Factors influencing the adherence behaviors of elderly incontinent women.

Abstract

The problem of urinary incontinence (UI) has become one of the most common causes of institutionalization of the elderly. Further, research has shown UI to be more prevalent in older women than in older men. For elderly women this means a greater risk of institutionalization related to urinary incontinence. Research has focused, largely, on the physical presentation of UI and approaches to treatment, but no studies have addressed the impact of factors influencing adherence to treatment. In this study, a model of adherence to treatment is proposed to examine the configuration of factors which operate in subjects who complete treatment and in those who do not. In this case, the model was applied to data from a subgroup of 151 community-living elderly women (55-90 years), in a treatment program for stress incontinence, drawn from a larger study of incontinent women (n = 398), (Wells, Brink and Diokno, 1987). The treatment protocol included pelvic muscle exercises, record keeping of exercises and voiding patterns, and monthly clinic appointments over a period of six months. A prediction model of adherence was confirmed through factor analysis. Regression analysis revealed those factor items which contributed most to treatment behaviors in completers. Source of referral and the factor "Perception of Seriousness" (which had the largest effect) contributed to the performance of pelvic exercises. The factor "Health Perceptions" and Source of Referral contributed the most to number of visits made to the clinic. Total amount of wetting was related to the factor "Prior Contact with Urinary Incontinence". These findings indicate multifactorial influences on adherence behaviors and support the usefulness of the model in delineating some factors.