Methods used to manage urinary incontinence by older adults in the community.

This paper addresses the ways that noninstitutionalized older adults deal with involuntary urine loss. The data come from a 1983-1984 sample survey of Washtenaw County, Michigan residents aged 60 and over. Five hundred twelve self-reported incontinent respondents are included in the analyses. About a quarter of the incontinent respondents had discussed their condition with a doctor in the previous year, while 66% used one or more methods to control urine loss. Respondents preferred using absorbent products (47% of those who used some method) and locating a toilet upon reaching a destination (42%). Fewer respondents manipulated their voiding patterns (29%) or diet and fluid intake (17%), or did pelvic muscle exercises (10%). Only 7% were taking medication for their incontinence. Logistic regression analyses were performed to identify factors associated with the choice of actions. Predictors were taken from theoretical models of health service utilization and health behavior, and included predisposing characteristics, health beliefs, enabling factors, and illness variables. Illness variables, particularly severity and type of incontinence, were the best predictors of consultation with a doctor and use of any urine control method. The predictors were less useful for understanding the choice of a specific method.

Medical correlates of urinary incontinence in the elderly.

A probability sample of noninstitutionalized elderly people in Washtenaw County, Michigan, was interviewed to determine the relationship between urinary incontinence and various health conditions. The results show that between both male and female respondents physical mobility problems, specific neurologic symptoms, lower urinary tract problems, bowel problems, respiratory problems, and history of genital surgery are more prevalent among those who are incontinent than among those who are continent. Additional factors associated with incontinence in females are: history of parent and sibling incontinence, incontinence either during pregnancy or postpartum, hearing problems, use of female hormones, and vaginal infections. Incontinence among males is associated with vision problems and a history of and symptoms of cardiovascular disease. These findings suggest urinary incontinence is part of a complex and multifactorial problem. Further studies are needed to confirm and explain these findings.

Prevalence and outcome of surgery for female incontinence.

A 4.7 percent surgery rate to correct urine loss conditions was found by a large scale survey of sixty-year and older non-institutionalized women in a Michigan county. The initial postoperative results reported by the respondents were 74 percent complete continence and 23 percent partial relief. The long-term self-reported outcomes (two years or more post-surgery) were an absolute continence rate of 39 percent and 17 percent with mild incontinence (the median time since surgery was 12 years), whereas the short term (4-23 months, mean 7.1 months) absolute continence rate was 71 percent. The characteristics of the incontinence respondent who had previous surgery showed 70 percent having mixed stress-urge type of incontinence and 66 percent losing urine almost weekly or daily. Bladder emptying symptoms were reported by 30.4 percent of the continent previously-operated respondents compared with 13.0 percent of the incontinent previously-operated respondents. All continent respondents and 84 percent of the incontinent respondents believed that physicians can help people with a urine loss condition.

Reliability of health belief indexes: confirmatory factor analysis in sex, race, and age subgroups.

Despite frequent reference to the Health Belief Model (HBM), few studies address the internal consistency (within questionnaires) or the stability across populations of scales used to measure HBM variables. As part of a 1983 Michigan statewide blood pressure survey, trained interviewers administered 32 health belief questionnaire items to 2,802 randomly selected adult Michigan residents. Exploratory common factor analysis was used to examine the structure of these questionnaire items. Six correlated factors, which corresponded closely with theoretical constructs, appeared. Guided by these results, we developed a confirmatory common factor model. The model's fit was examined in random population halves and in univariate sex, race, and age subgroups. Except perhaps in the oldest age group, the model's fit appeared constant. Reliabilities estimated for HBM factor scales formed with these questionnaire items appeared independent of age, race, or sex.

The structure and reliability of health belief indices.

A wealth of research using the Health Belief Model provides empirical evidence of the model's utility in predicting health, illness, and sick role behaviors. Until recently, however, little attention has been paid to the important issues of the validity and reliability of measures used to assess various health belief dimensions. Using factor analysis, our study demonstrates that moderately reliable indices covering a wide spectrum of distinct health beliefs can be constructed and then replicated across independent samples. The factor analysis approach revealed that condition-specific measures of perception of susceptibility and severity and situation-specific measures of perceived barriers are empirically distinct from general measures of these beliefs. We therefore recommend caution in mixing general and specific questionnaire items within the same index when measuring these beliefs. A factor representing perceptions of health threat emerged, but its composition require further clarification. The degree of similarity between the factor structures in the two independent samples provides support for the existence of independent health belief dimensions.

Urinary incontinence and psychological distress among older adults.

We examined the relationship between urinary incontinence and psychological distress in a sample of community-dwelling older adults. The data are from a probability sample of Washtenaw County, Michigan residents ages 60 years and older, who were interviewed in 1983 and 1984. A total of 747 women and 541 men were included in the analyses. Experiencing urinary incontinence, particularly in a severe form, was weakly related to depression, negative affect, and low life satisfaction. These relationships are partly explained by the fact that incontinent respondents are less healthy than are continent respondents.

