Nancy H. Fultz

Prevalence and Incidence of Urinary Incontinence in Community-Dwelling Populations

revalence and incidence represent important characteristics of urinary incontinence as it appears in the population. Prevalence estimates P provide an indication of how widespread involuntary urine loss is and have important implications for the level of medical and self-care that is needed. Incidence estimates provide an indication of the onset of the condition and are critical when studying its development, risk factors, and sequelae. Early estimates of prevalence of incontinence in the community came almost exclusively from European studies. Several reviews of these studies are The reviews point out that prevalence estimates vary, and they suggest that differences in the definition of incontinence and in the sample account for much of the variability. More recently, several prevalence estimates have become available from regional or national US samples that had not been previously reviewed nor, in several instances, been formally published. This article complles prevalence and incidence estimates from American and non-American studies published or conducted since 1970. These studies used survey respondents’ reports of involuntary urine loss to measure prevalence and, in some cases, incidence and symptoms of types of urinary incontinence. Some estimates had to be calculated from reported or computerized data. Because information regarding study design and measurement was incomplete for some of the studies, the estimates must be taken as close approximations only. Further details about the reestimation procedures are given in the Appendix.

Factors associated with women's decisions to seek treatment for urinary incontinence

BACKGROUND Urinary incontinence is a highly prevalent and burdensome condition among women. However, fewer than half of women with symptoms talk to a physician about incontinence, and the determinants of treatment seeking are not well understood. DESIGN A two-stage cross-sectional survey of adult U.S. women; 45,000 households participating in NFO Worldgroup survey research received a questionnaire to identify adults with incontinence. Based on stratified random sampling of identified incontinent women, 2310 women received a detailed questionnaire. RESULTS Among 1970 women with urinary incontinence symptoms, 38% had initiated a conversation with a physician about incontinence. In multivariate logistic regression analysis, some of the factors associated significantly with treatment seeking were symptom duration >3 years (OR 2.33, 95% CI 1.57-3.45), having a history of a noticeable accident (OR 1.41, 95% CI 1.06-1.87), worse disease-specific quality of life scores (OR 1.89, 95% CI 1.32-2.70), not being embarrassed to talk with a physician about urinary symptoms (OR 1.65, 95% CI 1.28-2.14), talking with others about urinary incontinence (OR 3.34, 95% CI 2.49-4.49), and keeping regular appointments for routine/preventive care (OR 2.25, 95% CI 1.54-3.29). CONCLUSIONS Less than half of community-dwelling adult U.S. women with symptoms of urinary incontinence have talked with a physician about urinary incontinence. In addition to duration of symptoms, factors associated with treatment seeking included the impact of incontinence on quality of life, lack of embarrassment about talking to a physician about urinary symptoms, and attitudes toward healthcare use. Concerns about the meaning of incontinence for overall and future health were important reasons for women choosing to seek treatment.

Self-Reported Social and Emotional Impact of Urinary Incontinence

OBJECTIVE: Incontinence‐specific and generic measures of well‐being were regressed on potential predictors to identify incontinent respondents at risk for psychosocial distress and to understand the relationship between urinary incontinence (UI) and other determinants of social and emotional status.

Urinary incontinence and psychological distress among older adults.

We examined the relationship between urinary incontinence and psychological distress in a sample of community-dwelling older adults. The data are from a probability sample of Washtenaw County, Michigan residents ages 60 years and older, who were interviewed in 1983 and 1984. A total of 747 women and 541 men were included in the analyses. Experiencing urinary incontinence, particularly in a severe form, was weakly related to depression, negative affect, and low life satisfaction. These relationships are partly explained by the fact that incontinent respondents are less healthy than are continent respondents.

EPIDEMIOLOGY OF URINARY SYMPTOMS IN THE GERIATRIC POPULATION

As the US population ages, there is a growing need for information about the urologic health problems facing older adults. In conjunction with findings from clinical studies and basic research on biological mechanisms, the epidemiologic approach offers insights on the prevalence, etiology, and impact of these geriatric conditions. This information can provide the basis for planning health care services and intervention programs. The authors discuss trends associated with population aging and the challenges posed by the epidemiologic study of older adults. Also reviewed are current findings on the prevalence, incidence, and correlates of urinary incontinence and other common urologic symptoms.

Methods used to manage urinary incontinence by older adults in the community.

