Perceptions and help-seeking behaviours among community-dwelling older people with urinary incontinence: A systematic integrative review.

Effectiveness of a nurse-led hybrid self-management program for community-dwelling older people with urinary incontinence: A randomized controlled trial.

Introduction: Nutrition plays an important role in older people. Numerous factors are associated with malnutrition among community-dwelling older people. However, little is known about how malnourished older people experience their nutritional status. This study aimed to explore how malnourished community-dwelling older people perceive the factors associated with their nutritional status. Methods: An explorative qualitative design was performed in Kandy District, Sri Lanka. A group of 150 malnourished community-dwelling older people identified from a cross sectional survey were invited for Focus Group Discussions (FGDs). A purposive sampling method was used. Fifteen FGDs were conducted among 85 participants. A thematic analysis was done to identify relevant themes related to malnutrition status. Results: The mean age of the participants was 68.74 years (SD± 6.32). Their age range was 60 to 97 years. Four main themes were identified through FGDs: (1) factors affecting dietary patterns, (2) food choices, (3) health status, and (4) psychological challenges.
 Conclusions: Community-dwelling malnourished older people stated factors associated with their dietary patterns, such as age-related factors, food choices, health status and mental status, lead to their malnutrition status. Public health professionals must understand and recognize these realities to improve the nutritional status of community-dwelling older people.
 Keywords: Community-dwelling, Malnutrition, Older people, Sri Lanka

The objective of this review was to examine community-dwelling older people's experiences of advance care planning with health care professionals. The importance of health care professionals initiating advance care planning for patients has been reported; however, because of the shift from institutionalized to community care, community-dwelling older people have fewer opportunities to discuss these plans with health care professionals compared with older people living in other settings. The timely initiation of advance care planning and sustainable discussions among older people, their families, and community health care professionals is necessary and may improve palliative and end-of-life care. Studies with participants aged 60 years and older who have experience with advance care planning and live in their own homes in the community were included. We considered qualitative studies and the qualitative component of mixed methods studies published between January 1999 and April 2023 in English or Japanese. MEDLINE (EBSCOhost), CINAHL (EBSCOhost), Embase, PsycINFO (EBSCOhost), JSTOR, Scopus, Japan Medical Abstract Society, and CiNii were searched for published papers. Google Scholar, ProQuest Dissertations and Theses Global and MedNar were searched for unpublished papers and gray literature. Study selection, critical appraisal, data extraction, and data synthesis were conducted by 2 independent reviewers using the JBI approach and JBI standardized tools. Findings were pooled using a meta-aggregation approach. The synthesized findings were graded using the ConQual approach for establishing confidence in the output of qualitative research syntheses and presented in a Summary of Findings. Five studies published between 2017 and 2022 were included in the review. Each study scored between 6 and 8 out of 10 on the JBI critical appraisal checklist for qualitative research. We extracted 28 findings and aggregated them into 7 categories, generating 3 synthesized findings: i) A trusting relationship with health care professionals is essential for older people's decision-making. Health care professionals' attitudes, knowledge, and skills play a role in this, influencing the perceived quality of care; ii) Shared decision-making and patient-centered communication are essential. Older people feel ambiguity toward end-of-life decision and advance care planning, and they want their wishes to be heard in any situation to maintain their autonomy and quality of life; iii) Older people need the appropriate forms and accessible and coordinated care to begin advance care planning. Qualitative studies on community-dwelling older people's experiences of advance care planning with health care professionals are scarce. The experiences have illustrated that trusting relationships influence people's perception of the quality of care they receive; there is uncertainty about their future; and they have varying feelings or attitudes toward their impending death, including denial and avoidance. This review highlights the need for appropriate forms, and accessible and coordinated care to begin advance care planning; thus, an approach that meets the individual's health and psychosocial status should be selected carefully. Further research is recommended to include older populations from broader geographical and cultural backgrounds, and to assess and evaluate the different advance care planning approaches and their implementation processes among groups of community-dwelling older people with different health and psychosocial statuses. PROSPERO CRD42020122803.

