Modelling factors of urinary incontinence in institutional older adults with dementia

Abstract

Aims and Objectives This study applied structural equation modelling to explore the relationships among agitated behaviours, depression, cognitive function and activities of daily living, as well as associations between these factors and urinary incontinence). Background A high prevalence of urinary incontinence is found among institutional older adults with dementia. People with urinary incontinence suffer from increased financial burden and social isolation and experience reduced quality of life. Design Cross‐sectional correlational research. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Methods In total, 226 older adults with dementia were recruited through convenience sampling at 15 long‐term care facilities in southern Taiwan. The urinary incontinence frequency, agitated behaviours, depression, cognitive function and activities of daily living were evaluated using bladder records, the Cohen‐Mansfield Agitation Inventory, the Cornell Scale for Depression in Dementia, the Mini‐Mental State Examination and the Barthel Index, respectively. Results Activities of daily living performance was found to be significantly associated with urinary incontinence; however, age, cognitive function, depression and agitated behaviours were not significantly related to urinary incontinence. Age did not have effects on any of the variables tested in this model, whereas activities of daily living performance was significantly associated with cognitive function and depression. Results further showed that cognitive function and depression were mediators between activities of daily living and agitated behaviours. Conclusion Enhanced activities of daily living independency directly reduced urinary incontinence, improved cognitive function, decreased degrees of depression and indirectly reduced agitated behaviours. Relevance to clinical practice The findings could serve as a valuable reference for long‐term care facilities in providing effective urinary incontinence care and prevention to older adults with dementia.

An Exergame Solution for Personalized Multicomponent Training in Older Adults

“…Studies recommend a multicomponent and personalized training approach for older adults with mobility limitations, cognitive impairment, and urinary incontinence [4,9,23,76]. Although exergames contribute to increased training motivation and can be used as an alternative to conventional training, current exergames fail to incorporate interventions for all required training components in one single session.…”

“…Mobility limitations, cognitive impairment, and urinary incontinence are particularly common in older adults [1], having a negative impact on their lives. Moreover, these conditions are associated with gait impairments, increased risk of falling, and all-cause mortality [2][3][4].…”

“…Mobility and cognitive impairments share common underlying mechanics of decline, and often coexist in older adults [5]. Results from several studies also suggest that mobility decline and cognitive impairment are associated-and frequently coexist-with urinary incontinence [4,[6][7][8]. According to [4] improving functional independence reduces urinary incontinence, and improves cognitive function in older adults.…”

The development and validation of instruments to measure dignity‐protective continence care for care‐dependent older people in residential aged care facilities: A study protocol

“…The etiology of incontinence in RACFs is multifactorial and is highly associated with impairments in cognition and physical function 14 . A recent model of risk factors associated with urinary incontinence (UI) among institutional older adults with dementia revealed UI in this population was significantly related to impaired ability to perform activity of daily living 15 . Indeed, in a population‐based study of 54 816 people aged 60 to 89 with dementia and an age‐gender stratified sample of 205,795 people without dementia, Grant et al, 16 found the adjusted rate ratio for first diagnosis of UI was 3.2 (2.7‐3.7) in men and 2.7 (2.3‐3.2) in women, and for fecal incontinence was 6.0 (5.1‐7.0) in men and 4.5 (3.8‐5.2) in women.…”

Strategies to Inform Innovations in Continence Care for People Living with Dementia in the Acute Hospital Setting: A Mixed Methods Narrative Synthesis Review

“…These approaches have implications for the occurrence of avoidable harm and patient outcomes during an acute admission; incontinence is a common risk factor for falls [26,27] and catheters are associated with high rates of urinary tract infections [28]. These factors are also associated with a greater nancial burden, prolonged hospitalisation, re-admission and increased mortality [29][30][31]. Incontinence can also be emotionally demeaning for patients [32] as well as being humiliating and embarrassing [33] and, combined with dementia, it increases the stigma [34] that PLWD already experience [35][36][37] which can have signi cant negative impacts on quality of life [38].…”