Urinary and faecal incontinence among older women and men in relation to other health complaints, quality of life and dependency

Sammanfattning: Aim: The aim of this thesis was to investigate type, degree and patterns of health complaints, need for help and health-related quality of life across gender among persons aged 75?105 as well as to identify how patterns of health complaints, gender, age and socio-economic factors related to need for help with daily activities and quality of life (Paper I). The aim was also to investigate the prevalence of self-reported symptoms of urinary, faecal and double incontinence among men and women aged 75 and above, and to identify how other health complaints and quality of life relate to incontinence symptoms (Paper II). Furthermore urinary symptoms and their influence on daily life among elderly (75+) women and men were compared in a sample that previously reported having incontinence and/or other urinary symptoms. A further aim was to find underlying structures of urinary symptoms and to identify symptoms which had an impact on seeking medical help and need for help in daily activities (Paper III). The aim of the fourth study was to compare faecal incontinence and related bowel symptoms in relation to gender and being dependent or not (aged 75 and above) and to identify which bowel symptoms predicted help seeking, dependency and low quality of life (Paper IV).

Design: A cross-sectional design in a randomly selected sample of 8500 persons 75 years and above in four age groups of five-year intervals. They received a postal questionnaire including questions about health, socio-economy, quality of life and need for help in daily activities. In the follow-up persons received another postal questionnaire with focused questions depending on previous reported health complaints. Those needing help in daily activities once a week or more were visited in their own homes and interviewed face to face. The first sample (Papers I, II) included 4277 persons, mean age for women 84.3 and for men 82.7 years. The second sample (Paper III) included 771 persons who had reported difficulties controlling urine or other urinary problems. The sample in Paper IV included 248 persons who had reported difficulties controlling stool.

Result: Coexisting health complaints, i.e. multi-complaints, had impact on QoL as well as on dependency. The patterns of health complaints could be understood from a functional perspective. Problems in communication, mobility and psychosocial functions were those most common and with the highest severity. Women were especially affected as they had more health complaints in functions that were related to help in ADL and to low QoL. Furthermore the prevalence of urinary, faecal and double incontinence was high in all age groups and higher with more advanced age. Incontinence had a negative impact on quality of life and increased need for help in daily activities, and those with double incontinence were the most affected. Among those with urinary problems the character of symptoms differed in storage or voiding symptoms among men and women. However, the influence on social life, avoidance of places and situations and the impact on the whole life seemed equal. Less than 50% had sought medical help for their symptoms and few wore protective aids, especially men. Diarrhoea, constipation, incomplete emptying and laxative use were common among those who reported faecal incontinence, and few had sought medical help or wore protection.

Conclusion: Patterns of health complaints indicated problems on a functional level of importance for need for help in daily activities as well as quality of life. Mobility, psychosocial, communication and elimination problems were strongly related to dependency and low health-related QoL. Women seem to be more at risk as they were more often affected in three of these functions and thus more often dependent and had lower QoL. Women also seemed to have more additional negative socio-economic factors. Dysfunctions that were most common should be focused on and interventions aiming to reduce such complaints are of high priority. Overall urinary and bowel functions seem to be equally as important as incontinence per se and therefore a wider perspective when investigating these symptoms would benefit decisions about investigations and help. Men and women have different needs and none of them should be overlooked. There is a risk that men are neglected as incontinence is regarded as a female problem. Urinary, faecal and double incontinence were common conditions but also other urinary and bowel problems, and few had sought help although they reported considerable problems. All urinary problems as well as bowel-related problems seemingly interacted and had equal effect on daily life and quality of life. Therefore those areas should preferably be seen together and not separately.