Factors Related to Quality of Life in the Older Adults: Urinary Incontinence, Comorbidity and Polypharmacy

Öz

Aim: Urinary incontinence (UI) is a health problem that has a significant impact on the quality of life of older adults, especially in the presence of comorbidity and polypharmacy, which tend to increase with age. This study aims to investigate the influence of UI, comorbidity and polypharmacy on quality of life in older adults. Method: This descriptive and correlational study was conducted with 328 older adults between November and June 2020. The data collection tools consisted of a “Personal Information Form” and Quality of Life Scale in older adults. Descriptive statistics, two-way analysis of variance and binary logistic analysis were used to evaluate the data. The significance level was accepted as p<0.05. Results: The prevalence of urinary incontinence in older adults was 46.6%. Female gender (OR: 0.54) and accepting urinary incontinence as a health problem (OR: 3.11) were found to be risk factors for urinary incontinence in older adults (p<0.05). For quality of life, the main effect of the urinary incontinence variable (p<0.001) and the main effect of the polypharmacy variable (p<0.05) were found to be statistically significant. The comorbidity*polypharmacy variable also has an effect on quality of life (p<0.05). Conclusions: According to the findings of this study, approximately one in two older adults experiences urinary incontinence. This condition is more prevalent among older women and among individuals who perceive urinary incontinence as a significant health issue. Both urinary incontinence and polypharmacy have a negative impact on quality of life, with urinary incontinence exerting a greater detrimental effect. Furthermore, the coexistence of comorbidities and polypharmacy is also associated with a decline in quality of life.

Anahtar Kelimeler

• Urinary incontinence
• older adults
• comorbidity
• polypharmacy
• quality of life

Yaşlılarda Yaşam Kalitesi ile İlişkili Faktörler: Üriner İnkontinans, Komorbidite, Polifarmasi

Öz

Amaç: Üriner inkontinans (UI), özellikle yaşla birlikte artma eğiliminde olan komorbidite ve polifarmasi varlığında yaşlı yetişkinlerin yaşam kalitesi üzerinde önemli bir etkiye sahip olan bir sağlık sorunudur. Bu çalışmada, üriner inkontinans, komorbidite ve polifarmasinin yaşlılarda yaşam kalitesi üzerindeki etkisini araştırmayı amaçlamaktadır. Yöntem: Bu çalışma tanımlayıcı ve ilişki arayıcı araştırma türünde 328 yaşlı ile yapılmıştır. Veri toplama formu olarak, “Kişisel Soru Formu” ve “Yaşlı Yaşam Kalitesi Ölçeği” kullanılmıştır. Verilerin değerlendirilmesinde tanımlayıcı istatistikler, iki yönlü varyans analizi ve binary logistic regresyon analizi kullanılmıştır. Anlamlılık düzeyi p<0,05 olarak kabul edilmiştir. Bulgular: Yaşlılarda üriner inkontinans sıklığı %46,6’dır. Yaşlılarda üriner inkontinans risk faktörü olarak kadın cinsiyeti (OR:0,54) ve üriner inkontinansı sağlık sorunu olarak kabul etme (OR:3,11) bulunmuştur(p<0,05). Yaşam kalitesi üzerine, üriner inkontinans değişkenine ilişkin ana etki (p<0,001) ve polifarmasi değişkenine ait ana etki (p<0,05) istatistiksel olarak anlamlı bulunmuştur. Komorbidite* polifarmasi değişkeni de yaşam kalitesi üzerinde etki oluşturmaktadır (p<0,05). Sonuç: Bu çalışma sonuçlarına göre yaklaşık her iki yaşlıdan biri üriner inkontinans yaşamaktadır. Kadın yaşlılarda ve üriner inkontinansı sağlık sorunu olarak kabul eden yaşlılarda üriner inkoninans daha fazladır. Üriner inkontinans ve polifarmasi yaşam kalitesini olumsuz etkilemektedir. Üriner inkontinansın yaşam kalitesini olumsuz etkileme durumu polifarmsiden daha fazladır. Ayrıca komorbidite ve polifarmasinin bir arada olması da yaşam kalitesini olumsuz etkilemektedir.