Background: Aging and its pathologies, particularly sleep problems, are increasingly affecting industrialized societies. This study aims to determine the effectiveness of different cognitive interventions for the treatment of insomnia or poor sleep quality in community-dwelling older people. Methodology: A systematic review was carried out from November 2023-July 2024 according to the standards of the Preferred Reporting Items for Systematic Review and Meta-Analyses in the databases. The following databases were consulted: Pubmed, Web of Science, and ClinicalTrials.gov. The studies included patients with sleep problems or insomnia over 60 years of age. To evaluate the quality of the studies, the Critical Appraisal Skills Program Spanish (CASPe) guide was used. Results: Nine clinical trials with intervention groups and control groups belonging to the last 10 years were selected. They were analyzed, and the results were verified via questionnaires, scales, sleep diaries, and objective measures. In general, the implementation of the interventions improved the quality of sleep and symptoms of insomnia. Conclusions: Cognitive interventions have been found to be safe and useful for the treatment of insomnia and poor sleep quality in older people. Furthermore, they are feasible in terms of cost effectiveness and can be easily implemented by primary care teams.

The purpose of this study was to describe knowledge of urinary incontinence among community nurses and community-dwelling older people in China. The descriptive study was undertaken in 2007 using a cross-sectional research design. A random sampling method was used to recruit 100 Chinese older people and 100 Chinese nurses in JinShan and NanHui communities, Shanghai, China. All participants completed all items of a demographic survey and the Urinary Incontinence Knowledge Scale (UIKS). Based on the literature, the UIKS was developed in 2007. The value of content validity index tested by five experts was 0.75. Measures of internal consistency (Kuder-Richardson formula 20) were 0.72 for the community nurses and 0.69 for the older people. The UIKS consisted of 30 items with dichotomous choices (Correct = 1; False or Do not know = 0). The mean UIKS score of the nurses (mean 20.7, SD 3.5) was significantly higher than that of the older people (mean 13.4, SD 4.0) with a 95% confidence interval for difference in means 6.3-8.4 (t = 13.84; df = 198; P < 0.001). Although community nurses had moderate knowledge of the impact of incontinence, they still lacked knowledge of risk factors, symptoms, prevention, treatment, and management. Older people had poor knowledge about risk factors, symptoms, impact, prevention, treatment and management of urinary incontinence. Because of their knowledge deficits, community nurses and older people viewed urinary incontinence as a normal part of the ageing process. The findings suggested that both nurses and older people in the community had educational needs related to the incontinence. Further studies to develop specific educational programmes concerning urinary incontinence are suggested. Ways to enhance support and acceptable forms of specific content knowledge, process measures and regulatory enforcement require additional exploration.

Background: Self-determination has emerged as an important concept within health care, used to emphasize clients' control and independence as they participate in rehabilitation. To strengthen clients' self-determination is a central aim in occupational therapy. However, there is a lack of a clear definition of self-determination concerning community-dwelling older people. The definition should be flexible in different contexts, such as cultural. Objective: To define and clarify the concept of self-determination in relation to community-dwelling frail older people. Method: Walker & Avant's analysis procedure was carried out to identify textual attributes to the concept of self-determination, supplemented by a content analysis of 21 articles that were used to define and further justify the textual attributes. Results: Self-determination was used in diverse contexts for community-dwelling older people, concerning: decision-making in everyday life, professionals' views, health, and legal/ethical rights. Different textual attributes were identified, to propose a conceptual definition of self-determination in relation to community-dwelling frail older people: A process in which a person has control and legal/ethical rights, and has the knowledge and ability to make a decision of his/her own free choice. Principal conclusion: This concept analysis has contributed to clarifying the concept for the convenience of research with community-dwelling frail older people.