This paper addresses the ways that noninstitutionalized older adults deal with involuntary urine loss. The data come from a 1983–1984 sample survey of Washtenaw County, Michigan residents aged 60 and over. Five hundred twelve self‐reported incontinent respondents are included in the analyses. About a quarter of the incontinent respondents had discussed their condition with a doctor in the previous year, while 66% used one or more methods to control urine loss. Respondents preferred using absorbent products (47% of those who used some method) and locating a toilet upon reaching a destination (42%). Fewer respondents manipulated their voiding patterns (29%) or diet and fluid intake (17%), or did pelvic muscle exercises (10%). Only 7% were taking medication for their incontinence. Logistic regression analyses were performed to identify factors associated with the choice of actions. Predictors were taken from theoretical models of health service utilization and health behavior, and included predisposing characteristics, health beliefs, enabling factors, and illness variables. Illness variables, particularly severity and type of incontinence, were the best predictors of consultation with a doctor and use of any urine control method. The predictors were less useful for understanding the choice of a specific method.

Gender Effects among Telephone Interviewers in a Survey of Economic Attitudes

Male and female telephone interviewers are compared on both administrative efficiency and data quality, using data from 24 replications of an attitudinal survey on personal and national economic prospects. The 40 male interviewers used over the two-year period are found to exhibit higher turnover rates and, because of that, lower response rates and higher training costs than the 80 female interviewers. However, there are no real differences on the total per minute interview costs by gender, in missing data rates, or on response distributions for factual questions. There does appear to be a systematic tendency for male interviewers to obtain more optimistic reports from respondents regarding their economic outlook. Multivariate models are constructed that attempt to explain these results and speculations are offered about causes of the impact of interviewer gender on response formation.

Is urinary incontinence a barrier to exercise in women

Objective: To describe the prevalence of urinary incontinence during exercise in women, estimate whether exercise intensity is related to leakage severity, and report women’s assessments of incontinence as a barrier to exercise. Methods: Questionnaires were mailed to 5,130 women aged 18–60 years drawn from National Family Opinion research panels. Physical activity levels were assessed by the International Physical Activity Questionnaire. Urinary incontinence, defined as involuntary leakage in the last 30 days, was assessed with the Sandvik Severity Index and a global measure of bother. Prevalence estimates were adjusted via post-stratification weighting. Results: A total of 3,364 eligible women responded (68%), of whom 34.6% were insufficiently active (95% confidence interval [CI] 32.7–36.5%), 29.7% were sufficiently active (95% CI 27.9–31.5%), and 35.7% were highly active (95% CI 33.8–37.6%). Urinary incontinence prevalence was 34.3% (95% CI 32.5–36.1%). One in seven women experienced urinary leakage during physical activity; this was more common among highly active (15.9%) than less active women (11.8%) (P = .01). After adjusting for age, comorbidities, education, and race, women with very severe incontinence were 2.64 times (95% CI 1.25–5.55) more likely to be insufficiently active than continent women. Incontinence was a moderate or substantial barrier to exercise for 9.8% (95% CI 8.8–10.9%) of women. Of incontinent women, the proportion for whom incontinence was a moderate or substantial barrier to exercise increased with each severity category: 9.2%, slight; 37.8%, moderate; 64.6%, severe; and 85.3%, very severe (P < .01). Conclusion: Urinary incontinence is perceived as a barrier to exercise, particularly by women with more severe leakage. Level of Evidence: II-3

Informal caregiving time and costs for urinary incontinence in older individuals in the United States

OBJECTIVES: To obtain nationally representative estimates of the additional time, and related cost, of informal caregiving associated with urinary incontinence in older individuals.

Establishing the Prevalence of Incontinence Study: Racial Differences in Women's Patterns of Urinary Incontinence

PURPOSE We examine racial differences in urinary incontinence prevalence, frequency, quantity, type, and risk factors in a population based sample of community dwelling black and white women. MATERIALS AND METHODS Women 35 to 64 years old were sampled from telephone records from 3 southeast Michigan counties. Women self-identifying as black or white race completed a telephone interview that assessed demographics, health history, lifestyle factors and urinary incontinence experience. Statistical analysis included descriptive statistics, factor analysis and multivariable logistic regression to determine adjusted odds of urinary incontinence. Estimates were weighted to reflect probability and nonresponse characteristics of the sample, and to increase generalizability of the findings. RESULTS Interviews were completed by 1,922 black and 892 white women (response rate = 69%). The overall prevalence of urinary incontinence was 26.5%. By race, urinary incontinence prevalence was 14.6% for black women and 33.1% for white women (p <0.001). Among incontinent women there was no difference by race in the frequency of urinary incontinence. However, black women reported more urine loss per episode (p <0.05). A larger proportion of white women with incontinence (39.2%) reported symptoms of pure stress incontinence compared to black women (25.0%), whereas a larger proportion of black women (23.8%) reported symptoms of pure urge incontinence compared to white women (11.0%). Risk factors for urinary incontinence were generally similar for white and black women. CONCLUSIONS In this population based study we observed racial differences in prevalence, quantity and type of urinary incontinence. Frequency of and risk factors for urinary incontinence were generally similar for white and black women.