, J.S., Shin, G.P., Luc, K.O. and Subak, L.L. (2001) Annual direct cost of urinary incontinence. American Journal of Obstetrics and Gynecology, 98, 398-406. doi:10.1016/S0029-7844(01)01464-8
[4] Newman, D.K. and Palmer, M.H. (1999) Incontinence and PPS: A new era. Ostomy Wound Management, 45, 32-44.
[5] Abrams, P., Cardozo, L., Fall, M., Griffiths, D., Rosier, P., Ulmsten, U., Von Kerrebroeck, P., Victor, A. and Wein, A. (2003) Standardisation subcommittee of the international continence society. The standardisation of terminology in lower urinary tract function: Report from the standardisation sub-committee of the international continence society. Urology, 61, 37-49. doi:10.1016/S0090-4295(02)02243-4
[6] Anger, J.T., Saigal, C.S., Pace, J., Rodriguez, L.V., Litwin, M.S. and the Urologic Diseases of America Project (2006) The true prevalence of urinary incontinence among female nursing home residents. Urology, 67, 281-287. doi:10.1016/j.urology.2005.08.062
[7] Brocklehurst, J.C. (1993) Urinary incontinence in the community-analysis of a MORI poll. British Medicine Journal, 306, 832-834. doi:10.1136/bmj.306.6881.832
[8] Offermans, M.P., Moulin, D., Hamers, J.P., Dassen, T. and Halfens, R.J. (2009) Prevalence of urinary incontinence and associated risk factors in nursing home residents: A systematic review. Neurourology Urodynamics, 28, 288-294. doi:10.1002/nau.20668
[9] Engberg, S., Kincade, J. and Thompson, D. (2004) Future directions for incontinence research with frail elders. Journal of Nursing Research, 53, 6S.
[10] Skelly, J. and Flint, A.J. (1995) Urinary incontinence associated with dementia. Journal of American Geriatrics Society, 43, 286-294.
[11] Dingwall, L. and Mclafferty, E. (2006) Do nurses promote urinary continence in hospitalized older people? An exploratory study. Journal of Clinical Nursing, 15, 1276-1286. doi:10.1111/j.1365-2702.2006.01381.x
[12] Palmer, M.H. and Newman, D.K. (2004) Bladder matters: Urinary incontinence in nursing homes. American Journal of Nursing, 104, 57-59. doi:10.1097/00000446-200411000-00028
[13] Watson, N., Brink, C.A, Zimmer, J.G. and Mayer, R.D. (2003) Use of the agency for health care policy and research urinary incontinence guideline in nursing homes. Journal of American Geriatrics Society, 51, 1779-1786. doi:10.1046/j.1532-5415.2003.51564.x
[14] Royal College of Physicians (1995) Incontinence. Causes, management and provision of services. A working Party of the Royal College of Physicians. The Royal College of Physicians of London, 29, 272-274.
[15] Omli, R., Skotnes, L.H., Mykletun, A., Bakke, A.M. and Kuhry, E. (2008) Residual urine as a risk factor for lower urinary tract infections: A one year follow up in nursing homes. Journal of American Geriatrics Society, 56, 871-874. doi:10.1111/j.1532-5415.2008.01646.x
[16] Omli, R., Skotnes, L.H., Romild, U., Bakke, A.M., Mykletun, A. and Kuhry E. (2010) Pad per day usage, urinary incontinence and urinary tract infections in nursing home residents. Age Ageing, 39, 549-554. doi:10.1093/ageing/afq082
[17] Lubke, N., Meinck, M. and Von Renteln-Kruse, W. (2004) The Bartel Index in geriatrics. A context analysis for the Hamburg Classification Manual. Archives of Gerontolology and Geriatrics, 37, 316-326.
[18] Mahony, F. and Barthel, D. (1965) Functional evaluation: The Barthel Index. Rehabilitation, 4, 61-65.
[19] Borrie, M.J., Campell, K., Arcese, Z.A., Bray, J., Hart, P. and Labate, T. (2001) Urinary retention in patients in a geriatric rehabilitation unit: Prevalence, risk factors, and validity of bladder scan evaluation. Rehabilitation Nursing, 26, 87-191.
[20] Teng, C.H., Huang, Y.U., Kuo, B.J. and Bih, L.I. (2005) Application of portable ultrasound scanners in the measurement of post-void residual urine. Journal of Nursing Research, 13, 216-224. doi:10.1097/01.JNR.0000387543.68383.a0
[21] Resnick, B. (1995) A bladder scan trial in geriatric rehabilitation. Rehabilitation Nursing, 20, 194-196.
[22] Declaration of Helsinki (1964) Archive of British medical journal, 313.
[23] Ouslander, J.G. and Schnelle, J.F. (1995) Incontinence in the Nursing Home. Annals of Internal Medicine, 122, 438-449.
