Literature Review
Incontinence is a common problem of elderly people and it needs adjustment and a great amount of care from family members and the health care workers. There are several types of incontinence, urge, faecal and urinary. Fecal incontinence, according to Mayo Clinic (2007) is the inability of an individual to control the bowel movement which causes stool to come out unexpectedly, it can range from occasional leakage of faeces to a complete loss of control of the bowel movement. Urinary Incontinence, on the other hand, is the inability of an individual to control the release of urine from the bladder (Mayo Clinic, 2007).
The failure to control urine and faeces causes psychological stress to individuals, in addition, it adds to the complication of the illness, and the patient as well as, the health providers and family members will have a hard time on management. Moreover, incontinence has a major financial and physical consequence on the patient and his or her family members. According to Miner (2004) the psychological impact of faecal and urinary incontinence is that patients feel shame and embarrassment which leads to isolation from family and friends. Furthermore, incontinence is also one of the reasons why family members institutionalise their elderly relatives due to the fact that family members have a difficult time coping up with the situation. Aside from the feeling of embarrassment and shame, Miner also discussed that patients with incontinence have increased symptoms of anxiety and depression, as well as, degradation in the quality of life.
According to Broome (2003) urinary incontinence affects 15 to 135% of the adult population with existing diseases. Urinary incontinence as discussed earlier is the involuntary loss of urine and according to Ouslander and Schnelle (1995) it has multiple implications for the individual that suffers from incontinence because it is considered a major hindrance to the physical and social life of the patient. Depression also occurs to incontinent patients. A number of studies have determined the association of incontinence to depression (Meade-D’Alisera, 2001; Watson, 2000 and Zorn, 1999). In addition, Hitti (2006) discussed that women with urinary incontinence are more likely to be depressed than their male counterparts. Hiiti discussed that in the study of Vigod’s team the data have revealed that 3% of the women surveyed have reported urinary incontinence; more than 80% of women were older than 44 and approximately 9% of the women surveyed experienced depression. The study has also revealed that younger women that suffer from incontinence are most likely to be depressed than women older than the age of 44. Furthermore, in the study of Chiverton et al (1996) the researchers found out that the incidence of depression is higher in women in comparison with the general population. Steers and Lee (2004) also pointed out that depression occurs in a significant percentage of the population.
Aside from depression, urinary incontinence also has a negative impact on the self-efficiency and the quality of life of the patient. And in the study of Hunskaar (1991) women with urinary incontinence are reported to have a poorer quality of life due to the fact that women experience depression than their male counterparts. Moreover, in the study of Yu Ko et al (2005) the researchers examined the impact of urinary incontinence on the health related quality of life of the patients. Yu Ko et al gathered the data wherein Medicare beneficiaries that are 65 years old and above are utilised for analysis. The study has revealed that the prevalence of urinary incontinence on elderly was 24.7% wherein 20.9% were men and 27.5% were women. The elderly that were suffering from urinary incontinence have the possibility of feeling depressed than elders that do not experience urinary incontinence. The findings of the study show that elderly patients suffering from urinary incontinence are more depressed compare to elders that do not have urinary incontinence, furthermore elderly UI patients have worse perception regarding their health.
Harkins, Elliot and Wan (2006) evaluated various appraisals o intefrence and personal tolerance in the prediction of stress among older women suffering from urinary incontinence. The results of the study indicated that greater tolerance was related with less interference established by urinary incontinence and greater tolerance is also associated with less distress. Furthermore, the severity of the symptoms such as the frequency of UI episodes indirectly influenced emotional distress. The study has pointed out that that appraisal of the ability of an individual to tolerate the condition, as well as, the interference of the condition and expected activities has a huge impact on emotional distress than the severity of the symptoms.
In the study of Fultz and Herzog (2001) it revealed that the majority of incontinent respondents have reported that urine incontinence did not stop them from doing their daily activities or even lowered their self-esteem. However, incontinent respondents that are younger, male, achieved less education, have lower social desirability and have poorer health status are most likely to experience psychosocial distress.
