Urinary and Faecal Incontinence in Community-residing Elderly Women A. L. M. KOK, F. J. VOORHORST, C. W. BURGER, P. VAN HOUTEN, P. KENEMANS, J. JANSSENS
Summary The prevalence of urinary and faecal incontinence was investigated in a sample of 1049 women aged 60 years and over in the municipality of Amstelveen, the Netherlands; 719 postal histories were completed. The overall prevalence of urinary incontinence was 23.5%. Daily urine loss was reported by 14.0% of all women. In women aged 60 to 84 years and 85 years and over 4.2% and 16.9% were faecally incontinent, respectively. In all age groups poor mobility and frequency were associated with urinary incontinence. Urgency was independently associated in women aged 60-85 years as was nocturia in women aged 85 years and over.
Introduction Incontinence is a common and distressing disorder of elderly people. The prevalence of urinary incontinence (UI) varies from 11 to 37% in community-residing population samples [1-5]. UI is recognized as one of the major causes of institutionalization of elderly people [6]. Faecal incontinence might be even more important in this process because of the embarassment it causes. Between 6% and 17% of residents in residential homes for the elderly are faecally incontinent, but little is known about the prevalence in the general population [7-9]. The aim of the study was to estimate the prevalence of both UI and faecal incontinence (FI) in community-residing women aged 60 years and over and to assess the association of age with the prevalence of UI and FI. Furthermore, factors which were potentially associated with urinary incontinence were investigated.
Methods The study was carried out in the municipality of Amstelveen, The Netherlands. Names, ages and
addresses were obtained of all women aged 60 years and over (n = 8967 resident in the municipality of Amstelveen, The Netherlands on 31/12/1988). A random sample was drawn to include 30 women bom in each year. Whenever there were fewer than 30 women born in the same year, all were included. Women living in institutions were excluded. In March 1989, 1049 women received a postal questionnaire and an accompanying letter explaining the aim of the study and requesting the completion of the questionnaire. The questionnaire could be completed in approximately 30 minutes. After three weeks a reminder was sent. The following points were investigated: presence of urinary and faecal incontinence, usual voiding pattern during the day and night and usual defaecating pattern. A woman was considered to have UI if she had involuntary urine loss at least twice a week, irrespective of the amount of urine loss. Frequent voiding was defined as more than seven voids a day, while nocturia was defined as a voiding pattern of more than twice a night. Urgency was defined as a strong desire to void accompanied by fear of leaking [10]. Faecal incontinence was defined as occasional involuntary loss of faeces. Mobility was assessed by subject's description whether she 'could manage well', 'less than others' or 'needed help'. The last two were considered as poor mobility. Data were collected about Age and Ageing 1992;21:211-215
A. L. M. KOK ET AL. Table I. Prevalence of unnary and faecal incontinence among community-residing elderly women by age groups Age group (years) 60-64 65-69 70-74 75-79
80-84 85-89 >90
Unknown Total
No. of women with UI (no. of respondents)
Percentage with UI
No. of women with FI (no. of respondents)
Percentage with FI
18(90) 23(121) 22(131) 22 (97) 26 (98) 32(104) 21 (74) 0(4)
20.0 19.0 16.8 22.7 26.5 30.8 28.4
2(86) 4(101) 3(116) 6(83) 4(86) 16(90) 10(63)
2.3 4.0
17.8 15.9
164(719)
23.5*
45(625)
16.9*
2.6 7.2 4.7
•Weighted mean as overall prevalence.
