Faecal incontinence affects 14% of female and 6% of male nursing home residents in Turkey, and urge incontinence is common
- Correspondence to Susi Saxer
Projektleitung, FHS Hochschule für Angewandte Wissenschaften, Institut für Angewandte Pflegewissenschaft, Rosenbergstrasse 22, 9000 St Gallen, Switzerland;
This study by Aslan and colleagues was performed to determine the prevalence of and factors related to urinary incontinence (UI) and faecal incontinence (FI) among older people residing in nursing homes in Istanbul. As in other countries, the population of older people is increasing in Turkey, and with this ageing of the population the prevalence of UI also increases. UI has a significant impact on quality of life1 but is nevertheless often underreported. Therefore the results of this prevalence study are important for informing clinical practice and research.
The study used a cross-sectional design and included people over 60 years of age living in five nursing homes in Istanbul. In addition to consent to participation, the inclusion criteria were no mental health problems and no disabilities related to hearing, vision and speech. After permission was obtained from the relevant ethics boards, interviews with the included residents focused on demographic details and incontinence complaints. The fact that data were collected by direct interview, rather than as secondary data, is a major strength of this study.
A total of 694 residents participated in the study, 392 women (56.5%) and 302 men (43.5%). Of this sample, 43.4% of the women and 20.9% of the men were incontinent. Table 1 provides a detailed breakdown of the findings for UI. The factors related to UI among older women were episiotomy, frequency, urgency, FI and functional status; among older men related factors were pulmonary diseases, stroke, frequency, FI and recurrent urinary tract infection. In total, 14% of women and 6% of men were faecally incontinent; more than 40% of these were faecally incontinent once a day, and almost 60% a couple of times/month.
The authors concluded that women were more often incontinent than men. The overall prevalences in this study were lower than in other studies; nevertheless, these results probably reflect the situation in many nursing homes across Turkey. The differences in prevalence and type of UI and FI in women and men and other differences are not explained only by the fact that “care dependent men are looked after longer at home than women”. The reasons include differences in age, body mass index and presence of chronic illnesses in women and men.2
UI was classified according to a range of categories: stress, urge, mixed, overflow and functional. The frequency of UI, frequency of pad use and amount of urine voided during incontinence episodes were measured. This information gives a very thorough picture of the residents' UI; however, the description of the methods failed to make clear who made these classifications and who took the measurements and how: were the measurements taken by the research group or the nurses, or were they based on residents' self-assessment? Different data collection methods can lead to different results, and thus it is important to know how the data were collected to better interpret the results. It is also unclear, with regards to the statistical analyses of the data, which factors were included in the logistic regression analysis: were only the ‘significant’ factors included, or were further factors such as other diseases, medications and cognitive abilities included? Again, it is necessary to know such details before the results can be interpreted with confidence.
For future prevalence studies, comparison of different data collection methods would be beneficial, including residents' self-assessment, interviews with residents and interviews with their caregivers. Prevalence results could vary among studies according to the choice of data collection method, and thus it is important to know the relative merits and accuracy of each method.
Competing interests None.