Study On Quality Of Life And Affecting Factors Of Elderly Patients With Urinary Incontinence

Objectives:Urinary incontinence(UI) is one of common diseases in old people, it'smorbidity is quite high. According to the epidemiologic investigation, about 30%people over 60 years old suffer from urinary incontinence. Urinary incontinence isone of the leaning problems for gerontology and gereology research, and it is theimportant area that can't be ignored in social medical research. The InternationalContinence Society thinks that urinary incontinence has already become social andhealth problem. Although urinary incontinence will not directly threaten the patients'life, it may decrease their quality of life seriously. UI will affect elderly people inphysiology, psychology and social activities. It also brings heavy mental andeconomic burdens to the patients, the patients' family and health workers. Elderlypatients with UI are more depressed and have worse perceived health. The patientsseparate themselves from society because of urinary incontinence, which mayaccelerate their intelligence to decline and increase nursing demand. The problem ofurinary incontinence is prominent in China. Currently, the treatment for urinaryincontinence put more emphasis on the physiological aspect than on thepsychosocial aspect. It is very necessary to assess the quality of life of patients with urinary incontinence. Only by fully understanding the impact of urinary incontinenceon life quality of elderly patients can we hope to improve its treatment and nursinglevel.This study is to conduct an overall assessment of quality of life of elderlypatients with UI from the needing of UI nursing development with holistic nursingtheory. Thus we can understand their quality of life condition and the factors thataffect the quality of life exactly. According to the research outcome we can putforward the nursing intervention to improve the quality of life of elderly people withUI and provide positive evidence for UI nursing of elderly patients in China.Subjects:One hundred and ten community-dwelling elderly patients (72 female and 38male) with UI were enrolled. The including standards for the patients were: thedefinition that was provided by International Continence Society (ICS) 'thecomplaint of any involuntary leakage of urine' found to be feasible for theepidemiological studies; being over 60 years of age living in Guangzhou; acceptingthe questionnaire voluntarily; have no cognition obstacle; having no serious disease.Excluding standards were: pathological deficits; having serious disease.Methods:This research was a cross-section investigation. Three instruments wereselected to carry on the data collection according to research purpose: InternationalConsultation on Incontinence Questionnaire Short Form (ICI-Q-SF), IncontinenceQuality-of-Life Measure(I-QOL), Social Disability Screening Schedule (SDSS).(1) Screen the UI patients with ICI- Q- SF;(2) Assess the quality of life of elderly patients on different type of UI with I-QOL;(3) Social and demographic data was collected to analyze the impacts on qualityof life of elderly patient with UI;(4) Use the SDSS to assess the social function of elderly patient with UI andanalyze the relation with their quality of life.All the data obtained in the investigation were statistically analyzed bycomputer with the software package SPSS11.5 for windows. Statistical methods suchas t-test, One-way ANOVA, several samples non-parameter analyze, Pearson relatedanalysis and multiple linear regression were used to assess the questionnaire.Results:The validity rate of the questionnaire was 91.7%. The investigation resultsshowed that Chinese version of I-QOL had fine internal consistency (Cronbach's a0.93) compared with the original version (Cronbach'sα0.94) and fine test-retestreliability (ICC 0.95) compared with the original version (ICC 0.91). The structureof I-QOL had some differences with the original version, but it did not affect its totaltest function.The main type of urinary incontinence was different between female and male(X~2=10.594, P=0.005). The type of male elderly patient is mainly urgent UI, whilefemale is mainly stress UI.The total I-QOL score of elderly patients with UI in Guangzhou downtown areawas quite low (mean score 56.31); Score of three fields of I-QOL was also analyzed.Among them, the score of 'Avoidance and Limiting Behavior' and 'Socialembarrassment' was relatively lower and the score of 'Social embarrassment' wasthe lowest one (mean score 50.51). The total I-QOL score of elderly patients reportedin this study was lower than patients in France, Sweden, Spain, Germany and the United States, which reflected that the quality of life of elderly patients was quiteworse, and cause extensive concern to the whole society.Age is one of the factors that affect the QOL of elderly patients with urinaryincontinence. The score of 'Avoidance and Limiting Behavior' was significantlydifferent between age of 60-69 years old, age of 70-79 years old and age of over 80years old. The score of age 60-69 is higher than that of age 70-79 (P=0.015); thescore of age 60-69 is also higher than that of age over 80(P=0.011). It was thus clearthat older patients with UI had worse ability of urinary control.The factors of education background, economic condition, occupation, maritalstatus and sexes had no outstanding effect on QOL of elderly patients with urinaryincontinence. There was no statistical significant. It showed that biological factorhad more effect on QOL than social and environmental factors.The total I-QOL score and subdomain score were both different between SUI, UUI and MUI patients. The mean score of SUI patients was the highest, the meanscore of UUI patients is moderate and the mean score of MUI patients is the lowest.There was statistically significant between subdomains: 'Avoidance and LimitingBehavior' (F=19.658, P=0.000), 'Psychosocial impact' (F=9.630, P=0.000), 'Socialembarrassment' (F=6.346, P=0.002), and total I-QOL score (F=13.211, P=0.000).The total I-QOL score and subdomains score were both different betweendifferent levels of severity: severe＜moderate＜mild. There was statisticallysignificant between subdomains: 'Avoidance and Limiting Behavior' (F=14.47, P=0.000), 'Psychosocial impact' (F=6.644, P=0.002), 'Social embarrassment'(F=13.298, P=0.000), and total I-QOL score (F=11.872, P=0.000).The mean score of SDSS of patients was 4.0, this score was between patientswith neurosis and patients with mental illness. The number of elderly patients withUI investigated in this research who had social disability was 90. The incidence of social function defect was 81.82%. Social activities decreased, having little interestand concern to outside world, responsibility and plans being affected were all theprominent characteristic of the patients with social function defect. There wassignificant correlation between social function and quality of life (P＜0.01).Theelderly patients' quality of life was worse, their social function defect was moreserious.The patients investigated in this research who were willing to seek medical helponly accounted for 45.5%, others chosen 'no'. Binary Logistic regression analysesshowed that the intention was not affect by factors of age, occupation, level ofeducation, marital status, economic incomes, urinary incontinence type and severity.Conclusions:1. I-QOL is a reliable clinical evaluation of quality of life and is suitable forelderly patients with UI in China.2. The quality of life of is quite low. It has many impacts on daily life actionand behavior, psychology, social association, and sex life of the elderly patients.Social function defect exists in many of the elderly patients with urinaryincontinence. The patients' social function has positive correlation with their qualityof life.3. The non-disease factors such as sex, education background, economiccondition, occupation and marital status have no effect on the quality of life ofelderly patients with UI.4. The disease-related factors have significant impact on the quality of life ofpatients.5. Because of the patients' misunderstanding to UI and less attention paid tothem by health workers, most of the elderly patients with UI do not willing to seek medical help. Thus healthy education must be extensively carried out to change thepeople's misunderstanding to urinary incontinence; the final aim is to raise thepatient's healthy level.This research can provide important scientific basis for clinic UI treatment andnursing and for the improvement of the quality of life of elderly patients with UI.The author hopes to get attention of the whole society and take some interventionstrategies, in this way we can help all of the patients with UI know their disease andconfront their problems, finally improve the quality of life.