Age and Ageing (1979), 8, 81
THE PREVALENCE, SEVERITY AND FACTORS ASSOCIATED WITH URINARY INCONTINENCE IN A RANDOM SAMPLE OF THE ELDERLY J. W. G. YABNELL AND A. S. ST LEGER
MRC Epidemiological Research Unit, 4 Richmond Road, Cardiff CF2 3AS
A study to determine the prevalence of urinary incontinence in a random sample of a total elderly community is described. The prevalence of incontinence in women aged 65 years or more wa3 found to be 17% and in men 11%. The findings show that the prevalence of incontinence is particularly high among residents of old people's homes and geriatric hospitals, but that the majority of cases occur within the general community. The prevalence increases with age in both sexes; associations with a history of cerebrovascular disease, certain surgical procedures, multiple hospital admissions and drug usage are described. Thefindingsof a follow-up study suggest that, although the disorder is long-standing and severe in a proportion of subjects, it is transient in approximately a third of all elderly subjects with the condition. INTRODUCTION
Urinary incontinence is a common cause of admission to geriatric units (Shuttleworth 1970) but there is limited information on the size of the problem in the general community. The population studies which have been done have been reviewed by Milne (1976) who noted that the prevalence of the disorder in women has been variously estimated to be from 1.6% to 42% according to the definition of incontinence used. This report assesses the prevalence and severity of urinary incontinence and associated factors in a representative sample of a total elderly population. Methods In 1975 two samples were drawn randomly from the age-sex registers of all the medical practices serving a town in South Wales with a population of 27 696: a random sample comprising men aged 70 years or more and women aged 75 years or more (the sample was drawn in this manner to provide approximately equal numbers of men and women); and a random sample of all men and women born in the years 1909 or 1910, i.e. aged 65 or 66 years at the time of the survey (this sample was drawn to serve as a comparison group to the former samples). Spouses of subjects thus selected were also included in the sample if within the correct age range; 15 spouses are therefore included in the final sample. Five women aged 70—74 years have also been included in the final sample (see Table I) because it was not discovered until they had been visited that their year of birth had been incorrectly recorded. All subjects were visited at home by the first author. A questionnaire on demographic variables, current symptoms, past medical and surgical history, and drug usage was completed. Several questions on urinary tract symptoms were asked towards the end of the interview; subjects were asked if there had been any leakage of urine in the previous twelve months and, if a positive history was obtained, the frequency of occurrence and time of day of the incontinent events were
Downloaded from http://ageing.oxfordjournals.org/ at Flinders University of South Australia on October 5, 2015
Summary
82
J. W. G. Yarnell and A. S. St Leger
also elicited. Not all subjects were able to give reliable medical histories; when a subject had obvious mental deterioration a history of current symptoms and previous medical history was sought from the subject's next of kin or other daily attendant. Between three and twelve months after the completion of die main survey all subjects who had reported any urinary incontinence were revisited by a trained nurse field-worker, the principal objective being to assess the severity of the condition and its significance to the individuals concerned.
Table I. Demographic characteristics of die study sample Age {years) 80 +
Total
Sex
Males Females Total
58 82 140
Accommodation 32 Lives alone 93 Lives with spouse Lives widi other relatives 15 Sheltered accommodation 0 0 Local authority home 0 Hospital
27
84 70* 154
67 94
169 219 388
41 74 30 1 5 3
25 22 32 3 10 2
98 189 77 4 15 5
•Five of this group of women were aged 70-74 years.
