Jean E. Kincade

The association of urinary incontinence with poor self-rated health

OBJECTIVES: To assess whether urinary incontinence (UI) and its severity are associated with poor self‐rated health in a national sample of community‐living older adults and whether this relationship persists after controlling for confounding attributable to functional status, comorbidity, and demographic factors.

Self‐Care Practices Used by Older Men and Women to Manage Urinary Incontinence: Results from the National Follow‐up Survey on Self‐Care and Aging

OBJECTIVES: To estimate the extent to which self‐care practices are employed by older adults with urinary incontinence (UI); to determine how demographic and functional status measures are associated with self‐care practice use; and to explore the relationship between contacting a doctor and disposable pad use.

Urinary Incontinence and Risk of Death among Community-Living Elderly People Results from the National Survey on Self-Care and Aging

Objectives:The authors explored whether urinary incontinence (UI) is associated with higher mortality and, if so, whether adjustment for demographics, health, and functional status diminishes the association. Methods:The Cox proportional hazards model was used with a nationally representative sample of community-living elderly people (N= 3,485). Results:In an analysis adjusted for age, gender, education, and probability sampling design, participants with mild to moderate UI (hazard ratio [HR] = 1.51; 95% confidence interval [CI] = 1.09-2.08) and severe UI (HR = 1.54; 95% CI = 1.03-2.29) experienced a higher risk of death. Adjustment for health and functional status diminished the association of UI and risk of death (mild to moderate UI, HR = 1.20, 95% CI = 0.85-1.68; severe UI, HR = 0.91, 95% CI = 0.59-1.39). Discussion:The relationship between UI and mortality in older adults can largely be understood on the basis of increased frailty in incontinent individuals.

Randomized clinical trial of efficacy of self‐monitoring techniques to treat urinary incontinence in women

AIM To assess the efficacy of self-monitoring techniques to reduce urine loss and increase quality of life for women with urinary incontinence. METHODS The design was a two arm, randomized, clinical trial with a wait list control group and 3-week intervention. Participants were 224 community-dwelling women 18 and older with UI. Self-monitoring was individualized counseling about fluid and caffeine intake, quick pelvic floor muscle contraction, voiding frequency, and management of constipation. The primary outcome measure was grams of urine loss. Secondary outcomes included episodes of urine loss, quality of life, and caffeine and fluid consumption. RESULTS The main effect of self-monitoring on grams of urine loss was significant. After adjusting for baseline urine loss, time in the intervention or in wait list group, age, hormone status, and race the self- monitoring group lost an average of 13.3 g less urine and had improved 26.1 points in quality of life compared to the wait list group. The effect of self-monitoring on episodes of urine loss was not significant in the total sample but was more effective for women who had 9 or more episodes of urine loss, were 65 years or older, and were premenopausal or taking hormone replacement therapy. Participants in the self-monitoring group reduced their caffeine intake, but did not increase their fluid intake compared to the wait list control group. CONCLUSIONS Since self-monitoring techniques are simple, safe, inexpensive, and within the scope of practice for most health professionals, they should be considered as first steps to treat women with UI.

A Pilot Study to Determine Reasons for Patient Withdrawal From a Pelvic Muscle Rehabilitation Program for Urinary Incontinence

This project explored reasons why patients with urinary incontinence withdrew from a behavioral treatment program before completion of all sessions. In-depth, semistructured interviews were conducted with 10 of 25 patients who had not completed prescribed behavioral treatment at the University of North Carolina–Chapel Hill School of Medicine Continence Clinic. The women interviewed made positive or neutral comments about Kegel exercises and understood the relationship between urinary incontinence and pelvic muscle weakness. They perceived a relationship between age and urinary incontinence but did not think that incontinence was inevitable with aging. Treatment of urinary incontinence became less of a priority when work, physical impairments, or illness intervened and when there appeared to be some misunderstanding about the treatment. These findings suggest that clinicians need to better understand perceived barriers to adherence in order to discuss these barriers and to design a more individualized approach for each patient in a continence clinic.

Bladder management in adult care homes. Review of a program in North Carolina.

In North Carolina there are approximately 34,000 residents in adult care homes (ACHs). Approximately 40% of these residents have urinary incontinence, and others require assistance with toileting. High prevalence of cognitive impairment, few licensed staff, and low staff-to-resident ratios in ACHs make behavioral techniques used in community-dwelling populations and toileting programs used in nursing homes inappropriate for these residents. This program was implemented using a two-level approach (facility and individual resident) and uses an education consultation approach for implementation.