The study was carried out to investigate the attitude of caregivers in the management of urinary incontinence among the elderly in Madonna University Teaching Hospital Elele, Rivers State. The objectives of the study were to find possible solutions to incontinence among the elderly; to identify way in which the elderly may be assisted to access continence services; and to identify the attitude of care givers in management of incontinence among the elderly and correct wrong notions. To achieve this purpose the quantitative descriptive survey design was used to assess 200 respondents drawn from the study area through simple random sampling technique and the Taro Yamane sample determination formula. A questionnaire with close ended questions was used to obtain responses from the respondents. Data collected for this study were analyzed using descriptive statistics of frequency, percentages and inferential statistics of the independent t- test. 0.05 level of significance was used for the test of significance. The findings show that majority of the respondents are comfortable visiting health centers when they are sick. 120 (60%) are not comfortable. 150 (75%) prefer visiting religious centres when they are sick while 50 (25%) said no. 10.1 (50.5%) respondents agreed that there are enough health services provided while 99 (49.5%) disagreed. 20 (10%) of the respondents believed that health dispensaries are within their reach while 180 (40%) did not believe. 120 (60%) of the respondents agreed that they are neglected by caregivers whenever the visit medical centres for treatment of incontinence while 80 (40%) disagreed. 110 60%) of the peculation prefer visiting traditional healers for treatment while 90 (45%) said otherwise. 130 (65%) of the population Agreed that they are unable to utilize health care services because of its high cost while 70 (35%) disagreed. 140 (70%) of the respondents said yes to the fact that there is insufficient transportation fee to visit medical centre which 60 (30%) said No. 170 (85%) agreed that they prefer home more than medical centre when they need medical attention for incontinence while 30 (15%) disagreed. In conclusion, the study showed that age and educational status have significant effect in health care seeking behaviour among the aged group, hence there is need for massive enlightenment programs for the elderly and their caregivers as well as provision of quality and accessible healthcare services for the aged. The researcher recommends that the elderly people should be provided free, accessible and comprehensive health care in hospitals and health centres because they would utilize the health services when available, accessible and affordable.
This chapter is the introductory chapter which presents the background of the study, the statement of the problem, the significance of the study, purpose of the study / broad objective, specific objectives of the study, research questions, hypothesis of the study, scope of the study and operational definition of terms.
BACKGROUND OF THE STUDY
According to the international continence society (ICS), Urinary incontinence is a condition in which there is involuntary urine loss which is objectively demonstrable; it is a social or hygienic problem (Abraham, Blaivais 2012). Incontinence is an embarrassing and deliberating condition that has become a major health concern for men and women of all ages but mostly seen in the elderly worldwide. Urinary Incontinence is unintentional loss of urine, inability to hold urine in the bladder due to loss of involuntary control over the urinary sphincters resulting in the involuntary passage of urine.
Urinary incontinence is a complex international public health problem. In Sweden, more than half a million people over the age of 65 have urinary incontinence (SBU, 2013). The majority are women, but a quarter of all 80 year old men also “leak urine”. In united kingdom, it is estimated that 5-10 million women over the age of 20 have urinary incontinence (Davis C; 2012), with the majority of this population being frail women over the age of 80years who have multiple morbidities, cognitive impairments, and need extensive help (Flanagan et al., 2010). The ongoing advancements in health care, together with improved technology and socio-economic developments relating to disease and injury has resulted to significant increase in human life expectancy over the years with a consequent need for better care giving options for the increasing number of older adults population. The UN report on the world’s population prospects in 2015 suggest that by 2050 about 22% of the world’s population will be 60 years and over.
Ageing is often accompanied by chronic illnesses and continuous deterioration of mental and physical independence, which makes care giving more complex and challenging. Many older adults are frail and have co-existing disabilities and co-morbidities, conditions that can influence the clinical presentation and assessment of urinary continence, as well as patient’s responsiveness to interventions (Wagg A,W Gibson et al., 2015). Many urinary incontinent patients do not have access to knowledge of evidence based medical therapy and their quality of life suffers because of the stigma inherent, this is where care giving plays a big role.
Care giving is the act of assisting with the care and wellbeing of another person. Care giving is a common phenomenon; caregivers have the responsibility to assist older adults in performing activities and preventing elderly abuse. More generally, they play a role in the physical, emotional, psychosocial, and sometimes financial assistance of the elderly who cannot care for themselves. In present times, caregivers take the attitude that urinary incontinence is a natural consequence of ageing. So assessment and treatment is often overlooked (Resnick et al., 2016). There also seems to be lack of knowledge and compliance as to whether or not guidelines are followed appropriately by members of different levels of staff hierarchy (Lin S, et al., 2012). There are several problems associated with wit deficit in understanding the impacts of urinary incontinence problems on older adults (Tuinissen D et al., 2016)
A study of practitioners revealed weakness in commitment, time and knowledge, and raised awareness of the beliefs that comorbidity, low motivation and older person’s acceptance of the problem existence. Similar results emerged among registered nurses, where Urinary incontinence problems were seen as a symptom of aging that can be addressed using incontinence protection. However, as mentioned previously, nurses/caregivers focus was on the choice of incontinence protection instead of the investigation of underlying causes (Dingwall L & Mclafferty E, 2016). These results are also supported by earlier research in which medical diagnosis were put before urinary incontinence problems.