significantly lower prevalence than those aged 85 years and over, with an overall prevalence of 4.2% and 16.9%, respectively. Additional analysis of factors potentially associated with UI was performed separately in the age groups below 85 years and those aged 85 years and over, since the age of 85 years marked a significant change in FI occurrence. First, all variables concerning micturition and defaecation patterns, mobility, medication and health problems were analysed in a univariate model. The results depicted in Table II show that in women aged 60-84 years poor mobility, freResults quency, urgency and FI were significantly more Of the 1049 questionnaires sent, 763 were prevalent in women with UI. Nocturia was not returned, 44 of these were unanswered includ- significantly associated. In the age group 85 ing seven instances when the addressee had years and over, poor mobility and nocturia were died. Thus 719 (69%) questionnaires were significantly associated with UI, whereas freavailable for analysis. Table I shows the preva- quency did not reach a level of significance. In lence reported of urinary and faecal inconti- this age group, urgency and FI showed no nence in the different age groups. The preva- association with UI. lence of UI did not differ between the age Second, all factors demonstrated in Table II groups (x2 = 9.Sb, 6 df, p > 0 . 1 ) . The weighted were included in a predictive multivariate mean as an overall prevalence of urinary incon- model in which mutual adjustment identified tinence was 23.5%. A daily loss of urine was factors independently associated with UI. This reported by 96 women, which represents 14% model has been drawn up for the 526 responof all the women. Information on FI was dents with information available on all variavailable from 625 women. In contrast to UI, ables. As seen in Table III, poor mobility and the distribution of FI in the age groups was not frequency were predictors of UI in all age homogeneous (*2 = 45.0, 6 df, p < 0.0004). The groups. In addition, in women aged 60-84 age groups below 85 years of age showed a years, urgency emerged as an independent disorders with a possible effect on the occurrence of UI or FI. Data from the questionnaire were analysed in seven age groups, y1 tests were used to test for homogeneity both for UI and FI. All statistical computations were adjusted for age. Possible associations between the factors investigated and UI were calculated as odds ratios (OR) with 95% confidence intervals (CI) [11]. Stepwise logistic regression with urinary incontinence as dependent variable was used to search for significant associations.
INCONTINENCE IN COMMUNITY-RESIDING ELDERLY WOMEN
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Table II. Factors associated with urinary incontinence (UI) in women aged 60 and over, standardized by age, univariate model With UI
Without UI
(%)
(%)
With/without UI
ORf
95% C\\
60-84 years Poor mobility Frequency Nocturia Urgency Faecal incontinence
19(17.1) 26(23.0) 15(13.6) 24(21.6) 8(8.5)
30(7.1) 30(7.2) 32(7.8) 14(3.3) 11(2.9)
111/422 113/416 110/412 111/422 103/389
2.50 4.04 1.33 8.46 5.78
1.10-5.68* 2.04-8.00* 0.53-3.30 3.35-21.36* 1.59-21.02*
85 years and over Poor mobility Frequency Nocturia Urgency Faecal incontinence
42 (79.2) 12(23.5) 15(30.6) 21 (39.6) 9(21.4)
42(35.0) 10(8.2) 14(11.6) 16(16.7) 15(12.2)
53/123 51/122 49/121 53/123 42/96
7.01 3.15 4.75 2.20 2.70
2.57-19.17* 0.97-10.16 1.66-13.59* 0.73-6.64 0.96-7.61
Factors
•p
Summary The prevalence of urinary and faecal incontinence was investigated in a sample of 1049 women aged 60 years and over in the municipality of Amstelveen, the Netherlands; 719 postal histories were completed. The overall prevalence of urinary incontinence was 23.5%. Daily urine loss was reported by 14.0% of all women. In women aged 60 to 84 years and 85 years and over 4.2% and 16.9% were faecally incontinent, respectively. In all age groups poor mobility and frequency were associated with urinary incontinence. Urgency was independently associated in women aged 60-85 years as was nocturia in women aged 85 years and over.
Introduction Incontinence is a common and distressing disorder of elderly people. The prevalence of urinary incontinence (UI) varies from 11 to 37% in community-residing population samples [1-5]. UI is recognized as one of the major causes of institutionalization of elderly people [6]. Faecal incontinence might be even more important in this process because of the embarassment it causes. Between 6% and 17% of residents in residential homes for the elderly are faecally incontinent, but little is known about the prevalence in the general population [7-9]. The aim of the study was to estimate the prevalence of both UI and faecal incontinence (FI) in community-residing women aged 60 years and over and to assess the association of age with the prevalence of UI and FI. Furthermore, factors which were potentially associated with urinary incontinence were investigated.
