The Impact Of Urinary Incontinence On Quality Of Life For Middleaged And Elderly Women Living In Community Of Shijiazhuang And The Strategy Of Patients’ Self-management

Objective: To survey the impact of urinary incontinence(UI) on women’s quality of life and to analyze the influencing factors on quality of life(QOL) for middle-aged and elderly women with UI, and to explore the strategy of patients’ self-management of UI in daily life, in order to provide valuable information for medical workers on better understanding and help of patients.Method: We used a complex research method that combines qualitative research with quantitative research. One hundred and fourteen middle-aged and elderly women with UI living in community of Shijiazhuang were selected as the population in the quantitative research. The population was investigated by short form of international consultation on incontinence questionnaire(ICIQ-SF), incontinence quality of life questionnaire(I-QOL) and demographics of respondents, to assess the QOL of patients and to analyze the influencing factors on QOL. The qualitative study was a phenomenological research. In-depth interviews were conducted with 8 people aged over 45 living in the community, purposely selected from a sample of patients with UI. Data were collected by semi-structured interviews and recording the content, and further analyzed by Colaizzi’s phenomenological approach.Results: The results of quantitative study:The validity rate of the questionnaire was 95%. In all the analyzed middle-aged and elderly women living in community, stress urinary incontinence(SUI), urge urinary incontinence(UUI) and mixed urinary incontinence(MUI) respectively accounted for 62.28%, 20.18% and 17.54%; mild, moderate and severe incontinence respectively accounted for 65.79%, 24.56% and 9.65%. Therefore, Most of the patients had SUI and were of mild degree.1 QOL for middle-aged and elderly women with UIThe mean of total QOL score was 75.63 for middle-aged and elderly women with UI in Shijiazhuang community. Among all subscales of QOL, the ‘avoidance and limiting behavior’ has the lowest score 63.60, which means the greatest impact.Distinct types and severities of UI have different aspects impact on QOL. Along with aggravation of severity, UI impacts increasingly. The main impact of SUI was on the ‘psychosocial impact’ subscale of I-QOL; the main impact of UUI was on the ‘avoidance and limiting behavior’ subscale of I-QOL; and the main impact of MUI was on the ‘social embarrassment’ subscale of I-QOL. Mild incontinence only affects the overall QOL slightly.2 The factors of overall QOLSingle factor analysis shows that, the middle-aged and elderly female patients have significantly different(in statistics) overall QOL, with respect to different age, body mass index(BMI), the type and severity of incontinence. Multiple regression analysis shows that, age, severity and type if UI are independent influencing factors of overall QOL. According to their degree of impact in descending order, they are severity of UI, age and type of UI, with the standard regression coefficient being-0.515,-0.374 and-0.140.3 The factors of avoidance and limiting behaviorSingle factor analysis shows that, the middle-aged and elderly female patients have significantly different(in statistics) avoidance and limiting behavior of QOL, with respect to different age, body mass index(BMI), ovariectomy, the type and severity of incontinence. Multiple regression analysis shows that, age, severity and type of UI are independent influencing factors of avoidance and limiting behavior of QOL. According to their degree of impact in descending order, they are age, severity and type of UI, with the standard regression coefficient being-0.406,-0.316 and-0.308.4 The factors of psychosocial impactSimilarly, the middle-aged and elderly female patients have significantly different(in statistics) psychosocial impact of QOL, with respect to different age, body mass index(BMI) and severity of incontinence. Age, severity and type of UI are independent influencing factors of psychosocial impact of QOL. According to their degree of impact in descending order, they are severity of UI, age and BMI, with the standard regression coefficient being-0.556,-0.222 and-0.127.5 The factors of social embarrassmentSimilarly, the middle-aged and elderly female patients have significantly different(in statistics) social embarrassment of QOL, with respect to different age, body mass index(BMI), and severity of incontinence. Age and severity of UI are independent influencing factors of social embarrassment of QOL. According to their degree of impact in descending order, they are severity of UI, and age, with the standard regression coefficient being-0.374,-0.314. The results of qualitative study:The strategy of patients’ self-management of UI in daily life for middle-aged and elderly women: 1 Theme 1---- neglecting strategy 1.1 Psychological neglect: they pay little attention to incontinence. 1.2 Behavioral neglect: they rarely use any methods to deal with UI in everydaylife. 2 Theme 2---- controlling strategy: 2.1 Using protective equipment: urine absorbent products or sanitary napkins areused. 2.2 Taking medication by themselves: anti-inflammatory drugs or Chinesetraditional medicine is used. 3 Theme 3-- restrictive strategy: 3.1 Limited outdoor activities: they reduce frequency, time and area of outdooractivities. 3.2 Restricting the behaviors that cause UI: they try to avoid standing for long time, strenuous exercise or laughing; avoid fatigue or suppressing urine;and restrict fluid intake. 4 Theme 4-- concealing strategy: 4.1 Hiding the symptoms: they select clothing of special styles and colors; theyimmediately go to the toilet after urine leak. 4.2 Hiding odors: frequent replacement and cleaning of clothing; frequentbathing. 5 Theme 5-- Modifying strategy: 5.1 Self-adjustment: contracting of the pelvic floor muscles when they want tourinate; sitting down when sneezing. 5.2 Planning in advance: emptying bladder before going out; preparing a bed panbefore sleep. 5.3 Functional Exercise: Pelvic floor functional exercise; walking; rope skipping. 6 Theme 6— Seeking help: 6.1 Acquiring relevant knowledge: Reading books, listening to health talks andsearching for knowledge online. 6.2 Seeking medical help: visiting the doctors of Chinese traditional medicine,specialist physician and general practitioner. 6.3 Seeking emotional support: they tell his family or communicate with friends.Conclusion:1 UI impacts on various aspects of QOL of middle-aged and elderly women living in community.2 The main factors of that affect QOL of middle-aged and elderly female patients are age, weight, type and severity of UI, where severity of UI is the greatest impact factor.3 The middle-aged and elderly women use a variety of strategies in everyday life for management of UI, including neglecting, containing, restricting, concealing, modifying strategies and seeking help.