Twelve years' experience of computer-aided diagnosis in a district general hospital.

This paper describes experience in a modern district general hospital with a small desktop system for computer-aided diagnosis of acute abdominal pain, over a 12-year period involving 5512 cases. When compared with a baseline year (1973) in which unaided performance was monitored, during an initial study period (1974-76) the diagnostic accuracy of junior staff rose by between 10 and 15%. This higher performance level was then maintained for a decade (1976-86) despite changes in staff. The perforation rate among appendicitis cases fell from 27% to 12.5%, accompanied by a smaller fall in negative laparotomy rates. The saving in surgical bednights devoted to acute abdominal pain was approximately 15%, and the notional cost of resources saved during the first 6 years of operation was 120,000 pounds. Other hospitals have shown--in the short term--benefits similar to those obtained at Airedale District General Hospital. The long-term benefits of the system at Airedale reinforce the conclusions of the earlier short-term trials that a comparable system should probably be offered to all DGHs in the UK, not as an exercise in 'artificial intelligence' but as an effective continuing stimulus to good clinical practice.

Alameda County redux: replication in Michigan.

This article describes an attempt to reproduce, in Michigan, cross-sectional findings concerning the relationship between health habits and health status previously obtained in Alameda County, California by Belloc and Breslow. Data for this study were gathered by a telephone interview of a state-wide sample of 3,259 adult Michigan residents. The ridit (relative to an identified distribution) analyses presented include a comparison of findings from the Michigan and Alameda County studies. In Michigan, as in Alameda County, health status was found to be associated with various health practices, both individually and in combination. Consistent relationships were found between physical health status and individual health practices regarding hours of sleep, eating breakfast, eating between meals, cigarette smoking, weight for height, and physical activity. Physical health status was also linked to the overall number of health practices individuals engaged in. When the confidence interval for each ridit value was taken into account, however, only some of the findings proved statistically reliable.

Cigarette smoking and changes in smoking among a cohort of Michigan adults, 1980-82.

Factors related to cigarette smoking and to changes over two years were investigated in a sample of Michigan adults. Smoking was associated with age, sex, education, occupation, and beliefs regarding its health effects. Cessation was predicted by amount smoked at baseline, desire to stop, and belief concerning difficulty stopping. Starting smoking was associated with time off cigarettes (negatively), age, belief about health effects, sex, and education. Heavy smoking and maintenance of cessation are major problems.

Health beliefs in a population: the Michigan blood pressure survey.

In a general population sample, we examined relationships between sociodemographic characteristics and health beliefs. Individual questionnaire measures for components of the health belief model were combined to form six scales. In analyses which adjusted for perceived levels of health, sociodemographic markers of social disadvantage (e.g., black race, or low socioeconomic status) appeared to associate with favorable health beliefs, that is, with health beliefs often associated with health promoting behaviors. Specifically, we found that blacks expressed greater concern about health. Women believed they tended to get sick more often and to suffer more severely from illness. Female and older respondents placed greater value on the kinds of services provided by members of the health professions. Female, black, older, and lower socioeconomic status respondents placed greater value on such healthful personal habits as exercise, alcohol avoidance, and proper diet. These results suggested that the poor health suffered by relatively disadvantaged members of society are not, in some manner, a consequence of fundamental beliefs about health.

Psychosocial determinants of immunization behavior in a swine influenza campaign.

A prospective design was used to study factors which predisposed individuals to receive vaccination in response to the anticipated outbreak of swine influenza in the fall and winter of 1976. Data were obtained from a telephone survey of 286 adults in Oakland County, Michigan. Predictor variables included Health Belief Model (HBM) variables as well as measures of behavioral intention, social influence, physician's advice, socioeconomic status and past experience with flu shots. In multivariate analysis, over 40 per cent of the variance in inoculation behavior was explained by the predictors used. Path analysis revealed that most of the HBM variables' influence on behavior was mediated through behavioral intention. While behavioral intention was an important predictor of inoculation behavior, other psychosocial factors played a significant role in explaining variance in the dependent variable.

Highly selective vagotomy: a 14-year experience.

Since August 1971, 244 highly selective vagotomies were performed for pyloric and duodenal ulceration by one surgeon (W.A.F.M.). There was one postoperative death. Twenty (8 per cent) patients were lost to follow-up. The remaining 223 patients were followed up for 1 to 14 years (mean 4.2 years). On the modified Visick grading system 83.4 per cent were Visick I or II and 16.6 per cent were Visick III or IV. The failures were mainly recurrences. The recurrence rate was 11.2 per cent. Certain factors were examined to try to elucidate those influencing recurrence rate but no significant prognostic indicator was found. Acid studies were analysed and no significant relationship between these and the development of a recurrence could be found. The second 100 vagotomies were better than the first as judged by the results of studies of insulin-stimulated acid. Finally, we question whether all recurrences should automatically be regarded as treatment failures and the patients classified as Visick IV.