Anahtar Kelimeler

• Üriner inkontinans
• yaşlı
• komorbidite
• polifarmasi
• yaşam kalitesi

Kaynakça

1. 1. D’Ancona C, Haylen B, Oelke M, et al. The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn. 2019;38:433–77.
2. 2. Pang H, Lv J, Xu T, et al. Incidence and risk factors of female urinary incontinence: A 4‐year longitudinal study among 24 985 adult women in China. BJOG: An International Journal of Obstetrics & Gynaecology. 2022;129(4):580-589.
3. 3. Ahmadi B, Alimohammadian M, Golestan B, et al. The hidden epidemic of urinary incon-tinence in women: A population‐based study with emphasis onpreventive strategies. Int Urogynecol J. 2010;21(4):453‐459
4. 4. Batmani S, Jalali R, Mohammadi M. et al. Prevalence and factors related to urinary incontinence in older adults women worldwide: A comprehensive systematic review and meta-analysis of observational studies. BMC Geriatr. 2021;21:212.
5. 5. Luo Y, Zou P, Wang K, et al. Prevalence and risk factors of urinary incontinence among elderly adults in rural China: A cross-sectional survey. Journal of Wound, Ostomy and Continence Nursing. 2022;49(1):78-86.
6. 6. Aly WW, Sweed HS, Mossad NA, et al. Prevalence and risk factors of urinary incontinence in frail elderly females. Journal of Aging Research. 2020;(1):2425945.
7. 7. Daneshpajooh A, Naghibzadeh‐Tahami A, Najafipour H, et al. Prevalence and risk factors of urinary incontinence among Iranian women. Neurourology and Urodynamics. 2021;40(2):642-652.
8. 8. Gibson W, Johnson T, Kirschner‐Hermanns R, et al. Incontinence in frail elderly persons: Report of the 6th International Consultation on Incontinence. Neurourology and Urodynamics. 2021;40(1):38-54.

