Abstract and Introduction
Abstract
Introduction: Pelvic floor dysfunctions (PFDs) increase with aging, affect quality of life (QOL), and are common in frail elderly women living in assisted living and long-term care facilities. Costs of care in these facilities are high, while some women may suffer needlessly without care. However, assessment and interventions may also be uncomfortable, and may be less effective in the frail elderly. Little is known about how elderly women in residential care facilities view their PFD, or about their preferences for care.
Purpose: The purpose of this study was to increase understanding of the views of frail elderly women in residential care related to QOL, values, and preferences for pelvic floor care. The study was initiated to inform a urogynecologic outreach project planned to bring on-site care to regional residential facilities in Central Massachusetts.
Method: This descriptive, qualitative study included in-depth semi-structured interviews with 25 women with PFD, aged 65 to 96, who lived in five residential care facilities. Participants and facilities were purposefully selected to provide a variety of rich information expediently. Interviews were audio-taped, transcribed, and analyzed using NVIVO 2.0 to identify representative descriptive categories. Trustworthiness was enhanced using participant and expert review.
Findings: Categories relating to general QOL included changing places, a good life (with (subcategories: social interactions, security, and breaking up the day), and worries and bothers (with subcategories: health, becoming a burden, loss, barriers and limits, vulnerability, and personal space). PFD were not reported to play a central role in either facility placement or general QOL in these women with multiple co-morbidities. Participants valued comfort, containment, restful sleep, and making do, and were resistant to evaluation or interventions, citing of risks of discomfort and ineffectiveness.
Conclusions: Frail elderly women in residential care facilities may prefer to live with PFD rather than undergo evaluation and treatment, even if it is accessible on site at their residence. Residents should be included in planning if improved quality of life is the goal.
Level of Evidence: VI.
Introduction
As women live longer, increasing numbers may transition from dwelling independently in the community to residence in care facilities, such as assisted living or long-term care. Maintaining quality of life (QOL) for these residents is one important goal of care (Medina-Walpole & Katz, 2003). Pelvic floor dysfunctions (PFD), including problems with urination, defecation, or pelvic organ prolapse, become increasingly common as women age (Bump & Norton, 1998). These PFDs may have a profound impact on QOL and play a role in the need to transition to residential care facilities (Medina-Walpole & Katz, 2003). Although effective medical and surgical treatments for pelvic floor problems are available (Walters & Karram, 2007), women often defer care for various reasons. One cited reason in community-dwelling women is low perception of bother (Kinchen et al., 2007; Papanicolaou, Hunskaar, Lose, & Sykes, 2005). While PFDs are common in long-term care residents, little is known about how frail, elderly women who no longer live independently in the community view the effect of PFD on their QOL or about their preferences for care (Engberg, Kincade, & Thompson, 2004).
Purpose of The Study
This exploratory, descriptive study was designed to increase understanding of how frail, elderly women living in residential care facilities perceive their general QOL, how their PFDs affect these perceptions, and their self- perceived needs and preferences for PFD care.
Urol Nurs. 2008;28(1):36-47. © 2008 Society of Urologic Nurses and Associates
Cite this: 'I'd Rather Just Go On as I Am' — Pelvic Floor Care Preferences of Frail, Elderly Women in Residential Care - Medscape - Feb 01, 2008.
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