Iran Journal of Nursing

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Mohammadi H, Bastani F. Perceived Stress and the Contributing Factors in the Elderly with Urinary Incontinence. IJN 2019; 32 (119) :41-51
URL: http://ijn.iums.ac.ir/article-1-2986-en.html

Background & Aim: Recently, lifestyle-related diseases (e.g., chronic diseases) have greatly increased in old age. Cardiovascular diseases, cancers, hypertension, urinary incontinence, hearing loss, musculoskeletal weakness, and mental disorders are highly prevalent among the elderly, imposing certain anxiety and stress on these individuals. Urinary incontinence is a common physical issue in the elderly, which influences their quality of life and causes stress and psychological tension. High stress levels not only affect the quality of life, but also may prevent the use of coping, self-care, and self-efficacy skills and might play a pivotal role in daily life activities and functional independence. Therefore, perceived stress could play a determining role in urinary incontinence as a psychological component. Therefore, there is a need for basic information and a more accurate assessment of this psychological component for accurate planning in order to formulate optimal care interventions in holistic geriatric nursing and provide resident care and support for health promotion and functional capacity increase in the elderly with urinary incontinence and provide educational-counseling strategies to control and manage stress. With this background in mind, the present study aimed to assess perceived stress and the contributing factors in the elderly with urinary incontinence referring to Hasheminejad Hospital in Tehran, Iran in 2017. 
Materials & Methods: This cross-sectional, causal-correlational study was conducted on 125 individuals aged 60-74 years with urinary incontinence referring to Hasheminejad Teaching Hospital (urology and urinary incontinence specialty and sub-specialty medical center) in Tehran. The participants were selected via continuous sampling, and the inclusion criteria were being a young elderly (in the range of 60-74 years based on the WHO classification), no urology surgery in the past three months, no history of malignancy of the urogenital system, urinary tract infection and serious psychiatric disorders (based on medical file), and no cognitive diseases (receiving a score of ≥7 in the abbreviated mental test [AMT] test). Data were collected using the AMT, a demographic characteristics questionnaire, and Cohen’s perceived stress scale with acceptable validity and reliability. Data collection was performed during three months via face-to-face interviews (15-20 minutes), and the process continued for three months. A perceived stress scale has been developed to determine the stress of individuals in the face of unpredictable and uncontrollable life events. After completing the demographic characteristics questionnaire and perceived stress scale, each part of the data collection tool was calculated, and data analysis was performed in SPSS version 16 using descriptive statistics (distribution frequency, frequency, mean and standard deviation) and inferential statistics (Scheffe test, analysis of variance, Pearson's correlation coefficient, and linear regression) at the significance level of P<0.05.
Results: The present study was performed on 125 elderlies (58 males and 67 females) with a mean age of 63.92±2.66 years. In terms of the level of education, 12% of the participants were illiterate, whereas 10.4%, 35.2%, 24.8%, 8%, and 9.6% had an elementary school diploma, a junior-high-school diploma, a high-school diploma, and a higher academic degree, respectively. Regarding marital status, 72.8% of the subjects were married while 1.6% and 25.6% were single and divorced or widowed, respectively. The mean and standard deviation of perceived stress in the elderly was estimated at 26.4±61.89, which showed a low stress level. The frequency distribution and percentage of perceived stress in the studied elderly showed that 56.6% of the subjects had low perceived stress and 42.3% had high perceived stress. According to the results, there was a significant relationship between perceived stress and variables of age, level of education, marital status, economic status, and duration of urinary incontinence, in a way that perceived stress was significantly higher in those aged 65 and higher, compared to those below the age of 65 (P<0.001). Moreover, perceived stress was higher in widowed participants, compared to married subjects (P=0.005). Scheffe test results were indicative of higher perceived stress in illiterate elderlies, compared to the other participants (P=0.036). There was also a significant relationship between economic status and perceived stress, meaning that those with unfavorable economic status had higher perceived stress, compared to those with good economic status (P=0.036). In addition, there was a significant relationship between stress of the elderly and urinary incontinence, in a way that stress was higher in those who were dealing with urinary incontinence for more than a year (P<0.001). Therefore, the higher the duration of urinary incontinence in the elderly, the higher their perceived stress. Regression results also showed that perceived stress in the elderly with urinary incontinence for less than one year was 2.84 units lower than in patients with urinary incontinence for more than one year.
Conclusion: According to the results of the study, about half of the participants had high perceived stress levels, and there was a correlation between the mentioned variables and age, level of education, marital status, economic status, and duration of urinary incontinence. In addition, we found a direct significant association between age and perceived stress, meaning that the higher the age of the elderly, the higher their perceived stress. Moreover, stress was significantly higher in the elderly aged 65 years and higher, compared to the elderly aged 60-65 years, and widowed participants experienced significantly higher perceived stress, compared to married subjects. Regarding the level of education, illiterate subjects had higher perceived stress, compared to the other subjects. However, no significant difference was observed at other levels of education. Moreover, those with unfavorable economic status had higher perceived stress levels, compared to those with good economic status. According to the results, stress was higher in the elderly experiencing urinary incontinence for a year or more. Considering that urinary continence affects the daily life of the elderly, planning for the development of community-based nursing interventions, performing educational/counseling strategies for the control and management of stress, and provision of family and social support are recommended in order to enhance the functional capacity of the elderly with urinary incontinence.