[24] Resnick, N.M., Yalla, S.V. and Laurino, E. (1989) The pathophysiology of urinary incontinence among institutionalized elderly persons. The New England Journal of Medicine, 320, 1-7. doi:10.1056/NEJM198901053200101
[25] Taylor, J.A. and Kuchel, G.A. (2006) Detrusor underactivity: Clinical features and pathogenesis of an underdiagnosed geriatric condition. Journal American Geriatrics of Society, 54, 1920-1932. doi:10.1111/j.1532-5415.2006.00917.x
[26] Kebapci, N., Yenilmez, A., Efe, B., Entok, E. and Deminirustu C. (2007) Bladder dysfunction in type 2 diabetic patients. Neurourology and Urodynamics, 26, 814-819. doi:10.1002/nau.20422
[27] Kaplan, S.A., Te, A.E. and Blaivas, J.G. (1994) Urodynamic findings in patients with diabetic cystopathy. Journal of Urology, 153, 342-344. doi:10.1097/00005392-199502000-00013
[28] Menéndez, V., Cofán, F., Talbot-Wright, R., Ricart, M.J., Gutiérrez, R. and Carretero, P. (1996) Urodynamic evaluation in simultaneous insulindependent diabetes mellitus and end stage renal disease. Journal of Urology, 155, 2001-2004. doi:10.1016/S0022-5347(01)66074-9
[29] Ueda, T., Yoshimura, N. and Yoshida, O. (1997) Diabetic cystopathy: Relationship to autonomic neuropathy detected by sympathetic skin response. Journal of Urology, 157, 580-584. doi:10.1016/S0022-5347(01)65209-1
[30] Kaplan, S.A. and Blaivas, J.G. (1988) Diabetic cystopathy. Journal of Diabetes Complications, 2, 133-139. doi:10.1016/S0891-6632(88)80024-2
[31] Goode, P.S. and Burgio, K.L. (1997) Pharmacologic treatment of lower urinary tract dysfunction in geriatric patients. The American Journal of the Medical Sciences, 314, 262-267. doi:10.1097/00000441-199710000-00010
[32] Hajjar, E.R., Cafiero, A.C. and Hanlon, J.T. (2007) Polypharmacy in elderly patients. The American Journal Geriatric Pharmacotherapy, 5, 345-351. doi:10.1016/j.amjopharm.2007.12.002
[33] Gormley, E.A., Griffiths, D.J., McCracken, P.N. and Harrison, G.M. (1992) Polypharmacy and its effect on urinary incontinence in geriatric population. British Journal of Urology, 71, 265-269. doi:10.1111/j.1464-410X.1993.tb15940.x
[34] Ekundayo, O.J., Markland, A., Lefante, C., Sui, X., Goode, P.S., Allman, R.M., Ali, M., Wahle, C., Thornton, P.L. and Ahmed, A. (2009) Association of diuretic use and overactive bladder syndrome in older adults: A propensity score analysis. Archives of Gerontolology and Geriatrics, 49, 64-68. doi:10.1016/j.archger.2008.05.002
[35] Rodhe, N., Englund, L., M?lstad, S. and Samuelsson, E. (2008) Bacturiuria is associated with urge urinary incontinence in older women. Scandinavian Journal of Primary Health Care, 26, 35-39. doi:10.1080/02813430701878250
[36] Palmer, M.H. (1996) Urinary continence: Assessment and Promotion. Aspen Publication, Gaithersburg.
[37] Morris, J. (2007) Behind closed doors. Working with older people. Brighton, 11, 35-39.
[38] Schnelle, J.F., Cadogan, M.P., Dragan, G., Bates-Jensen, B.M., Osterweil, D., Yoshii, J. and Simmons S.F. (2003) A standardized quality assessment system to evaluate incontinence care in the nursing Home. Journal of American Geriatrics Society, 51, 1754-1761. doi:10.1046/j.1532-5415.2003.51560.x
[39] Resnick, B., Keilman, L.J., Calabrese, B., Parmelee, P., Lawhorne, L., Pailet, J. and Ouslander, J. (2006) Nursing staff beliefs and expectations about continence care in nursing homes. Journal of Wound, Ostomy and Continence Nursing, 6, 610-618. doi:10.1097/00152192-200611000-00004
[40] Mangnall, J., Taylor, P., Thomas, S. and Watterson, L. (2006) Continence problems in care homes: Auditing assessment and treatment. International Journal of Older People Nursing, 18, 20-22.
[41] Smith, D.B. (1998) The culture of long-term care: Impact on a continence care program. Urologic Nursing, 18, 291-295.
[42] MacDonald, C.D. and Butler, L. (2007) Silent no more: Elderly women’s stories of living with urinary incontinence in long-term care. Journal of Gerontological Nursing, 33, 14-20.
[43] Peet, S.M., Castleden, C.M., McGrother, C.W. and Duffin, H.M. (1996) The management of urinary incontinence in residential and nursing homes for older people. Age Ageing, 25, 139-143. doi:10.1093/ageing/25.2.139

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