| While there are different models of prevention, the
following definitions related to prevention were used as points for
discussion. It was noted that these definitions are embedded in a
disease model.
The Impairment-Disability-Handicap
Model
Recognizing that incontinence is not a disease but is a symptom or
condition the panel felt it may be necessary to consider a prevention
model similar to the Rehabilitation Model of
Impairment-Disability-Handicap. Using this model, impairment would be
the underlying bladder or sphincter dysfunction (or dysfunction of the
neurological control system at any level). Disability would be the
consequent symptom of incontinence. The limitations imposed on the
individual's quality of life is the handicap. Therefore, primary
prevention would be aimed at preventing the underlying impairment from
developing. Secondary prevention would be preventing the individual,
despite an underlying predisposition, from becoming incontinent.
Tertiary prevention would be preventing incontinence from worsening, or
causing complications (such as skin problems) or limiting the impact of
being incontinent upon the individual and those around them.
Quality of Life
Quality of life was a recurring theme at the conference. Although the
concept is frequently addressed in research, it is often not clearly
defined. It was agreed that the outcome of any prevention strategy
should be assessed not only in terms of bladder function, but also
should incorporate the individual's perspective. Quality of life
outcomes need to include overall benefits to both the individual and
society as a whole. It was recognized that prevention programs are
likely to be costly. Consequently, future prevention research should
consider a cost-benefit analysis.
It was agreed that the focus of this meeting should be on primary and
secondary prevention as treatment and containment are discussed and
researched elsewhere. It was further agreed that some primary prevention
measures, such as those aimed at preventing neurological disease or
injury (with subsequent incontinence) were beyond the scope of this
conference.
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