Care givers showed lack of understanding of problems and failed to ask older adults about urinary incontinence (Norhein A, and Guttormsen vinsnes, 2015). Care givers have different educational needs and require different levels of support depending on what level of urinary incontinence they have to deal with, whether mild, moderate, or catheter managed (Wagg A, et al., 2015). Earlier research about care givers revealed deficits in time and prioritization of tasks; staff did not take the older adults to lavatory in time. However, there was no expectation that urinary incontinence could be improved because urinary incontinence problems were seen as a normal consequence of ageing (Resnick et al., 2016).
Nursing staff who worked most closely with older adults exhibited weaknesses in recognizing urinary incontinence problems sufficiently to undertake investigative measures (Davis C 2012). Care givers fail to understand that incontinence is not just caused by ageing but also certain factors such as urinary tract infection etc. Although it is mostly caused by ageing. Deficiencies in documentation where also found, whereby documentation of bladder and bowel movements was overlooked. Instead being described as incontinence occurring but with no investigation being conducted (Mangall J et al., 2016). Incontinence in present times can be managed by instilling toilet habits based on the client’s need. This can be beneficial for maintaining health and well being (Orem D 2011).
Also the elderly could be assisted to access health care services given the important social and psychological costs of incontinence. A review of research relating to the management of urinary incontinence identified lack of qualitative research that sought the views of elderly people (Wyman JF et al., 2012). Incontinence is a pressing issue because it may result to elderly abuse, and can affect an individual’s physical, emotional, psychosocial, and sometimes financial wellbeing.
Promotion of continence forms part of the remit of community nurses are health visitors for the elderly with training, support and clinic services provided by specialist continent nurses. In the past, an assessment of continence was carried out in general practice annually as part of the over “15 years check”. However, following health policy changes, this health check is no longer a requirement for general practice and there is variation in the extent to which it is carried out by primary care staff. Recent initiatives have attempted to promote high standard of care and access to services for older people, including the promotion of best practices in continence services (Dept of health 2010, 2011).
STATEMENT OF THE PROBLEM
Incontinence is a global problem, it occurs in people of all ages but mostly seen in older adults. It could be either urinary or fecal, with our main focus on urinary, this study is important to find out the attitude of caregivers managing incontinent patients, the causes of incontinence, possible solutions, and better management of incontinence
OBJECTIVES OF THE STUDY
The main purpose of this study is to investigate the attitude of caregivers in the management of urinary incontinence among the elderly in Madonna University Teaching Hospital Elele, Rivers State. Specifically, the following objectives will guide the study;
- To find possible solutions to incontinence among the elderly
- To identify way in which the elderly may be assisted to access continence services.
- To identify the attitude of care givers in management of incontinence among the elderly and correct wrong notions.
The following questions were formulated to guide the study based on the research objectives;
- How can the elderly be assisted to access continence services?
- How do care givers behave towards the elderly incontinent individuals?
- What are the possible solutions to incontinence among the elderly?
SIGNIFICANCE OF THE STUDY
The findings of this study will be of great use to the elderly, caregivers and the general public. To the elderly, this study will be of good use to the elderly people having continence problems leading to adverse effects not only on their health but also on their psychosocial life. To the Nurses/care givers, it will also help caregivers to promote high standards of care, of the elderly with training and support and promoting best practices in continence services. Also, to the public, the result obtained from this study will help the public prevent elderly abuse and also assist the elderly in seeking continence services. Finally, information gathered from this study will serve as a source of literature and guide for future research and as well serve as empirical reference for further studies.
SCOPE OF THE STUDY
This study is delimited to the attitude of caregivers and supportive care in the management of incontinence among the elderly. Madonna University teaching Hospital will be used as the study area, and elderly patients suffering from urinary incontinence will be used as the respondents. This study covered variables that include care givers attitude to urinary incontinence among the elderly, role of caregivers in treatment of urinary incontinence among the elderly, and practice of the aged persons towards healthy lifestyle for management of incontinence.
OPERATIONAL DEFINITION OF TERMS
For the purpose of this study, the key terms have been defined as follows:
Urinary Incontinence: is unintentional loss of urine, inability to hold urine in the bladder due to loss of control over the urinary sphincters resulting in the involuntary passage of urine.
Care giving: Is the act of assisting with the care and wellbeing of another person.
Care giver: Is an unpaid or paid member of person’s social network who helps them with activities of daily living.
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