RESULTS
From a total sample of 396 subjects eligible for inclusion in the survey, 388 were interviewed and completed questionnaires were obtained for them—a response of 98%. None of the subjects who refused to participate in the survey had urinary incontinence to the knowledge of their general practitioners. Table I shows the distribution of the subjects by age, sex and type of accommodation. Table II shows the distribution of subjects with incontinence by age and severity (frequency of occurrence) of the incontinence. There is a general tendency for the prevalence and severity of incontinence to increase with age; on average, the prevalence of incontinence is higher among women than among men. Table III shows the distribution of subjects with daytime incontinence by age and type of accommodation. The results demonstrate the high prevalence of the disorder within long-term accommodation for the elderly; but it is worth noting that the overwhelming majority of incontinent subjects are living in the general community. In order to investigate possible aetiological factors the prevalence of certain disorders and treatments was compared in subjects with and without incontinence. Table IV shows the results. Table V shows the results of the follow-up study on the 49 incontinent subjects who could be located three to twelve months after the completion of the main study. Of the
Downloaded from http://ageing.oxfordjournals.org/ at Flinders University of South Australia on October 5, 2015
65/66 (Af)70 + (.F)75 +
Factors Associated with Urinary Incontinence
83
Table II. Distribution of subjects with urinary incontinence by age, sex and occurrence of symptoms Age (years) 65/66
(Af)70+ (F)75 +
80 +
Total
5 (9%) 10 (12%) 15 (11%)
7 (8%) 15 (21%) 22 (14%)
6 (22%) 12 (18%) 18 (19%)
18(11%) 37 (17%) 55 (14%)
15 4
21 13
17 8
53 25
7 5 3
6 5 11
7 4 7
20 14 21
Sex
•Incontinence by night was not reported in the absence of daytime incontinence except in two instances in female subjects aged 79 and 80 years. Table III. Distribution of subjects with daytime urinary incontinence by age and accommodation* Age (years) Accommodation 65/66 Lives alone Lives with spouse Lives with other family Local authority home Hospital Total
(Af) 70 + (F) 75 +
2 (6%) 13(14%) 0(0%) 0 (0%) 0 (0%) 15(11%)
7 (17%) 4(5%) 4(13%) 3 (60%) 3 (100%) 21(14%)
80+
Total
5 (20%) 4(18%) 2(6%) 5 (50%) 1 (50%) 17(18%)
14 (14%) 21(11%) 6(8%) 8 (53%) 4 (80%) 53(14%)
•Only four subjects in the study sample were resident in sheltered accommodation (Table I); none of these subjects had urinary incontinence. Table IV. Distribution of subjects with a history of certain disorders, hospital admissions and drug consumption by presence or absence of urinary incontinence Continent subjects
Subjects withincontinence Af(n = 18) Cerebrovascular disease Prostatic hypertrophyf Uterovaginal prolapsef Multiple medical or geriatric admissions Mean no. of drugs per subject
F (n = 37)
1 (5.6%) 4 " (22.2%)
6"
(16.2%)
—
8*
(21.6%) • (24.3%)
3*
(16.7%) 1.72
M(n = 151) F(n = 182)
1.95
•P
THE PREVALENCE, SEVERITY AND FACTORS ASSOCIATED WITH URINARY INCONTINENCE IN A RANDOM SAMPLE OF THE ELDERLY J. W. G. YABNELL AND A. S. ST LEGER
MRC Epidemiological Research Unit, 4 Richmond Road, Cardiff CF2 3AS
A study to determine the prevalence of urinary incontinence in a random sample of a total elderly community is described. The prevalence of incontinence in women aged 65 years or more wa3 found to be 17% and in men 11%. The findings show that the prevalence of incontinence is particularly high among residents of old people's homes and geriatric hospitals, but that the majority of cases occur within the general community. The prevalence increases with age in both sexes; associations with a history of cerebrovascular disease, certain surgical procedures, multiple hospital admissions and drug usage are described. Thefindingsof a follow-up study suggest that, although the disorder is long-standing and severe in a proportion of subjects, it is transient in approximately a third of all elderly subjects with the condition. INTRODUCTION
Urinary incontinence is a common cause of admission to geriatric units (Shuttleworth 1970) but there is limited information on the size of the problem in the general community. The population studies which have been done have been reviewed by Milne (1976) who noted that the prevalence of the disorder in women has been variously estimated to be from 1.6% to 42% according to the definition of incontinence used. This report assesses the prevalence and severity of urinary incontinence and associated factors in a representative sample of a total elderly population. Methods In 1975 two samples were drawn randomly from the age-sex registers of all the medical practices serving a town in South Wales with a population of 27 696: a random sample comprising men aged 70 years or more and women aged 75 years or more (the sample was drawn in this manner to provide approximately equal numbers of men and women); and a random sample of all men and women born in the years 1909 or 1910, i.e. aged 65 or 66 years at the time of the survey (this sample was drawn to serve as a comparison group to the former samples). Spouses of subjects thus selected were also included in the sample if within the correct age range; 15 spouses are therefore included in the final sample. Five women aged 70—74 years have also been included in the final sample (see Table I) because it was not discovered until they had been visited that their year of birth had been incorrectly recorded. All subjects were visited at home by the first author. A questionnaire on demographic variables, current symptoms, past medical and surgical history, and drug usage was completed. Several questions on urinary tract symptoms were asked towards the end of the interview; subjects were asked if there had been any leakage of urine in the previous twelve months and, if a positive history was obtained, the frequency of occurrence and time of day of the incontinent events were
Downloaded from http://ageing.oxfordjournals.org/ at Flinders University of South Australia on October 5, 2015
Summary
82
J. W. G. Yarnell and A. S. St Leger
also elicited. Not all subjects were able to give reliable medical histories; when a subject had obvious mental deterioration a history of current symptoms and previous medical history was sought from the subject's next of kin or other daily attendant. Between three and twelve months after the completion of die main survey all subjects who had reported any urinary incontinence were revisited by a trained nurse field-worker, the principal objective being to assess the severity of the condition and its significance to the individuals concerned.
