Geriatric Patients' Preferences for Treatment of Urinary Incontinence: A Study of Hospitalized, Cognitively Competent Adults Aged 80 and Older

Authors

  • Mathias H.-D. Pfisterer MD,

    1. From the *Bethanien-Krankenhaus Geriatric Center, and §Department of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, GermanyBirmingham/Atlanta Veterans Affairs Geriatric Research Education and Clinical Center, Decatur, GeorgiaDivision of Geriatric Medicine and Gerontology, Emory University, Atlanta, Georgia.
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  • Theodore M. Johnson II MD, MPH,

    1. From the *Bethanien-Krankenhaus Geriatric Center, and §Department of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, GermanyBirmingham/Atlanta Veterans Affairs Geriatric Research Education and Clinical Center, Decatur, GeorgiaDivision of Geriatric Medicine and Gerontology, Emory University, Atlanta, Georgia.
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  • Ekkehart Jenetzky MD,

    1. From the *Bethanien-Krankenhaus Geriatric Center, and §Department of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, GermanyBirmingham/Atlanta Veterans Affairs Geriatric Research Education and Clinical Center, Decatur, GeorgiaDivision of Geriatric Medicine and Gerontology, Emory University, Atlanta, Georgia.
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  • Klaus Hauer PHD,

    1. From the *Bethanien-Krankenhaus Geriatric Center, and §Department of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, GermanyBirmingham/Atlanta Veterans Affairs Geriatric Research Education and Clinical Center, Decatur, GeorgiaDivision of Geriatric Medicine and Gerontology, Emory University, Atlanta, Georgia.
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  • Peter Oster MD

    1. From the *Bethanien-Krankenhaus Geriatric Center, and §Department of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, GermanyBirmingham/Atlanta Veterans Affairs Geriatric Research Education and Clinical Center, Decatur, GeorgiaDivision of Geriatric Medicine and Gerontology, Emory University, Atlanta, Georgia.
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  • This research was supported by the Robert Bosch Foundation, Germany, with a mid-career fellowship in geriatrics for Dr. Pfisterer.

Address correspondence to Dr. med. Mathias H.-D. Pfisterer, Kontinenzberatungsstelle Bethanien-Krankenhaus -Geriatrisches Zentrum-, Rohrbacherstrasse 149, 69126 Heidelberg, Germany.
E-mail: mpfisterer@bethanien-heidelberg.de

Abstract

OBJECTIVES: To elicit preferences for different urinary incontinence (UI) treatments of geriatric patients, to contrast these answers with answers from potential health proxies and providers, and to understand how select demographic factors might explain differences in patients' preferences.

DESIGN: Cross-sectional, descriptive.

SETTING: German geriatric hospital.

PARTICIPANTS: Medical inpatients aged 80 and older in a geriatric hospital, their physicians and nurses, and their family members.

MEASURES: Six forced-choice paired comparisons of four UI treatments were measured on an 11-point visual analog scale, with verbal anchors.

RESULTS: One hundred seventeen patients (mean age 84.6; 43% with UI), 72 staff members, and 71 family members participated. Although some preferred even “unpopular” management strategies, most respondents preferred diapers (79%), medications (78%), and scheduled toileting (79%) to urinary catheters; 64% preferred scheduled toileting to diapers. When choosing between diapers and medication, equal proportions preferred each option. In regression models, sex, activity of daily living score, and past treatment experience were significantly associated with expressed preferences. Proxies expressed greater preference for scheduled toileting than for diapers than patients did (P<.001). Intraclass correlation coefficients indicated at most only slight to fair agreement between patients and most other groups; spouses showed moderate to almost perfect agreement with patients.

CONCLUSION: Preferences of cognitively competent geriatric patients for treatment of UI differed from those of their potential proxies (other than spouses), which emphasizes the need for focused communication to properly elicit patient preferences to achieve appropriate treatment decisions.

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