In a randomly selected sample of 559 subjects 65 years and over living in the community and in institutions the prevalence of urinary incontinence was found to be 11.6%. In those 80 years and over the prevalence rose to 21.7%. Those with dementia were more likely to be incontinent than those with normal mental function. In the majority of those over 80 who were incontinent, the incontinence was associated with either confusion or a combination of factors. The estimated population prevalence of faecal incontinence for those 65 years and over was 3.1%. Urinary incontinence was associated with an increased risk of death. In a review of subjects after three years 73.5% of the incontinent group had died while only 34.9% of those originally continent had died. Because incontinent elderly people are commonly frail, with a number of conditions contributing to the disorder, the extent of investigation of the disorder needs to be carefully assessed for each patient.
determine factors predicting mortality in the elderly are therefore unlikely to identify a single factor, the treatment of which would increase life expectancy. Such studies may, however, increase the understanding of the relation of ageing and disease processes causing morbidity and mortality in the elderly. Studies may also indicate that certain risk factors for death in young people are no longer important predictors in the elderly. This would have important implications in the investigation and treatment of these conditions. Studies may enable identification of an at risk group of elderly people for whom health care services would be of value. Information obtained will enable better planning of health care provision.The majority of studies investigating factors predicting mortality in old people have examined a selected population such as those in institutions' 2 or receiving particular benefits,3 or have investigated certain specific variables only.' There have been few studies of randomly selected community samples, and each has investigated different variables.7'9We have investigated factors predicting mortality in a prospective study of a randomly selected sample of elderly people living in both the community and in institutional care.Sample and method Names, ages, and addresses of all people 65 years and over who lived in Gisborne, New Zealand were obtained from a sample frame estimated to represent 97% of the elderly in the area.10 The sample frame included all elderly people living in the area, whether they lived in the community or in institutions. From this a randomly selected sample stratified by age was obtained. The sample included all those aged 80 years or more, a 1 in 6 sample of those 75-79 years, and a 1 in 20 sample of those aged 65-74 years.
A randomly selected sample of subjects aged 65 years and over was investigated to determine the prevalence of dementia. The sample, which was stratified by age, consisted of 559 subjects living in the community and institutions. It was estimated that 7.7% of those aged 65 years and over suffered from dementia. The disorder affected both sexes equally. There was a marked increase in the prevalence with age so that in those 80 years and over the prevalence rate of dementia was found to be 19%. Those suffering from dementia were significantly more likely to be receiving institutional care than those with normal intellectual function. Those with dementia used significantly more domiciliary services than did those with normal mental function and were more likely to require additional services not already provided. There was a particular need for district nursing supervision, day care and relief admissions. The high prevalence rate of dementia in the elderly, and the high use those suffering from the disorder make of both domiciliary and institutional services, should be appreciated in the planning of services for the elderly.
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