Understanding help-seeking in older people with urinary incontinence: an interview study.

The prevalence of urinary incontinence (UI) increases with age and can negatively affect quality of life. However, relatively few older people with UI seek treatment. The aim of this study was to explore the views of older people with UI on the process of seeking help. Older people with UI were recruited to the study from three continence services in the north of England: a geriatrician-led hospital outpatient clinic (n = 18), a community-based nurse-led service (n = 22) and a consultant gynaecologist-led service specialising in surgical treatment (n = 10). Participants took part in semi-structured interviews, which were transcribed and underwent thematic content analysis. Three main themes emerged: Being brushed aside, in which participants expressed the feeling that general practitioners did not prioritise or recognise their concerns; Putting up with it, in which participants delayed seeking help for their UI due to various reasons including embarrassment, the development of coping mechanisms, perceiving UI as a normal part of the ageing process, or being unaware that help was available; and Something has to be done, in which help-seeking was prompted by the recognition that their UI was a serious problem, whether as a result of experiencing UI in public, the remark of a relative, the belief that they had a serious illness or the detection of UI during comprehensive geriatric assessment. Greater awareness that UI is a treatable condition and not a normal part of ageing is needed in the population and among health professionals. Comprehensive geriatric assessment appeared an important trigger for referral and treatment in our participants. Screening questions by healthcare professionals could be a means to identify, assess and treat older people with UI.

Improving continence services for older people from the service-providers' perspective: a qualitative interview study.

OBJECTIVE: To examine in depth the views and experiences of continence service leads in England on key service and continence management characteristics in order to identify and to improve our understanding of barriers to a good-quality service and potential facilitators to develop and to improve services for older people with urinary incontinence (UI). DESIGN: Qualitative semistructured interviews using a purposive sample recruited across 16 continence services. SETTING: 3 acute and 13 primary care National Health Service Trusts in England. PARTICIPANTS: 16 continence service leads in England actively treating and managing older people with UI. RESULTS: In terms of barriers to a good-quality service, participants highlighted a failure on the part of commissioners, managers and other health professionals in recognising the problem of UI and in acknowledging the importance of continence for older people and prevalent negative attitudes towards continence and older people. Patient assessment and continence promotion regardless of age, rather than pad provision, were identified as important steps for a good-quality service for older people with UI. More rapid and appropriate patient referral pathways, investment in service capacity, for example, more trained staff and strengthened interservice collaborations and a higher profile within medical and nurse training were specified as being important facilitators for delivering an equitable and high-quality continence service. There is a need, however, to consider the accounts given by our participants as perhaps serving the interests of their professional group within the context of interprofessional work. CONCLUSIONS: Our data point to important barriers and facilitators of a good-quality service for older people with UI, from the perspective of continence service leads. Further research should address the views of other stakeholders, and explore options for the empirical evaluation of the effectiveness of identified service facilitators.

The relationship between building design and residents' quality of life in extra care housing schemes.

Well-designed housing is recognised as being an important factor in promoting a good quality of life. Specialised housing models incorporating care services, such as extra care housing (ECH) schemes are seen as enabling older people to maintain a good quality of life despite increasing health problems that can accompany ageing. Despite the variation in ECH building design little is known about the impact of ECH building design on the quality of life of building users. The evaluation of older people's living environments (EVOLVE) study collected cross-sectional data on building design and quality of life in 23 ECH schemes in England, UK. Residents' quality of life was assessed using the schedule for the evaluation of individual quality of life-direct weighting (SEIQoL-DW) and on the four domains of control, autonomy, self-realisation and pleasure on the CASP-19. Building design was measured on 12 user-related domains by means of a new tool; the EVOLVE tool. Using multilevel linear regression, significant associations were found between several aspects of building design and quality of life. Furthermore, there was evidence that the relationship between building design and quality of life was partly mediated by the dependency of participants and scheme size (number of living units). Our findings suggest that good quality building design in ECH can support the quality of life of residents, but that designing features that support the needs of both relatively independent and frail users is problematic, with the needs of highly dependent users not currently supported as well as could be hoped by ECH schemes.

Development and validation of a very brief questionnaire measure of physical activity in adults with coronary heart disease.