9. 9. Talasz H, Lechleitner M. Polypharmacy and incontinence. Zeitschrift für Gerontologie und Geriatrie. 2012;45(6):464-467.
10. 10. Scharp D, Harkins SE, Topaz M. Comorbidities of community-dwelling older adults with urinary incontinence: A scoping review. Geriatric Nursing. 2023;53:280-294.
11. 11. Menditto E, Gimeno Miguel A, Moreno Juste A, et al. Patterns of multimorbidity and polypharmacy in young and adult population: Systematic associations among chronic diseases and drugs using factor analysis. PLoS One. 2019;14(2):e0210701.
12. 12. Küçükdağlı P. Polypharmacy and related factors in geriatric outpatients. European Journal of Geriatrics and Gerentology. 2019;1(2):56-60.
13. 13. Gutiérrez-Valencia M, Herce PA, Lacalle-Fabo E, et al. Prevalence of polypharmacy and associated factors in older adults in Spain: Data from the National Health Survey 2017. Medicina Clínica. 2019;153(4):141-150.
14. 14. Van Wilder L, Devleesschauwer B, Clays E, et al. Peer reviewed: polypharmacy and health-related quality of life/psychological distress among patients with chronic disease. Preventing Chronic Disease. 2022;19:E50.
15. 15. Landi F, Cesari M, Russo A, et al. Benzodiazepines and the risk of urinary incontinence in frail older persons living in the community. Clinical Pharmacology & Therapeutics. 2002;72(6):729-734
16. 16. Fritel X, Tsegan YE, Pierre F, et al. Association of postpartum depressive symptoms and urinary incontinence: A cohort study. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2016;198:62-67.
17. 17. Felde G, Engeland A, Hunskaar S. Urinary incontinence associated with anxiety and depression: The impact of psychotropic drugs in a cross-sectional study from the Norwegian HUNT study. BMC Psychiatry. 2020;20:1-10.
18. 18. Ruby CM, Hanlon JT, Boudreau RM, et al. The effect of medication use on urinary incontinence in community‐dwelling elderly women. Journal of the American Geriatrics Society. 2010;58(9):1715-1720.
19. 19. Murukesu RR, Singh DK, Shahar S. Urinary incontinence among urban and rural community dwelling older women: Prevalence, risk factors and quality of life. BMC Public Health. 2019;19(4):1-11.
20. 20. Alshammari S, Alyahya MA, Allhidan RS, et al. Effect of urinary incontinence on the quality of life of older adults in Riyadh: Medical and sociocultural perspectives. Cureus. 2020;12(11):e11599.
21. 21. Zhang D, Wang S, Gao L, et al. Analysis of characteristics and quality of life of elderly women with mild to moderate urinary incontinence in community dwellings. International Journal of Environmental Research and Public Health. 2022;19(9):5609.
22. 22. Ragins AI, Shan J, Thom DH, et al. Effects of urinary incontinence, comorbidity and race on quality of life outcomes in women. The Journal of Urology. 2008;179(2):651-655.
23. 23. Prud'homme G, Alexander L, Orme S. Management of urinary incontinence in frail elderly women. Obstetrics, Gynaecology & Reproductive Medicine. 2018;28(2):39-45.
24. 24. Schenker Y, Park SY, Jeong K, et al. Associations between polypharmacy, symptom burden, and quality of life in patients with advanced, life-limiting illness. Journal of General Internal Medicine. 2019;34:559-566.
25. 25. Bitek DE, Ulukoca N, Helvacı M. Evde bakım hizmetinden yararlanan engelli yaşlı bireylerin sağlık durumları ve yaşam kalitelerinin değerlendirilmesi. In: 3rd International, 21st National Public Health Congress; November 26–30, 2019; Antalya, Turkey.
26. 26. Türkoğlu N, Adıbelli D. Yaşlılarda yaşam kalitesi ölçeğinin (CASP-19) Türk toplumuna adaptasyonu. Akad Geriatri. 2014;6:98-105.
27. 27. Luo Y, Zou P, Wang K, Li X, Wang J. Prevalence and risk factors of urinary incontinence among elderly adults in rural China: A cross-sectional survey. Journal of Wound Ostomy & Continence Nursing. 2022;49(1):78-86.
28. 28. Jerez-Roig J, Farrés-Godayol P, Yildirim M, et al. Prevalence of urinary incontinence and associated factors in nursing homes: A multicentre cross-sectional study. BMC Geriatrics. 2024;24(1):169.
29. 29. Scime NV, Hetherington E, Metcalfe A, et al. Association between chronic conditions and urinary incontinence in females: A cross-sectional study using national survey data. Canadian Medical Association Open Access Journal. 2022;10(2):E296-E303.
30. 30. Huang H, Ding G, Li M, et al. Menopause and stress urinary incontinence: The risk factors of stress urinary incontinence in perimenopausal and postmenopausal women. Journal of Obstetrics and Gynaecology Research. 2023;49(10):2509-2518.
31. 31. Liu B, Wang L, Huang SS. et al. Prevalence and risk factors of urinary incontinence among Chinese women in Shanghai. Int J Clin Exp Med. 2014;7(3):686-96.
32. 32. Siddiqui NY, Ammarell N, Wu JM, et al. Urinary incontinence and health-seeking behavior among white, black, and Latina women. Female Pelvic Med Reconstr Surg. 2016;22(5):340-5.
33. 33. Silay K, Akinci S, Ulas A, et al. Occult urinary incontinence in elderly women and its association with geriatric condition. Eur Rev Med Pharmacol Sci. 2016;20(3):447-51
34. 34. Purchase T, Trilloe G, Ahmed H, et al. Polypharmacy and smoking as potentially modifiable risk factors associated with symptom severity in men with lower urinary tract symptoms in primary care: Findings from the PriMUS study. European Urology Focus. 2022;8(1):8-10.
35. 35. Tegegn HG, Erku DA, Sebsibe G, et al. Medication-related quality of life among Ethiopian elderly patients with polypharmacy: A cross-sectional study in an Ethiopia university hospital. PloS One. 2019;14(3):e0214191.
36. 36. Aljeaidi MS, Haaksma ML, Tan EC. Polypharmacy and trajectories of health-related quality of life in older adults: An Australian cohort study. Quality of Life Research. 2022;31(9):2663-2671.
37. 37. Chen HM, Chen CM. Factors associated with quality of life among older adults with chronic disease in Taiwan. International Journal of Gerontology. 2017;11(1):12-15.
38. 38. Xiao S, Shi L, Dong F, et al. The impact of chronic diseases on psychological distress among the older adults: The mediating and moderating role of activities of daily living and perceived social support. Aging & Mental Health. 2022;26(9):1798-1804.
39. 39. İşli F. Yaşlılarda polifarmasi. Turkey Health Literacy Journal. 2022;3(3):171-174.