A Qualitative Study of What Matters Most to Women with Geriatric Incontinence

Objectives: The geriatric incontinence syndrome (GIS) is a phenotype of urinary incontinence (UI) defined by moderate to severe UI symptoms presenting concomitantly with physical, cognitive, or sensory geriatric impairments. To facilitate the development of a non-surgical treatment for GIS, we conducted a qualitative study to understand patients’ perceptions of the impact of geriatric impairments on UI evaluation and their attitudes towards non-surgical and surgical treatment options for UI.

Methods: Semi-structured interviews were conducted to assess: (1) treatment priorities, (2) perceived barriers to therapy, (3) preferences and attitudes towards treatment delivery (group-based vs individual, in person vs virtual), and (4) solutions to perceived barriers. Targeted participants were 70 years or older, with a diagnosis of GIS based on confirmation of severe UI symptoms and gait speed of slower than 1 meter/second (m/s) on a 4 meter usual gait speed assessment. Interviews were conducted by a trained qualitative researcher. All interviews were audio recorded and transcribed. Transcripts were cleaned and imported into Dedoose® for coding. A codebook was developed using a combined inductive-deductive approach, and transcripts were independently coded by two researchers. Coded text was reviewed iteratively and synthesized into themes.

Results: Of the 40 women approached, 21 were ineligible due to gait speed < 1 m/s. Of the 19 women enrolled, the mean age±standard deviation was 72.95±4.6; 95% of our subjects were Non-Hispanic White and 5% were Black or Hispanic.

Regarding treatment priorities, subjects prioritized eliminating or significantly reducing UI symptoms to enable greater freedom to participate in enjoyable life activities; primarily travel, recreation, and spending time with grandchildren. Subjects also wished to decrease or eliminate use of pads. Participants preferred conservative treatments. The primary barriers to exercise treatment included: 1) concern about mobility limitations impacting ability to participate in physical exercise, 2) frequency of visits to the clinic for exercise treatment, and 3) transportation to visits. The primary barriers to medication management included side effect profile and poor efficacy. These perceived barriers were influenced by prior experience with medications.

The primary barriers to surgical treatments included the following concerns: 1) extended recovery period, 2) immobilization, and 3) feeling ‘too old for surgery’. Concerns about efficacy were heavily influenced by prior personal history or an associate’s experience of ineffective UI procedure.

Conclusions: Patients with GIS phenotype prioritize treatments to significant improve their UI symptoms to increase their confidence in their daily life activities. Participation in exercise-based treatments may be limited by mobility impairments and feasibility. Adapting a program for home implementation and/or virtual follow up may improve participation in exercise-based treatments.