Table I. Demographic characteristics of die study sample Age {years) 80 +
Total
Sex
Males Females Total
58 82 140
Accommodation 32 Lives alone 93 Lives with spouse Lives widi other relatives 15 Sheltered accommodation 0 0 Local authority home 0 Hospital
27
84 70* 154
67 94
169 219 388
41 74 30 1 5 3
25 22 32 3 10 2
98 189 77 4 15 5
•Five of this group of women were aged 70-74 years.
RESULTS
From a total sample of 396 subjects eligible for inclusion in the survey, 388 were interviewed and completed questionnaires were obtained for them—a response of 98%. None of the subjects who refused to participate in the survey had urinary incontinence to the knowledge of their general practitioners. Table I shows the distribution of the subjects by age, sex and type of accommodation. Table II shows the distribution of subjects with incontinence by age and severity (frequency of occurrence) of the incontinence. There is a general tendency for the prevalence and severity of incontinence to increase with age; on average, the prevalence of incontinence is higher among women than among men. Table III shows the distribution of subjects with daytime incontinence by age and type of accommodation. The results demonstrate the high prevalence of the disorder within long-term accommodation for the elderly; but it is worth noting that the overwhelming majority of incontinent subjects are living in the general community. In order to investigate possible aetiological factors the prevalence of certain disorders and treatments was compared in subjects with and without incontinence. Table IV shows the results. Table V shows the results of the follow-up study on the 49 incontinent subjects who could be located three to twelve months after the completion of the main study. Of the
Downloaded from http://ageing.oxfordjournals.org/ at Flinders University of South Australia on October 5, 2015
65/66 (Af)70 + (.F)75 +
Factors Associated with Urinary Incontinence
83
Table II. Distribution of subjects with urinary incontinence by age, sex and occurrence of symptoms Age (years) 65/66
(Af)70+ (F)75 +
80 +
Total
5 (9%) 10 (12%) 15 (11%)
7 (8%) 15 (21%) 22 (14%)
6 (22%) 12 (18%) 18 (19%)
18(11%) 37 (17%) 55 (14%)
15 4
21 13
17 8
53 25
7 5 3
6 5 11
7 4 7
20 14 21
Sex
•Incontinence by night was not reported in the absence of daytime incontinence except in two instances in female subjects aged 79 and 80 years. Table III. Distribution of subjects with daytime urinary incontinence by age and accommodation* Age (years) Accommodation 65/66 Lives alone Lives with spouse Lives with other family Local authority home Hospital Total
(Af) 70 + (F) 75 +
2 (6%) 13(14%) 0(0%) 0 (0%) 0 (0%) 15(11%)
7 (17%) 4(5%) 4(13%) 3 (60%) 3 (100%) 21(14%)
80+
Total
5 (20%) 4(18%) 2(6%) 5 (50%) 1 (50%) 17(18%)
14 (14%) 21(11%) 6(8%) 8 (53%) 4 (80%) 53(14%)
•Only four subjects in the study sample were resident in sheltered accommodation (Table I); none of these subjects had urinary incontinence. Table IV. Distribution of subjects with a history of certain disorders, hospital admissions and drug consumption by presence or absence of urinary incontinence Continent subjects
Subjects withincontinence Af(n = 18) Cerebrovascular disease Prostatic hypertrophyf Uterovaginal prolapsef Multiple medical or geriatric admissions Mean no. of drugs per subject
F (n = 37)
1 (5.6%) 4 " (22.2%)
6"
(16.2%)
—
8*
(21.6%) • (24.3%)
3*
(16.7%) 1.72
M(n = 151) F(n = 182)
1.95
•P
