Impact of urine and mixed incontinence on long-term care preference: a vignette-survey study of community-dwelling older adults

Abstract

Background: In view of population aging, a better knowledge of factors influencing the type of long-term care (LTC) among older adults is necessary. Previous studies reported a close relationship between incontinence and institutionalization, but little is known on opinions of older citizens regarding the most appropriate place of care. This study aimed at evaluating the impact of urine and/or fecal incontinence on preferences of communitydwelling older citizens. Methods:We derived data from the Lausanne cohort 65+, a population-based study of individuals aged from 68 to 82 years. A total of 2974 community-dwelling persons were interviewed in 2017 on the most appropriate place of LTC delivery for three vignettes displaying a fixed level of disability with varying degrees of incontinence (none, urinary, urinary and fecal). Multinomial logistic regression analyses explored the effect of respondents' characteristics on their opinion according to Andersen's model. Results: The level of incontinence described in vignettes strongly determined the likelihood of considering institutional care as most appropriate. Respondents' characteristics such as age, gender, educational level, being a caregiver, knowledge of shelter housing or feeling supported by family influenced LTC choices. Self-reported incontinence and other indicators of respondents' need, however, had no significant independent effect.Conclusion: Among older community-dwelling citizens, urinary and fecal incontinence play a decisive role in the perception of a need for institutionalization. Prevention and early initiation of support for sufferers may be a key to prevent this need and ensure familiar surrounding as long as possible.

Factors associated with the willingness of older people to engage with long‐term care services: A systematic review

“…Twenty‐nine studies out of 35 studies explored the impact of age on willingness of older people to engage with long‐term care services in 110,119 participants. Fifteen studies found a significant association between age and the willingness of older people to engage with long‐term care services (Carvalho et al, 2020; Hajek et al, 2017; Han et al, 2017; Kim & Kim, 2004; Liao, 2019; McCormick et al, 2002; Qian et al, 2018; Rodríguez, 2014; Shi & Hu, 2020; Sugisawa et al, 2020; Wang et al, 2004, 2020; Wei & Zhang, 2020; Xu et al, 2018; Zeng et al, 2019). And 10 studies found that the younger older people were likely to choose formal care.…”

“…Seventeen studies, with 58, 894 participants in total, reported the relationship between living arrangements and the willingness of older people to engage with long‐term care services. Thirteen studies out of the 17 studies found a significant association between living arrangements and willingness to choose long‐term care services of older people (Carvalho et al, 2020; Hajek et al, 2017; Han et al, 2017; Wang & Wu, 2008; Qian et al, 2017; Li, Yue, & Bi, 2015; Li, Fu, et al, 2015; Peng, 2017; Rodríguez, 2014; Shi & Hu, 2020; Wang et al, 2020; Liao, 2019; Wang et al, 2017; Zhang et al, 2017). And older people who lived with spouse or children were more likely to opt for informal long‐term care.…”

“…Four studies reported that primary caregivers were relevant to the willingness of older people to engage with long‐term care services in 7, 394 participants (Carvalho et al, 2020; Wang et al, 2020; Wei & Zhang, 2020; Ye, 2013). And older people who were cared for by their children or spouse were more likely to choose informal long‐term care.…”

“…Twenty‐six studies, with 74,264 participants, explored the relationship between gender and the willingness of older people to engage with long‐term care services. Eleven studies found a significant association between gender and the willingness of older people to engage with long‐term care services (Carvalho et al, 2020; Hajek et al, 2017; Han et al, 2017; Kim & Choi, 2008; Liao, 2019; McCormick et al, 2002; Peng, 2017; Qian et al, 2017; Rodríguez, 2014; Shi & Hu, 2020; Tong & Wang, 2015). Among them, six studies showed that older female tended to choose informal long‐term care (Hajek et al, 2017; Han et al, 2017; Kim & Choi, 2008; Liao, 2019; Qian et al, 2017; Rodríguez, 2014).…”

Cohort Profile: The Lausanne cohort 65+ (Lc65+)

“… 23 Among the disability and social characteristics displayed in the vignettes, incontinence was a key factor explaining the perception of a need for institutionalization. 24 In a longitudinal study applying Andersen’s Behavioural Model of Health Services Use, incident utilization of formal home care appeared to be largely determined by need factors such as chronic health conditions and functional limitations, as compared with predisposing factors (e.g. sociodemographic characteristics, beliefs about health services) and enabling factors (e.g.…”