Hypothesis / aims of study
Urinary incontinence and other lower urinary tract symptoms (LUTS) are common and increase in prevalence with increasing age in both men and women [1, 2]. Although numerous studies have examined the prevalence among the general population in Western countries, the prevalence of incontinence among Indigenous seniors in northern Canada is unknown. The northern territories of Canada comprise of Yukon, Northwest Territories (NT) and Nunavut have some geographically isolated and sparsely populated communities. The land mass comprises 3.5 million square kilometres with a population of 125,000 people.
Indigenous seniors (50+) in northern Canada face particular challenges in gaining access to healthcare, and form a vulnerable group due to factors including geographical isolation and ethnicity-based discrimination . Rates of some chronic medical conditions and life expectancy remains significantly lower (up to 13 years) than in the non-Indigenous Canadian population.
The Northwest Territories have a total population of 42,000, of whom approximately half live in the capital, Yellowknife. The community in which this project was conducted is a semi-remote community with road access available for nine months of the year and a population of 3,170 with a 65% Indigenous population. In 2013 , 49% of Indigenous people were women, and 25% were 50+ years old. There is one dental clinic, one health clinic, and one hospital, which serves the surrounding remote smaller communities.
The aim of this study was to establish estimates of the distribution, impact, and correlates of urinary incontinence (UI) in Indigenous seniors in a medium-sized community in Canada’s North.
Study design, materials and methods
The basis of this project is rooted in years of previous partnership between local communities in the Northwest Territories, including Nihtat Gwich’in Council, Inuvialuit Regional Corporation, and Gwich’in Tribal Council, the Government of NT Department of Health and Social Services and Community Advisory Boards (CAB), composed of Elders, local healthcare professionals, community members, key government officials and policy makers. As part of a wider research programme examining the health and healthcare experience of Indigenous seniors, data on continence status and associated comorbidities were obtained during structured interviews with a convenience sample of Indigenous seniors in the community studied. This work formed part of a larger project covering other health conditions and as such validated LUTS questionnaires (which have not been validated in this population) were not used. All self-identifying Indigenous women and men aged 50+ years, who were residing in the community for the last six months were eligible to participate. An Indigenous community coordinator actively recruited eligible community members by word-of-mouth and conducted in collaboration with community leaders following consultation with local Elders to ensure cultural appropriateness. In addition, passive advertisements were placed in local food stores, health centres, and at community senior and elder’s groups. The project was also advertised on social media, community radio, and a local TV channel.
Descriptive statistics were generated for the distribution of UI, subtype, and associated comorbidities.
71 people were recruited, representing approximately 10% of seniors in the community. The mean age of participants was 65.5 years (SD 8.9). Of the participants, 33 (46%) reported at least weekly incontinence, with 15% experiencing daily UI. More women than men reported incontinence (60% vs 29%). Of the people reporting UI, 21% described urgency incontinence, 51% stress incontinence, 9% nocturnal enuresis and 6% post-micturition dribble. Six percent described UI as having “no reason”. Only 45% of participants with incontinence had sought medical advice from a physician or nurse.
Although the small sample size did not allow formal statistical analysis, the distribution of diabetes and myocardial infarction (MI) did not differ between the continent and incontinent groups (21% vs 18% and 15% vs 16% respectively). There was a higher prevalence of stroke in the incontinent group (9% vs 5%).
Interpretation of results
was common in the participating group of Indigenous seniors and particularly high among women, greater than that observed in studies of other populations. The underlying reasons for this were not assessed but may include obstetric practice, parity, and the high rates of diabetes, a known risk factor for incontinence. The rate of incontinence in men was low, and this may be due to under-reporting. Anecdotal evidence from our previous project suggests high levels of misunderstanding of the nature or meaning of UI amongst men. There were no obvious associations with reported comorbidities. Although based on a small sample size, 10% of seniors in the community were recruited. Future research will use qualitative methods to explore the lived experience of UI and its treatment and management in Indigenous seniors living in NT.