Sex and age interactions in the association between alcohol and blood pressure.

The cross-sectional association between alcohol intake and blood pressure was examined in a probability sample of Michigan adults surveyed in 1983. Despite adjustments for race, sex, age, Quetelet index, and current treatment with antihypertensive medications, heavier alcohol intakes (more than one drink daily) were associated with increased systolic blood pressure, diastolic blood pressure, and prevalence of elevated blood pressure. These associations were somewhat exaggerated in women and in younger persons. Statistically significant differences in blood pressure were demonstrated only among consumers of more than one drink daily. Attributable risk calculations indicated that no more than 8.4 and 8.5% of instances of elevated blood pressure (systolic pressure greater than or equal to 140 mmHg or diastolic pressure greater than or equal to 90 mmHg) in men and women, respectively, could be attributed to alcohol intakes exceeding one drink daily.

Psychosocial factors and blood pressure in the Michigan Statewide Blood Pressure Survey.

The relationships between various psychosocial factors and blood pressure were examined in a probability sample of the adult population of the state of Michigan in 1980-1983. Excluding individuals diagnosed by a physician as having high blood pressure and controlling for the major risk factors for hypertension, a number of psychosocial factors significantly predicted blood pressure. Among both men and women, those who generally did not express their emotions (including anger) and who harbored grudges and aggressive impulses had higher diastolic blood pressure. Among men only, those with low self-confidence and less perceived control over their lives had higher systolic and diastolic blood pressures. Those who reported poorer mental health had higher diastolic blood pressure. Among women only, those who rated their relationships with family and best friend more poorly had higher systolic blood pressure. Possible explanations are discussed for the gender-specific relationships between blood pressure and certain psychosocial factors.

Prevalence of urinary incontinence and other urological symptoms in the noninstitutionalized elderly.

The prevalences of urinary incontinence, difficulty in bladder emptying and irritative bladder symptoms are not known in the noninstitutionalized elderly in this country. A survey, consisting of a multi-stage probability sample of 13,912 households, was done in Washtenaw County, Michigan to estimate these prevalences. A total of 1,955 senior citizens 60 or more years old was interviewed. The prevalences of urinary incontinence, difficult bladder emptying and irritative bladder symptoms were 18.9, 22.1 and 11.8 per cent, respectively, in men, and 37.7, 10.8 and 17.4 per cent, respectively, in women. Urinary incontinence was significantly more prevalent among all respondents with bladder emptying and irritative symptoms than those without such symptoms (p less than 0.001). The frequency of voiding was significantly increased among respondents with incontinence, or emptying or irritative symptoms compared to asymptomatic respondents (p less than 0.001). These survey data are of importance to senior citizens, care providers and governmental agencies.

Clinical and cystometric characteristics of continent and incontinent noninstitutionalized elderly.

A survey of the clinical and cystometric characteristics of continent and incontinent elderly subjects living in a community has not been reported previously. Household respondents identified initially from a random probability sample were invited to undergo a free clinic evaluation followed by an invitation to free urodynamic testing. Of the 1,955 household respondents 456 women and 298 men attended the clinic. From this group 169 women and 94 men accepted the urodynamic invitation. Cystometric studies reveal a significant difference between the over-all prevalence of uninhibited detrusor contraction between genders, 7.9 per cent for women and 35 per cent for men. The occurrence of uninhibited detrusor contractions is more prevalent among incontinent than continent subjects and this difference is marginally significant. There is no significant association between uninhibited detrusor contractions and symptoms of difficult bladder emptying, irritative symptoms, voiding frequency, nocturia and urodynamic diagnosis of outlet obstruction (normal or high pressure and poor flow) but there were significant associations with responses to questions about the delay in getting to a toilet. The mean bladder capacities of men and women do not differ significantly between the different age groups but the capacity is significantly smaller for those with uninhibited detrusor contractions. The post-void residual urine volume shows no association with the continence status. These findings raise questions regarding our conventional thinking as to the etiology of uninhibited detrusor contractions, especially in men, and of urinary incontinence in general.

Two-year incidence, remission, and change patterns of urinary incontinence in noninstitutionalized older adults.

In this study, patterns of urinary incontinence, its severity and types were studied by three sequential data collections at annual intervals. The data are from a panel survey of a probability sample of 1,956 noninstitutionalized persons aged 60 and over residing in Washtenaw County, Michigan, who were interviewed in their homes about urine loss. Based on these self-reports, the prevalence of urinary incontinence was 18.9% in men and 37.7% in women. One-year incidence rates of about 20% among women and about 10% among men were found. One-year remission rates were about 12% for women and about 30% for men. When becoming incontinent, respondents were most likely to develop mild incontinence. Those who changed their severity level were most likely to progress from mild to moderate.