Urinary Incontinence (UI) can affect women’s ability to carry out activities of daily living as well as provide care to others. However, little is known about clinical and demographic factors that predispose older women with UI to becoming functionally dependent and how UI affects their ability to serve as caregivers. We aimed to describe the prevalence of care-dependence and caregiving among older community-dwelling women with UI and assess the strength of relationships between UI and care dependence and caregiving in this population.

We conducted a cross-sectional analysis of data from the National Social Life, Health, and Aging Project, a multiethnic, national sample of community-dwelling adults in the United States aged 57 to 83 years at baseline. Urinary incontinence, care dependence, and caregiving were assessed by questionnaire among female participants in 2010-2011. Participants were asked about difficulty controlling their bladder in the past 12 months, including “leaking small amounts of urine, leaking when you cough or sneeze, or not being able to make it to the bathroom on time”. Care dependence was assessed by asking women if they had difficulty carrying out each of 7 activities of daily living (ADLs) and 7 instrumental activities of daily living (IADLs); those reporting difficulty were asked whether they received assistance from another person for ADLs or IADLs. Caregiving was assessed by asking women if they were currently assisting an adult who needed help because of age or disability. Multivariable logistic regression models evaluated associations between UI and care dependence and caregiving behaviors. Among women with UI, additional models assessed risk factors for care dependence. Models were tested both unadjusted and adjusted for age, race/ethnicity, marital status, education level, and overall self-reported health. Among caregivers, additional multivariate models examined differences in self-reported health by UI status.

Of the 1703 women (mean age 71 years), 27% reported UI at least a few times a week (severe UI), 13% a few times a month (moderate UI), and 59% a few times a year or less (minimal or no UI). The proportion of women receiving care for ADLs and IADLs increased with frequency of UI symptoms (Figure 1). Compared to women with minimal or no UI, women with moderate-severe UI were more likely to have difficulty with at least one ADL (AOR=2.6, 95%CI 1.9-3.4) or IADL (AOR=1.7, 95%CI 1.3- 2.3) and receive care for at least one ADL (AOR=2.4, 95%CI 1.6-3.6) or IADL (AOR=1.9, 95%CI 1.4-2.6). Compared to 46% of women with minimal or no UI, 60% of those with moderate-severe UI reported an unmet need for assistance, defined as having difficulty with but not receiving care for one or more ADL/IADLs (p=.0002 in adjusted models). Among women with moderate-severe UI, factors associated with care dependence included more frequent UI, older age, being married, and having fair/poor self-reported health (p <.05 for all). Overall, 14% of women reported serving as caregivers for others. 15% of women with moderate-severe UI and 13% of women with minimal or no UI identified as caregivers (p=.84). The number of hours per day spent providing care also did not significantly differ by UI status (p=.31) (Figure 2). However, female caregivers with moderate-severe UI reported lower average health scores than those with minimal or no UI, based on a 5-level self-report measure of overall health (p=.0004).

Older women with UI are more likely to be functionally dependent and have an unmet need for care than those without UI, even after adjusting for other clinical and demographic factors. At least one in ten older U.S. women with UI serves as a caregiver, despite having worse overall health than female caregivers without UI.

Findings support the need for more systematic assessment of the care needs of older women with UI in order to preserve their ability to live independently and provide care for others. Prevention and treatment of UI may not only help to reduce care dependence in older women, but also strengthen the older female caregiver workforce.