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Delay in Seeking Care for Pelvic Floor Disorders Among Caregivers

Mishra, Kavita, MD*; Locci-Molina, Natalie C., MD; Chauhan, Bhavya, BA; Raker, Christina A., ScD§; Sung, Vivian W., MD

Female Pelvic Medicine & Reconstructive Surgery: July 24, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000609
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Objective In 2015, 44 million adults were informal, unpaid caregivers to an adult or child. Caregiving (CG) is associated with poor self-care, higher depression rates, and decreased quality of life. Our primary objective was to determine if CG is associated with a delay in seeking care for pelvic floor disorders (PFDs).

Methods We performed a cross-sectional survey of new urogynecology patients from September 2015 to January 2016. Subjects completed the Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, Patient Reported Outcomes Measurement Information System–Depression surveys, and a survey of care-seeking practices. Caregiving was defined as considering one’s self a primary caregiver and assisting with 2 or more activities and instrumental activities of daily living. Multiple logistic regression identified variables associated with delayed care-seeking for 1 or more year.

Results Two hundred fifty-six patients completed the survey, 82 caregivers (32%) and 174 noncaregivers (NCGs). Sixty-seven percent of caregivers cared for a child and 33% for an adult. There was no difference between caregivers and NCGs in PFD symptom duration, Pelvic Floor Distress Inventory, or Patient Reported Outcomes Measurement Information System depression scores. Caregiving had higher mean Pelvic Floor Impact Questionnaire scores (69.6 vs 51.0, P = 0.02). There was no difference in proportion of patients who delayed care for 1 year or more (42% vs 54%, P = 0.08). A higher proportion of caregivers for an adult waited for 1 year or more (75% vs 42% NCG, P = 0.001). On multiple logistic regression, CG for adults only was associated with delaying care for 1 year or more (adjusted odds ratio, 3.73; confidence interval, 1.33–10.44; P = 0.01).

Conclusions One third of patients presenting to a urogynecology practice are caregivers. Caregiving for an adult was associated with a delay in seeking care for PFDs.

From the *Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Stanford University Medical Center Palm Alto, CA;

Warren Alpert Medical School of Brown University, and

Division of Urogynecology, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University; and

§Division of Research, Women & Infants Hospital of Rhode Island, Providence, RI.

Correspondence: Kavita Mishra, MD, Urogynecology and Pelvic Reconstructive Surgery, Obstetrics and Gynecology, Stanford University, 300 Pasteur Drive, HG332, Stanford, CA 94305. E-mail: mishrak@stanford.edu.

The authors have declared they have no conflicts of interest.

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