Urinary Incontinence and Nursing Home Residents’ Quality of Life

The incidence of urinary incontinence (UI) in American nursing homes is high. According to recent studies, between 43% and 81% of nursing home residents in the United States have this condition.¹ UI is increasingly common with advancing age, and older adults with this condition often have underlying cognitive and mobility problems. UI can increase the risk of falls and fractures, urinary tract infections, and skin irritation.

To evaluate the effects of UI on nursing home residents’ quality of life and domains of quality of life, Dongjuan Xu, RN, of both the Shandong University School of Nursing in China and the University of Minnesota School of Public Health, Minneapolis, and Robert L. Kane, MD, of the University of Minnesota School of Public Health, analyzed data from the Long-Term Care Minimum Data Set, the 2010 Minnesota Nursing Home Report Card, and the responses to a questionnaire completed by 8600 Minnesota nursing home residents. The residents had an average age of 87 years, and two-thirds leaked urine and therefore met the criteria for UI.

The questionnaire asked each resident about his or her mood, overall quality of life, and 11 domains of quality of life, which included the following:

•   Comfort;

•   Environmental adaptation;

•   Privacy;

•   Dignity;

•   Meaningful activity;

•   Food enjoyment;

•   Autonomy;

•   Individuality;

•   Security;

•   Relationships; and

•   Satisfaction.

Xu and Kane found that residents with and without UI ranked their overall quality of life similarly, with both groups giving it an equally high average score of 7 out of 10. Both groups also ranked eight of the 11 domains of quality of life similarly.

“We found no difference between residents with and without UI in the domains of comfort, environmental adaptation, privacy, meaningful activity, individuality, security, relationships, and satisfaction,” the researchers report. Residents with UI, however, had lower scores in the domains of dignity and autonomy, as well as mood, than those who did not have urinary incontinence.

“The embarrassment of wetting themselves may result in residents feeling a loss of personal dignity [so these] residents…make extra efforts to preserve dignity,” Xu and Kane note, emphasizing the importance of dignity among these older adults. In light of this, long-term care facilities should focus on protecting and fostering dignity among these older adults, the researchers recommend.

“These findings underscore the need for improved recognition of how UI affects nursing home residents’ quality of life,” write the researchers. “Interventions should specifically target…domains of dignity, autonomy, and mood among nursing home residents with UI to improve their quality of life.”

Reference

1. Xu D, Kane RL. Effect of urinary incontinence on older nursing home residents' self-reported quality of life. J Am Geriatr Soc. 2013;61(9):1473-1481.