**8. Implications for future research**

Research is required to improve and advance evidence-based continence care practices. From the literature it is evident there are areas where further research is recommended. One potential area for further research is the impact of culture, economic and social factors associated with elderly women's experiences and perceptions of UI in LTC. This research would provide healthcare providers with the knowledge to understand the implications of UI on the QoL of elderly women, and assist in implementation strategies to ensure individualized continent care. With regards to cultural factors affecting women's perceptions of UI, it would be interesting to complete a research study with extended families where long- term care would not be considered an option, and to explore how significant an impact ageism has on a women's experience with UI. Also, to complete a comparative study of for profit and non-profit LTC facilities to determine differences and similarities in the experiences women have with UI. Further, conduct research on the prevention of UI in elderly women, design and test interventions that are based on evidence, and research that supports the implementation of nurse-led continence clinics that are costeffective. More research that improves the diagnosis, treatments and management strategies, and outcomes is necessary to guide evidenced-based clinical practice for elderly women with UI in LTCis needed (Borrie et al., 2002; MacDonald & Butler, 2007; Du Moulin et al., 2009). Du Beau et al (2007) suggested that more research is required that determines residents' and families' definitions and values of "quality" UI care and how to incorporate them into quality improvement strategies. More research that address nurses' attitudes, and their cultural and ethnic perspectives about UI are imperative to advancing continence care practices (Zeznock et al., 2009).

A comparative study to explore similarities and differences between younger women experiencing UI and older women experiencing UI in LTC could be conducted. The knowledge attained from this type of study would be fundamental to care of all women experiencing UI in LTC. This research could assist healthcare providers to understand the impact of ageing, which potentially may optimize the quality of incontinent care. Also, a research study that developed and implemented an individualized continence care program in LTC is essential given the current state of knowledge about continence care. Such a study could combine quantitative and qualitative methods. Further, more research that considers

Elderly Women and Urinary Incontinence in Long-Term Care 107

Also apparent from the literature is the importance of the physical and economic burdens of UI. Although the literature does cite the psychosocial, physical and economic burdens of UI on elderly women, few explored how these burdens impact QoL or a sense of well-being for incontinent elderly women in LTC. As well, research is needed that explores the knowledge, attitudes and behaviours of the public related to UI to develop strategies that will assist in

The research reviewed revealed that elderly women in society are marginalized by gender and age, which in turn contributes to the lack of health maintenance services for elderly women. Some literature findings reflected some healthcare providers' stereotypes of ageing further marginalized elderly women and devalued their concerns and stories, which silenced them. Yet, throughout the literature, the management of UI in LTC was emphasized. Nurses and other healthcare providers focused on the management of the soiling, and many viewed UI as a task for which incontinent products were the solution. UI care was found to be frustrating, time-consuming and comparable to a housekeeping task by healthcare professionals. The literature asserted that strategies such as pad use, fluid management, and voiding schedules were implemented by nursing staff in an attempt to reduce or eliminate UI. Unfortunately, fluid management put the elderly at risk for dehydration while voiding schedules were not individualized by nursing staff. Some literature addressed the need for comprehensive assessments and the importance of

According to the research available elderly women experiencing UI practiced a number of self-management strategies; secrecy, isolation, frequent voiding, using incontinent products, reducing fluid intake, clothing changes, and wearing scents. Elderly women preferred to normalize UI into daily routines, thus preventing shame and embarrassment. Further research is required that allows elderly women to tell their stories about UI, and explore the impact of UI on women's sense of identity. By generating new knowledge, misconceptions and myths surrounding UI in elderly women can be dispelled. Knowledge will further nurses' and other healthcare providers' understanding of the meanings and effects of UI on women's QoL and sense of self, ultimately impacting healthcare practices of caring for

I would like to acknowledge all elderly women experiencing UI in Long-term care, Dr. Lorna Butler, Dean of Nursing at the University of Saskatchewan, The Nova Scotia Gerontological Nursing Society, Atlantic Aboriginal Health Research Program (AAHRP) funding, Electa MacLennan and Margaret Cragg Scholarships, Dalhousie University, Ruby Blois Scholarship, IWK Health Centre, Halifax, Nova Scotia, Astra Zeneca Rural Scholarship,

Bayliss, V. & Salter, L. (2004). Pathways for Evidenced-based Continence Care. *Nursing Standard*, Vol.19, No.9, (November 10-16, 2004), pp. 45-52 ISSN: 0029-6570

educating the public and dispel myths and ageist perceptions about the elderly.

individualized continence care.

elderly women experiencing UI in LTC.

and Canadian Nurses Association.

**10. Acknowledgement** 

**11. References** 

gender is essential to understanding the impact of UI on elderly women's QoL, and research that addresses the psychological, social, economic, and/or physical implications and contexts of UI, is crucial to developing and implementing holistic and quality continence care programs.
