Factors Associated with Urine Control in Elderly Nursing Home Residents with Chronic Memory Problems.

Chronic degenerative brain disease is the most common disability among the elderly. Urinary incontinence is frequently encountered when caring for patients with some type of brain failure. Nevertheless, incontinence is a relatively unexplored problem with this group of patients. A review of the nursing literature revealed no clear guidelines for managing urinary incontinence when patients have some type of chronic organic brain syndrome. A theoretical model was constructed to explain the relationship between urine control and physical, psychosocial, and environmental factors. The sample consisted of 61 nursing home residents identified by the nurses as having chronic memory problems. Independent variables included physical examination findings, fluid intake, mobility, cognitive ability, and environmental factors. The dependent variable was urine control. Subjects were divided into continent and incontinent groups. Multivariate statistical procedures were used with nonparametric tests to explore the differences between the urine control groups. Chi square analyses were used to determine if urine control was related to differences in recent physical examination findings and environmental features. Continent and incontinent subjects were not found to differ on findings of the most recent physical examination. This supports the likelihood that the incontinence seen in this group of patients does not stem from physical impairment. A significantly greater number of incontinent patients lived in areas where environmental cues were not likely to promote urine control. Incontinent patients also were significantly more severely impaired on all measures of cognitive ability. Similarly, incontinent patients scored significantly lower on all measures of mobility. Continent patients were able to walk farther, were able to walk faster, required less help with ambulation, and could balance longer than incontinent patients. Mobility not previously indentified in the literature, emerged as an important variable in urine control. At the same time, the incontinence seen in this group of patients is at least in part due to a memory deficit. Intervention strategies need to be developed that not only provide environmental cues conducive to urine control, but compensate for the memory deficits and maximize individual mobility.Ph.D.NursingGerontologyUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/160542/1/8512438.pd