To identify the challenges and opportunities among primary health care nurses and general practitioners (GPs) in the care of older people with urinary incontinence (UI) and other chronic conditions in China. UI is highly prevalent among community-dwelling older people with chronic conditions but is underreported and poorly managed. Understanding the factors that affect primary health care professionals' practices in their care for this population is imperative to foster nurse-led UI care services. A qualitative descriptive study. Four focus groups were held with 24 primary health care nurses and GPs in Changsha, Hunan Province, China, between July and September 2021. A reflective thematic analysis was used to identify themes. This study revealed misconceptions regarding older people living with UI and other chronic conditions in primary care health professional participants. Moreover, primary health care nurses had very limited autonomy in UI diagnosis and initiating care interventions for this patient population. By reflecting on practices, participants recognized various practical solutions to improve the detection and management of UI. Participants also identified barriers to accessing care services in older people with UI. They suggested changes in the health care system to achieve universal access to UI care services for older people. Nurse-led UI care services in primary health care for community-dwelling older people with chronic conditions are in high demand but are underdeveloped due to professional and health care system factors. Findings from this study provide new insights into challenges faced by primary health care professionals and illuminate practical solutions to address these challenges. Adherence to COREQ guidelines was maintained. No patient or public contribution.

The prevalence of urinary incontinence and factors associated with urinary incontinence in community dwelling older Turkish people

ObjectiveFalls represent the most frequent reason older people are admitted to hospital and significantly increase the likelihood of functional decline, healthcare utilisation and early mortality. The aim of this study is to comprehensively delineate the burden of falls amongst community-dwelling older people in Ireland.DesignPopulation-representative analysis of Wave 6 of the Irish Longitudinal Study on Ageing (TILDA) estimating incidence of falls requiring medical attention and emergency department (ED) attendance, fractures and fear of falling over 12 months. Additional data detailing falls-risk increasing drugs (FRIDs) and prior falls were also analysed.Using Central Statistics Office Census 2022, the population of older people in Ireland was multiplied by the proportion of TILDA participants with each outcome of interest to yield population-level estimates.Participants/SettingPopulation-representative sample of 2299 (55% female) community-dwelling people in Ireland aged ≥70 years.ResultsAlmost 12% (proportion 0.12 (95% CI 0.10 to 0.13)) of participants, corresponding to almost 62 000 older people in Ireland, reported a fall requiring medical attention in 12 months, with 6% (proportion 0.06 (95% CI 0.05 to 0.07)), or over 32 000 people, attending ED due to a fall. Over 3% (proportion 0.03 (95% CI 0.03 to 0.04)) reported sustaining a fracture. Almost half of participants reporting a fall requiring medical attention were prescribed FRIDs, and over half had also reported a fall when assessed at the prior wave of the study (ie, 2 years ago).ConclusionsThe burden of falls amongst community-dwelling older people is considerable; 1 in 8 required medical attention for a fall and 1 in 16 attended the ED with falls over 12 months.Currently, there is no national falls strategy in Ireland. These findings, alongside our ageing population, underscore the need for strengthened falls-prevention strategies to reduce avoidable morbidity and healthcare utilisation.

BackgroundLife-space mobility is reflected in comprehensive longevity and health outcomes and is also an important indicator for preventing mortality and decline in well-being among older people. However, a comprehensive framework of life-space mobility and modifiable individual and environmental factors has not been well validated among community-dwelling independent older people, for primary prevention. We examined individual and environmental factors affecting life-space mobility among community-dwelling independent older people.MethodsThis cross-sectional study included 3500 community-dwelling independent older people randomly selected using the National Basic Resident Registration System in Japan. Life-space mobility was measured using the Japanese version of the Life-Space Assessment (LSA) instrument, which is used to assess an individual’s pattern of mobility. Negative multivariate binomial regression analysis was performed in a final sample of 1258 people. Individual factors (including physical, mental, and social characteristics) and environmental factors (including the social and material environment) were measured and analyzed as potential factors.ResultsNegative multivariable binomial regression analysis, adjusted for demographics, showed that LSA score was associated with locomotive syndrome (β = − 0.48, 95% confidence interval [CI] = − 0.24 to − 0.73), depression (β = − 0.29, 95% CI = − 0.03 to − 0.55), health literacy (β = 0.20, 95% CI = 0.39–0.01), and participation in community activities (β = 0.23, 95% CI = 0.03–0.43) among individual factors, and receipt of social support (β = − 0.19, 95% CI = 0.00 to − 0.38) and social network (β = 0.29, 95% CI = 0.48–0.10) among environmental factors.ConclusionsOur findings suggest that modifiable individual factors and environmental factors are related to life-space mobility among community-dwelling older people.