BACKGROUND: The aim of this study was to validate the Total Activity Measure, a brief questionnaire, to measure physical activity in an older adult population with heart disease. METHODS: Two versions of the Total Activity Measure were administered twice, 7 days apart. The Total Activity Measure 1 asked respondents for the frequency and average duration of bouts of physical activity at three different intensity levels per week, whereas the Total Activity Measure 2 asked respondents for the total time spent in activity at each activity level per week. Questionnaire accuracy was studied in 62 men and 15 women aged 47-84 years, by repeatability and comparison of both administrations of the Total Activity Measure 1 and Total Activity Measure 2 with 7-day RT3 accelerometer data. RESULTS: Seventy-three adults (58 men, 15 women) were used for all statistical analyses. Intraclass correlation coefficients for the Total Activity Measure 1 and Total Activity Measure 2 total activity scores (metabolic equivalent per minute) were r=0.73 (95% confidence intervals, 0.56-0.83) and r=0.82 (95% confidence intervals, 0.71-0.88), respectively. Correlations between the Total Activity Measure 1 and RT3 accelerometer for total activity score (metabolic equivalent per minute) were significant, r=0.26 at time 1 and r=0.27 at time 2 for moderate intensity activities. Correlations between the Total Activity Measure 2 and RT3 accelerometer for total activity score (metabolic equivalent per minute) were also significant, r=0.38 at time 1 and r=0.36 at time 2, r=0.31 at time 2 for strenuous intensity activities and r=0.29 at time 1 and r=0.25 at time 2 for moderate intensity activities. Participants overestimated the amount of physical activity on both questionnaires as compared with the RT3 accelerometer. CONCLUSIONS: The Total Activity Measure 2 was reasonably accurate in assessing total and moderate intensity activity over a 7-day period and demonstrated good test-retest reliability. The Total Activity Measure 1 was less accurate. The Total Activity Measure 2 is a suitable measure of total or moderate intensity physical activity for surveys and audits in an adult cardiac population.

Failure to validate the Health Survey for England physical activity module in a cardiac population.

OBJECTIVES: The Health Survey for England physical activity module interview, although not validated, is used as a performance indicator to see if people are achieving current physical activity targets and is the primary source of information for physical activity related policy making. The aim of this study was to assess the validity of the Health Survey for England physical activity module as a measure of physical activity in older adults with coronary heart disease. METHODS: Seventy-two older adults who had experienced a cardiac event completed the Health Survey for England physical activity interview and wore an accelerometer for seven consecutive days. Physical activity classification levels were derived from accelerometry and from the Health Survey for England physical activity interview, together with the number of episodes in which participants were moderately active for 30 min or more. RESULTS: The Health Survey for England physical activity interview exhibited high sensitivity (1.0) and specificity (0.76) for people engaged in high levels of physical activity, moderate sensitivity (0.40) and specificity (0.56) for people engaged in medium levels of physical activity and low sensitivity (0.35) and high specificity (0.92) for people engaged in low levels of physical activity. Compared with the accelerometer, the survey misclassified 63% of participants. CONCLUSIONS: The Health Survey for England physical activity interview misclassified true activity levels in older adults with heart disease by overestimating actual activity in the less active participants. Similar biases on self-report physical activity measures have been demonstrated in the general population, suggesting that the Health Survey for England physical activity module interview may be providing inaccurate information on national activity levels.

Motor learning of a dynamic balancing task after stroke: implicit implications for stroke rehabilitation.

BACKGROUND AND PURPOSE: After a stroke, people often attempt to consciously control their motor actions, which, paradoxically, disrupts optimal performance. A learning strategy that minimizes the accrual of explicit knowledge may circumvent attempts to consciously control motor actions, thereby resulting in better performance. The purpose of this study was to examine the implicit learning of a dynamic balancing task after stroke by use of 1 of 2 motor learning strategies: learning without errors and discovery learning. PARTICIPANTS AND METHODS: Ten adults with stroke and 12 older adults practiced a dynamic balancing task on a stabilometer under single-task (balance only) and concurrent-task conditions. Root-mean-square error (in degrees) from horizontal was used to measure balance performance. RESULTS: The balance performance of the discovery (explicit) learners after stroke was impaired by the imposition of a concurrent cognitive task load. In contrast, the performance of the errorless (implicit) learners (stroke and control groups) and the discovery learning control group was not impaired. DISCUSSION AND CONCLUSION: The provision of explicit information during rehabilitation may be detrimental to the learning/relearning and execution of motor skills in some people with stroke. The application of implicit motor learning techniques in the rehabilitation setting may be beneficial.