Quality of life impact of urge incontinence in older persons: A new measure and conceptual structure

OBJECTIVE: To develop a condition-specific measure for assessing the impact of urge urinary incontinence (UI) on the quality of life (QoL) of older pe rsons. DESIGN: A 32-item Urge Impact Scale (URIS) was drafted using content area d ata from focus groups composed of urge incontinent older persons. Pilot tes ting in 21 urge incontinent persons (mean age 67.7 years) resulted in the e limination of eight items by internal consistency, skew, and patient respon se criteria. The resulting scale (URIS-24) was tested for reliability (inte rnal consistency and test-retest correlation) and construct validity (corre lation with UI severity from voiding records) in a separate group of 27 urg e incontinent persons (89% women, mean age 72 years). Factor analysis of UR IS-24 data from the combined 48 persons was used to explore the conceptual structure underlying urge UI-related QoL. SETTING: University-affiliated community-based practice and tertiary hospit al. PARTICIPANTS: Community-dwelling women and men, older than age 60 and with urge incontinence at least twice weekly, recruited from newspaper, newslett er, and radio advertisements. RESULTS: Cronbach's alpha for URIS-32 was 0.84, and for URIS-24 it was 0.94 . When administered (mean +/- standard deviation) 9.2 +/- 5.1 days apart, U RIS-24 had good test-retest reliability for total scores (interclass coeffi cient = .88. concordance coefficient = .88), and individual item scores at time 2 were within 1 point (on a 5-category Likert scale) of time 1 answers for 89% of responses. URIS-24 scores had modest but nearly significant cor relation with the number of UI episodes (r = -0.39, P = .05). Factor analys is revealed a three component structure corresponding to psychological burd en, perception of personal control, and self concept. CONCLUSIONS: The URIS-24 is an internally-consistent, highly reproducible t ool for the assessment of the QoL impact of urge UI on older persons. It ca n be used to evaluate QoL impact by specific items as well as by overall sc ore. Compared with other UI-specific QoL measures, the URIS-24 had similar or superior internal consistency, test-retest reliability, and validity, bu t it is the first measure designed and tested specifically for older person s with urge UI. These results also highlight the multifactorial structure o f urge UI-related QoL and the importance of its psychological dimensions.