Falls are common among older people. Previous studies have shown that falls were multifactorial. However, data regarding community-dwelling Chinese population are minimal. We aimed to study factors associated with falls among community-dwelling older Chinese people. We conducted a cross-sectional study in a community hospital in Taiwan in 2010. Our sample included 671 elders from the 3680 examinees of the free annual Senior Citizens Health Examination. Participants were interviewed with a detailed questionnaire, and 317 elders were further invited for serum vitamin D tests. The main outcome was falls in the previous 12 months. Predictor variables included sociodemographic characteristics, lifestyle risk factors, body stature, frailty, serum 25 (OH) D levels, and medications. The mean age of the 671 participants was 75.7 ± 6.4 years old, and 48.7% of which were female. Fallers comprised 21.0% of the study population. In multivariate models, female gender (adjusted odds ratio (aOR): 2.32), loss of height in adulthood (aOR: 1.52), low body weight (aOR: 2.69), central obesity (aOR: 1.67), frailty (aOR: 1.56), polypharmacy (aOR: 2.18) and hyperglycaemia (aOR: 1.56) were factors associated with falls. Vitamin D insufficiency (serum 25 (OH) D levels <30 ng/mL) was not associated with falls (OR: 0.78; 95% CI, 0.38 to 1.60) (n = 317) in this study. Among community-dwelling older people in Taiwan, falls were mainly associated with female gender, polypharmacy, frailty, reduced body height, low body weight or central obesity, and hyperglycaemia. In addition to other risk factors, body stature should be considered as a novel risk factor when screening elders at risk for falls.

Background This thesis aimed to investigate if adverse health outcomes in older community-dwelling people can be predicted, through the application of measures of prescribing, multimorbidity and emergency admission risk models. There were five objectives: 1) to determine if there is a longitudinal association between potentially inappropriate prescribing (PIP) and future adverse drug events (ADEs), reduced health related quality of life (HRQOL) and increased use of Accident & Emergency (AE 2) to assess the performance of different measures of multimorbidity and vulnerability in predicting emergency hospital attendance and functional decline; 3) to conduct a systematic review of emergency admission risk prediction models developed for use in community-dwelling adults; 4) to systematically review and meta-analyse the validation studies of the Probability of repeated admissions (Pra) risk model; and, 5) to externally validate the Pra risk model in predicting emergency hospital admission over the following year. Methods A prospective cohort study with two year follow-up was conducted linked to the national Health Services Executive Primary Care Reimbursement Services (HSE-PCRS) pharmacy claims database (2010-2012). At baseline a total of 904 older (≥70 years) community-dwelling people were recruited from 15 general practices. The Screening Tool of Older Persons Prescriptions (STOPP) and Beers 2012 prescribing indicator sets were applied to the pharmacy data to elicit PIP. ADEs were recorded through patient interview with corresponding review of the GP medical record. HRQOL was determined through the Euro-Qul-5Dimensions (EQ-5D) administered through a patient questionnaire. Emergency attendance was ascertained through a detailed review of the GP medical record. Multilevel regression modelling was used to investigate if PIP was longitudinally associated with ADEs, HRQOL and emergency hospital attendance (Poisson (incidence rate ratio (IRR) (95% CI) and linear regression models (regression co-efficient (95% CI)). Different medication and diagnosis based measures of multimorbidity, the Vulnerable Elders Survey (VES-13) and the Pra model were investigated by examining their discrimination (the ability of the model to distinguish correctly the patients with different outcomes, c-statistic (95% CI)) and calibration (reflects how closely predicted outcomes agree with the actual outcomes, Hosmer-lemeshow statistic). Results Of 791 participants eligible for follow-up, 673 (85%) returned a questionnaire and 605 (77%) also completed an ADE interview. Baseline STOPP PIP prevalence was 42% and 445 (74%) patients reported ≥1 ADE at follow-up. In multivariable analysis, ≥2 STOPP PIP was associated with ADEs (adjusted IRR: 1.29 (95% CI 1.03, 1.85, p=0.03); poorer HRQoL (adjusted regression co-efficient: -0.11 (-0.16, -0.06; p Conclusions Older community-dwelling people, prescribed ≥2 PIP, as defined by the STOPP prescribing criteria, are more likely to report ADEs, poorer HRQOL and attend A&E over two year follow-up. Both medication and diagnosis-based measures of multimorbidity demonstrated similar performance in predicting emergency admission. The VES-13 may be useful in identifying older people at risk of functional decline in the community. In certain circumstances, while acknowledging the limitations of risk stratification, the Pra tool may have a role in targeting older people at higher risk of emergency admission.

