Urinary Incontinence in a National Cohort of Older Women: Implications for Caregiving and Care Dependence

Abstract

Background: Urinary incontinence (UI) can interfere with older women's ability to perform activities of daily living (ADLs), but little is known about factors that predispose incontinent women to become functionally dependent or compromise their ability to serve as caregivers to others.

Study design: UI, caregiving, and care-receiving behaviors were assessed by questionnaire in a national sample of community-dwelling older women. Multivariable models evaluated associations between incontinence and care dependence, assessed factors associated with care dependence among incontinent women, and compared health among female caregivers with and without incontinence.

Results: Of the 1703 women, 27% reported weekly or more incontinence and 13% monthly incontinence. Women with weekly or more incontinence were more likely than women without incontinence to report receiving care for ADLs (AOR = 2.39, CI = 1.61-3.56) or instrumental ADLs (AOR = 1.94, CI = 1.42-2.63). Compared to 46% of women without incontinence, 60% of women with monthly or weekly incontinence reported unmet care needs (p = 0.0002). Factors associated with care dependence included more frequent incontinence, older age, marital status, and fair/poor health (p < 0.05 for all). Overall, 15% of women served as a caregiver for another adult, which did not differ by incontinence status (p = 0.84), but female caregivers with incontinence reported worse health than those without incontinence (p = 0.0004).

Conclusions: In this national cohort, older women with incontinence were more likely to be functionally dependent and have unmet care needs than those without incontinence, after adjustment for other factors. At least one in ten incontinent women served as caregivers, despite having worse health than female caregivers without incontinence.

Keywords: activities of daily living; caregiving; functional dependence; urinary incontinence.

Figures

FIG. 1.

Proportion of Women (a) Receiving Care or (b) Serving as Caregivers, by UI Status. p < 0.0001 for test of heterogeneity in care receiving for any ADL by UI frequency. p < 0.0001 for test of heterogeneity in care receiving for any IADL by UI frequency. p = 0.84 for test of heterogeneity in proportion of women serving as caregivers by UI frequency. p = 0.31 for test of heterogeneity in hours per day of caregiving by UI frequency. ADL, activity of daily living; IADL, instrumental activity of daily living; UI, urinary incontinence.