Elderly are often times affected by incontinence. And according to Dingwall and McLaffery (2006) if the urinary incontinence of elderly is left untreated it could lead to prolonged admission in the hospital and have the higher possibility of admission to institutions and long-time care. And aside from the physical effects, Dingwall and Lafferty also discussed the UI has severe effects on the psychosocial being of older people. The findings of the study have indicated that some nurses believe that older people accept urinary incontinence as a consequence of ageing. Most of the health care facilities, as well as, the health providers lack assessment for older people with UI and the assessment strategies utilised by nurses emphasises on the management and identification of the products. Aside from the nurses the general practitioners or the physicians also play an important role in the assessment and management of individuals with urinary incontinence. The attitudes of general practitioners toward urinary incontinence were studied by Teunisses, van de Bosch, van Weel and Lagro-Janssen (2006) and three main themes of attitudes among GPs have emerged and these are; the therapeutic nihilisms of the general practitioners and the low motivation of patients with UI, the general practitioners experience lack of time due to the difficulties of explaining the therapy to the older patients and his or her family members, in addition to the impaired mobility of older patients, and due to the fact that urinary incontinences is a complex problem and is coupled with co-morbidity, the general practitioners and the patients are thinking twice in undergoing treatment of UI. And because of the hindrances mentioned physical examination do not occur in patients with UI despite the fact that GPs have determined the benefit of having one and the knowledge of general practitioners regarding the treatment of UI among elderly patients is substandard thus it interferes with the sound management of urinary incontinences among the elderly.
It is a significant problem among older people, however the elderly usually do not seek treatment because of barriers such as UI is a complex problem. Horrocks, Somerset, Stoddart, Peters and Tim (2004) determined the reasons why elderly do not seek treatment for urinary incontinence; moreover the researchers determined ways in which elderly may be assisted in order to access the services. Horrock et al identified that the older people usually perceive urinary incontinence as a process of degeneration and most of them have reduced expectations regarding the status of their health. Furthermore, the elderly have accepted the fact that it happens and must be managed independently. Embarrassment and shame on their situation coupled with differences in attitudes regarding personal issues have prevented elderly from seeking treatment. Therefore, a mixture of personal attitudes and barriers has prevented older individuals from seeking treatment for urinary incontinence.
Death of older patients is due to co-morbidities and complications, in the study of Holroyd-Ludec,, Mehta and Covinsky (2004) the researchers tried to identify if urinary incontinence is an independent predictor of death, as well as, admission to nursing facilities and diminish daily activities. The study indicated that the prevalence of urinary incontinence was 14.8% and after two years the subject were most likely have died, be admitted to nursing facilities and have reduced activities of daily living. The results of the study suggests that even though urinary incontinence could be an indicator of the weakness of the elderly in the community, however UI is not a strong independent factor for determining the death, admission to the nursing home and decline on the functions of an individual.
Urge incontinence is another type of incontinence wherein it involves as sudden and strong need to urinate which leads to leakage (Medline Plus, 2007). And just like other forms of incontinence it also has a negative effect on individuals suffering from it. In the study of Perry, McGrother and Turner (2006) the researchers have pointed out that a significant percentage of women having urge incontinence have reported symptoms of depression and anxiety, and the study have indicated the importance of emotional factors in the development and management of urge incontinence. The current assessment and treatment for urge incontinence focuses on the toiler behaviours and physical symptoms of the patient.
The health care providers and the family members are the ones that take care of patients with incontinence particularly the elderly. Simmons and Ouslander (2005) evaluated the satisfaction levels of the family members and long-term care residents regarding incontinence and care were sensitive enough to an improvement intervention. The study have indicated that the residents and the family members have high satisfaction rates and the residents of the facilities have reported that the care given especially to elderly were sensitive to improvements, on the other hand, only a few family members were able to answers to particular questions regarding incontinence and the frequency of mobility care, moreover, most of the family members have reported that the care given is insensitive to care improvements. Simmons and Ouslander discussed that the majority of long-term residents of facilities that are suffering from incontinence were able to answer the questions regarding their perceived care and the frequency of care provided in relation to their situation and the mobility care while the reports of family members were not sensitive enough to improvements.
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