BackgroundOlder community-dwelling people with multimorbidity are often not only vulnerable, but also suffer from several conditions that could produce a multiplicity of symptoms. This results in a high symptom burden and a reduced health-related quality of life. Even though these individuals often have frequent contact with healthcare providers they are expected to manage both appropriate disease control and symptoms by themselves or with the support of caregivers. The aim of this study was therefore to describe the symptom management strategies used by older community-dwelling people with multimorbidity and a high symptom burden.MethodA qualitative descriptive design using face-to-face interviews with 20 community-dwelling older people with multimorbidity, a high healthcare consumption and a high symptom burden. People ≥75 years, who had been hospitalized ≥3 times during the previous year, ≥ 3 diagnoses in their medical records and lived at home were included. The participants were between 79 and 89 years old. Data were analysed using content analyses.ResultTwo main strategy categories were found: active symptom management and passive symptom management. The active strategies include the subcategories; to plan, to distract, to get assistance and to use facilitating techniques. An active strategy meant that participants took matters in their own hands, they could often describe the source of the symptoms and they felt that they had the power to do something to ease their symptoms. A passive symptom management strategy includes the subcategories to give in and to endure. These subcategories often reflected an inability to describe the source of the symptoms as well as the experience of having no alternative other than passively waiting it out.ConclusionsThese findings show that older people with multimorbidity and a high symptom burden employ various symptom management strategies on daily basis. They had adopted appropriate strategies based on their own experience and knowledge. Healthcare professionals might facilitate daily life for older people with multimorbidity by providing guidance on active management strategies with focus on patient’s own experience and preferences.

Improving Oral Health Care for Frail, Community-Dwelling Older People: Exploring Barriers and Facilitators for Interprofessional Collaboration.

Background/Aims: Urinary incontinence (UI) is a very common and bothersome condition among women, affecting up to 50% of women during their lifetime. Older women are disproportionately affected and often view UI as a normal part of aging, thus precluding contact with medical professionals. The aim of this study was to determine the frequency and risk factors of UI in women aged 20 years or older, as well as to examine its effects on women’s quality of life (QOL). Methods: The study was conducted on 1,585 women aged 20 years and over between January and March 2007. Data were obtained by a face-to-face interview, using a questionnaire consisting of questions pertaining to the women’s demographic characteristics, medical and obstetric history and UI. The Short Form-36 (SF-36) scale was used to assess the QOL of the women. Results: The prevalence of UI in this group of women was 49.5%. UI was significantly associated with advanced age (p < 0.05), lower education level (p ≤ 0.001), recurrent urinary tract infection (p < 0.001), chronic obstructive pulmonary disease (p < 0.001), diabetes mellitus (p ≤ 0.001), a history of nocturnal enuresis in childhood (p < 0.001), taking diuretics (p < 0.05) and body mass index (p < 0.001). When the QOL of the women with and without UI were evaluated, the scores for women without UI were higher than those with mild, moderate or severe UI (p < 0.001 for each). Women with UI of varying severity had lower mean domain scores on the SF-36 than women without UI (p < 0.001 for each). As the severity of UI increased, it was seen that the mean domain scores according to the scale showed a decrease (p < 0.001). Conclusion: It is concluded that UI is a common disorder among women in this region of Turkey and that it also negatively affects these women’s QOL, suggesting the need for more social and medical study in this area.