Exploring a Path Model of Cognitive Impairment, Functional Disability, and Incontinence Among Male Veteran Home Residents in Southern Taiwan

Abstract

, chiao-Lee chu 1 , chien-chih Lin 3 & chun-Min chen 4* Most studies focusing on only one directional effect among cognitive health, physical function, and incontinence may miss potential paths. this study aimed to determine the pathway by analyzing the bidirectional effects of exposure (X) on outcome (Y) and explore the mediating effect (M) between X and Y. Secondary data analyses were performed in this study. the original data were collected from August to October 2013 in one VH in Tainan, Taiwan, and the final sample size was 144 older male veterans. path analysis was performed to test the pathway sequence X → M → Y among the three outcome variables. Approximately 80% of the veterans were aged 81 or older, approximately 42% had a functional disability, 26% had cognitive impairment, and 20% had incontinence. The relationships between functional disability and incontinence and between functional disability and cognition impairment were bidirectional, and functional disability played a key mediating role in the relationship between cognitive impairment and incontinence. physical more than cognitive training in order to improve or at least stabilize functional performance could be a way to prevent or reduce the process of developing incontinence. Aging society is a worldwide concern, and the size of the elderly population in Taiwan continues to increase with the development of medical technology and health care delivery systems 1. The growth of the elderly population has triggered increasing demand for long-term care and skilled nursing institutions. Additionally, approximately 50.9% of senior citizens in need of long-term care services are veterans, and these veterans requiring care account for 23.7% of the total population of senior veterans 2. With the growing average life span and the increasing prevalence of degenerative and psychosocial diseases with age, providing care for veterans has a considerable impact on medical resources and the cost of care. Geriatric symptoms are often multifactorial in etiology; in addition to age-related change in physical function, risk factors such as coexisting cognitive impairment 3 , functional disability 4 , and incontinence 5 cause or contribute to health decline. Studies have examined the association between cognitive impairment and its related factors, such as functional disability 6,7 and incontinence 8,9. Furthermore, other studies on incontinence 10,11 have found that declines in cognitive 12 and physical function 12,13 are noteworthy contributors to incontinence but have not confirmed the direction of the association. Although most literature has confirmed that any two of these three health factors may have a bidirectional association, the pathway between the three factors and whether there is a potential moderating or mediating effect between these three is unclear. In order to improve the effectiveness of treatment, it is necessary to develop multimodal interventions, but first we need to understand the pathways between the health factors that affect aging. Therefo...

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