Hypothesis / aims of study
Type of incontinence ( stress vs. urge vs. mixed ) ,age, social activities, general health conditions, mobility, co-morbility and other mixed parameters have an influence on diaper consumption, other than degree of incontinence. Our work aims to correlate the severity of urinary incontinence, as perceived by patients, to the use of pads and the costs for continence products , making distinction between the costs that are sustained by the national healthcare system (NHS) and private expenditures
Study design, materials and methods
We have investigated by means of a self-administered questionnaire a group of 68 female patients attending centres for incontinence care, affected by various degree of incontinence. The questionnaire is composed by 20 questions, investigating the subjective degree and the type of incontinence, the perceived condition and related modification in quality of life. We added questions about the type and number of continence products used both daily and nightly, how much the diapers were wet when changed, the eventual reimbursement by NHS. These data were examined under an economic point of view to quantify the related costs. Patients data were categorized by subjective incontinence ( very slight, slight, moderate, heavy and very heavy ), number and type of product used ( small or medium or large sized diapers daily or nightly) quality of life decrease ( in a subjective scale 0-10 ). A correlation between these data and the rate of reimbursement by NHS was made.
Results
Patients age ranged from 22 to 85 yrs. ( average 61.8 yrs.): 48.1 % pts. were older than 65 yrs. Daily leakage frequency ranged from 0 to continuous leakage ( see table 1 ):38.2 % low frequency ( less than once a day), 61.7 % moderate or severe frequency leakage ( once daily or more). The QoL was heavily affected by incontinence ( 6-10 points) in 73.5 % of pts. The subjective severity of incontinence was reported as very slight or slight in 25% of pts., moderate in 47 % and severe or very severe in 27.9% of pts. The daily diapers use was reported as low ( 1-2 of small size) in 39.7 % , medium ( 2 or more of medium size) in 32.3 % and high ( large products) in 27.9 % of pts. Considering the correlation between the subjective severity index and the use of diapers, we observed that 70.5 % of pts. with slight incontinence used only small diapers, 68.7 % of pts. with moderate incont. used small or medium diapers, and finally 47.3% of pts. with severe incont. used large diapers.
The correlations between the subjective severity index and the decrease in Q.o.L. was significant, as we showed that Q.o.L. was heavily deteriorated in 47.0 %, 71.8 % and 100 % of pts. respectively in the 3 groups of increasing severity ( p< .05). Very good correlations were found even between the subjective severity index and the frequency and quantity of daily leakage.
27% of pts. underwent or were under rehabilitative or pharmacological treatment. In our samples only in 10 % of pts. diapers were provided by NHS.
Interpretation of results
A good correlation between the subjective severity index and the use of diapers was observed, as well as the correlation with Q.o.L. modifications. In a previous report ( 2 ) we found that the average expenses were 291 €, 684 € and 795 € per year in the 3 groups of severity, respectively: these data can be confirmed by the present study . However the rates of products provided by NHS is very different from those commonly reported in the literature: therefore data must be re-considered in larger samples in order to explain this incongruence, that may be due partially to the fact the small diapers are not reimbursed.