Urinary incontinence in older people living in the community: examining help-seeking behaviour.

Background: Only a small proportion of older people with urinary incontinence seek help, despite the availability of adequate treatment.

Aim: To ascertain the patient- and disease-specific factors that determine whether medical care for urinary incontinence is sought by independently living older people with urinary incontinence.

Design Of Study: Qualitative and quantitative analyses of interview data.

Setting: All independently-living older patients aged 60 years or over from nine family practices involved in the Nijmegen Monitoring Project.

Method: All the independently-living patients aged 60 years or over with uncomplicated urinary incontinence were interviewed at home using the Protection, Amount, Frequency, Adjustment, Body image (PRAFAB) assessment tool, the Incontinence Impact Questionnaire, and the Urogenital Distress Inventory (UDI).

Results: In total, 56 men and 314 women were interviewed. Half of the patients had sought help from a GP. Help-seeking was related to the duration of symptoms, the severity of incontinence, the impact experienced emotionally and/or physically, and the presence of concomitant symptoms, particularly of urinary obstruction. Only the presence of incontinence-related complaints as listed on the UDI (odds ratio = 2.74, 95% confidence interval = 1.42 to 5.29) was a significant predictor of help-seeking. Most of the patients who had not sought help did not do so because they considered incontinence as not very serious, or because of a lack of knowledge about cause and treatment options - comments such as 'incontinence is age-related', and 'there is nothing that can be done about incontinence', were reported. Major reasons for seeking help were perceived increase in severity or distress and the need for incontinence materials.

Conclusions: Seeking help is particularly determined by the impact experienced and presence of concomitant symptoms. When patients perceive their incontinence as not very serious or distressing and have a lack of knowledge about cause and treatment options, they usually do not seek help. When they perceive an increase in severity or distress or require incontinence materials, they usually do seek help.