**9. Conclusion**

The minimal literature on such a specialized topic as UI in elderly women in LTC necessitates the use of literature that may be considered by some to be a little outdated. However, the relevance of this valuable research and insights into the topic continues to offer support in the absence of more recent research contributions. A review of the literature on UI in elderly women indicates that much of research has concentrated on the medicalization of UI, as evidenced by the predominance of diagnostic and surgical treatment regimes. Many of the studies found were quantitative, employing convenience samples of elderly women in treatment facilities or in the community, with wide age variances. Thus, these studies were not representative of the larger population of incontinent elderly women, who according to the literature, tend to harbour the secret of incontinence..Furthermore, much of the existing literature continues to explore UI from the contexts the physical and economic burdens of UI, the marginalization of elderly women experiencing UI in long- term care, and healthcare providers' attitudes, approaches, and strategies to managing UI in LTC. There is a lack of research found regarding elderly women's experiences of UI in LTC or the psychosocial impacts of UI on elderly women. Although, 80% of elderly women in one study indicated that UI was more than a minor problem, it was apparent from the literature that many healthcare providers considered UI a normal part of the aging process and a management issue, rather than a healthcare issue (Taunton et al., 2005).

Evident from the literature was the diversity in definitions and perspectives pertaining to UI, which may cause confusion and ambiguity for elderly women, healthcare providers and society. There exists a need to clearly define UI, so that there is common language to discuss UI, and common meanings about solutions and interventions for UI (Palmer, 1996; Zeznock et al., 2010). This in turn, may potentially assist in dispelling misconceptions and myths about UI, while providing elderly women with terms to foster discussions with healthcare providers about their experiences with UI.

Existing literature on elderly women's experiences with UI indicates that UI negatively impacts physical, social and emotional aspects of health, contributing to women feeling anxious, embarrassed and unwilling to participate in a wide range of activities. However, to what extent age impacts on the psychosocial effects of UI is unclear due to wide age variances in many of the study samples. Of the literature found, three of the studies (DuBeau et al, 2006; Sandvik et al., 1993; Whyman et al., 1987) quantified the psychosocial consequences of UI in elderly women, which supported the negative impact of UI. One qualitative study found described the meaning of UI to elderly women living in LTC (MacDonald & Butler, 2007). Another qualitative study by Dowd (1991) suggested that older women's UI posed a threat to their self-esteem and in order to maintain control of their lives implemented self-care strategies. However, this study neglected to discuss the self-care strategies that elderly women employed to maintain their self-esteem.

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

The minimal literature on such a specialized topic as UI in elderly women in LTC necessitates the use of literature that may be considered by some to be a little outdated. However, the relevance of this valuable research and insights into the topic continues to offer support in the absence of more recent research contributions. A review of the literature on UI in elderly women indicates that much of research has concentrated on the medicalization of UI, as evidenced by the predominance of diagnostic and surgical treatment regimes. Many of the studies found were quantitative, employing convenience samples of elderly women in treatment facilities or in the community, with wide age variances. Thus, these studies were not representative of the larger population of incontinent elderly women, who according to the literature, tend to harbour the secret of incontinence..Furthermore, much of the existing literature continues to explore UI from the contexts the physical and economic burdens of UI, the marginalization of elderly women experiencing UI in long- term care, and healthcare providers' attitudes, approaches, and strategies to managing UI in LTC. There is a lack of research found regarding elderly women's experiences of UI in LTC or the psychosocial impacts of UI on elderly women. Although, 80% of elderly women in one study indicated that UI was more than a minor problem, it was apparent from the literature that many healthcare providers considered UI a normal part of the aging process and a management issue, rather than a healthcare issue

Evident from the literature was the diversity in definitions and perspectives pertaining to UI, which may cause confusion and ambiguity for elderly women, healthcare providers and society. There exists a need to clearly define UI, so that there is common language to discuss UI, and common meanings about solutions and interventions for UI (Palmer, 1996; Zeznock et al., 2010). This in turn, may potentially assist in dispelling misconceptions and myths about UI, while providing elderly women with terms to foster discussions with healthcare

Existing literature on elderly women's experiences with UI indicates that UI negatively impacts physical, social and emotional aspects of health, contributing to women feeling anxious, embarrassed and unwilling to participate in a wide range of activities. However, to what extent age impacts on the psychosocial effects of UI is unclear due to wide age variances in many of the study samples. Of the literature found, three of the studies (DuBeau et al, 2006; Sandvik et al., 1993; Whyman et al., 1987) quantified the psychosocial consequences of UI in elderly women, which supported the negative impact of UI. One qualitative study found described the meaning of UI to elderly women living in LTC (MacDonald & Butler, 2007). Another qualitative study by Dowd (1991) suggested that older women's UI posed a threat to their self-esteem and in order to maintain control of their lives implemented self-care strategies. However, this study neglected to discuss the self-care

strategies that elderly women employed to maintain their self-esteem.

care programs.

**9. Conclusion** 

(Taunton et al., 2005).

providers about their experiences with UI.

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

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 individualized continence care.

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 elderly women experiencing UI in LTC.