Methods The study was carried out in the municipality of Amstelveen, The Netherlands. Names, ages and
addresses were obtained of all women aged 60 years and over (n = 8967 resident in the municipality of Amstelveen, The Netherlands on 31/12/1988). A random sample was drawn to include 30 women bom in each year. Whenever there were fewer than 30 women born in the same year, all were included. Women living in institutions were excluded. In March 1989, 1049 women received a postal questionnaire and an accompanying letter explaining the aim of the study and requesting the completion of the questionnaire. The questionnaire could be completed in approximately 30 minutes. After three weeks a reminder was sent. The following points were investigated: presence of urinary and faecal incontinence, usual voiding pattern during the day and night and usual defaecating pattern. A woman was considered to have UI if she had involuntary urine loss at least twice a week, irrespective of the amount of urine loss. Frequent voiding was defined as more than seven voids a day, while nocturia was defined as a voiding pattern of more than twice a night. Urgency was defined as a strong desire to void accompanied by fear of leaking [10]. Faecal incontinence was defined as occasional involuntary loss of faeces. Mobility was assessed by subject's description whether she 'could manage well', 'less than others' or 'needed help'. The last two were considered as poor mobility. Data were collected about Age and Ageing 1992;21:211-215
A. L. M. KOK ET AL. Table I. Prevalence of unnary and faecal incontinence among community-residing elderly women by age groups Age group (years) 60-64 65-69 70-74 75-79
80-84 85-89 >90
Unknown Total
No. of women with UI (no. of respondents)
Percentage with UI
No. of women with FI (no. of respondents)
Percentage with FI
18(90) 23(121) 22(131) 22 (97) 26 (98) 32(104) 21 (74) 0(4)
20.0 19.0 16.8 22.7 26.5 30.8 28.4
2(86) 4(101) 3(116) 6(83) 4(86) 16(90) 10(63)
2.3 4.0
17.8 15.9
164(719)
23.5*
45(625)
16.9*
2.6 7.2 4.7
•Weighted mean as overall prevalence.
significantly lower prevalence than those aged 85 years and over, with an overall prevalence of 4.2% and 16.9%, respectively. Additional analysis of factors potentially associated with UI was performed separately in the age groups below 85 years and those aged 85 years and over, since the age of 85 years marked a significant change in FI occurrence. First, all variables concerning micturition and defaecation patterns, mobility, medication and health problems were analysed in a univariate model. The results depicted in Table II show that in women aged 60-84 years poor mobility, freResults quency, urgency and FI were significantly more Of the 1049 questionnaires sent, 763 were prevalent in women with UI. Nocturia was not returned, 44 of these were unanswered includ- significantly associated. In the age group 85 ing seven instances when the addressee had years and over, poor mobility and nocturia were died. Thus 719 (69%) questionnaires were significantly associated with UI, whereas freavailable for analysis. Table I shows the preva- quency did not reach a level of significance. In lence reported of urinary and faecal inconti- this age group, urgency and FI showed no nence in the different age groups. The preva- association with UI. lence of UI did not differ between the age Second, all factors demonstrated in Table II groups (x2 = 9.Sb, 6 df, p > 0 . 1 ) . The weighted were included in a predictive multivariate mean as an overall prevalence of urinary incon- model in which mutual adjustment identified tinence was 23.5%. A daily loss of urine was factors independently associated with UI. This reported by 96 women, which represents 14% model has been drawn up for the 526 responof all the women. Information on FI was dents with information available on all variavailable from 625 women. In contrast to UI, ables. As seen in Table III, poor mobility and the distribution of FI in the age groups was not frequency were predictors of UI in all age homogeneous (*2 = 45.0, 6 df, p < 0.0004). The groups. In addition, in women aged 60-84 age groups below 85 years of age showed a years, urgency emerged as an independent disorders with a possible effect on the occurrence of UI or FI. Data from the questionnaire were analysed in seven age groups, y1 tests were used to test for homogeneity both for UI and FI. All statistical computations were adjusted for age. Possible associations between the factors investigated and UI were calculated as odds ratios (OR) with 95% confidence intervals (CI) [11]. Stepwise logistic regression with urinary incontinence as dependent variable was used to search for significant associations.
INCONTINENCE IN COMMUNITY-RESIDING ELDERLY WOMEN
213
Table II. Factors associated with urinary incontinence (UI) in women aged 60 and over, standardized by age, univariate model With UI
Without UI
(%)
(%)
With/without UI
ORf
95% C\\
60-84 years Poor mobility Frequency Nocturia Urgency Faecal incontinence
19(17.1) 26(23.0) 15(13.6) 24(21.6) 8(8.5)
30(7.1) 30(7.2) 32(7.8) 14(3.3) 11(2.9)
111/422 113/416 110/412 111/422 103/389
2.50 4.04 1.33 8.46 5.78
1.10-5.68* 2.04-8.00* 0.53-3.30 3.35-21.36* 1.59-21.02*
85 years and over Poor mobility Frequency Nocturia Urgency Faecal incontinence
42 (79.2) 12(23.5) 15(30.6) 21 (39.6) 9(21.4)
42(35.0) 10(8.2) 14(11.6) 16(16.7) 15(12.2)
53/123 51/122 49/121 53/123 42/96
7.01 3.15 4.75 2.20 2.70
2.57-19.17* 0.97-10.16 1.66-13.59* 0.73-6.64 0.96-7.61
Factors
•p
