Understanding the complexity of diabetes and urinary incontinence in older adults with multiple chronic conditions receiving home care: A mixed-methods study

Abstract

Urinary incontinence (UI) is a common complication of type 2 diabetes mellitus (T2DM) for older adults (≥65 years) that is associated with reduced quality of life and risk of institutionalization. This convergent, mixed methods research study, informed by a model of clinical complexity, explored the complexities for older adults living with UI and T2DM, and home-care nurses providing care to this population in Ontario. In the quantitative strand, the most recently completed Resident Assessment Instruments for Home Care from 2011-2016 for older home-care clients with diabetes were analyzed to determine the prevalence and correlates of UI. The qualitative strand used interpretive description methodology to explore the experiences of 18 older adults living with T2DM and UI receiving home-care services and the experiences of 15 home-care nurses caring for this population. These data sources were converged to describe the factors that contributed to complexity for older adults with UI and T2DM: (a) challenges of living with multiple chronic conditions (MCC), medical instability, and high care needs; (b) financial barriers; (c) lack of understanding of older adults’ values and preferences by health-care providers; (d) caregiver burden; and (e) functional impairments. The health-care system contributed to this complexity through: (a) inadequate and minimal provision of nursing and interprofessional home-care services; (b) task-focused structure of home care; (c) minimal interprofessional collaboration; (d) lack of an integrated communication system; and (e) lack of navigation to community resources. Providing health-promoting care for older adults with UI and T2DM requires a system-wide enactment of integrated care that takes both a person- and family-centred care and social determinants of health approach. Interventions for older adults with MCC should involve standardized and comprehensive assessment, care coordination, enhanced nursing service provision, and interprofessional team collaboration to attend to the dimensions of complexity and ensure the needs of older adults and their caregivers are met.