Determinants of Urinary Incontinence and Subtypes Among the Elderly in Nursing Homes

Abstract

Urinary incontinence (UI) is a common problem among older adults. This study investigated the prevalence of UI in nursing home residents aged ≥75 years in China and examined potential risk factors associated with UI and its subtypes. Data were collected during face-to-face interviews using a general questionnaire, the International Consultation Incontinence Questionnaire Short-Form, and the Barthel Index. A total of 551 participants aged ≥75 years residing in Changsha city were enrolled from June to December 2018. The UI prevalence rate among nursing home residents aged ≥75 years was 24.3%. The most frequent subtype was mixed (M) UI (38.1%), followed by urge (U) UI (35.1%), stress (S) UI (11.9%), and other types (14.9%). In terms of severity, 57.5% had moderate UI, while 35.1% had mild and 7.5% had severe UI. Constipation, immobility, wheelchair use, cardiovascular disease (CVD), and pelvic or spinal surgery were significant risk factors for UI. Participants with a history of surgery had higher risks of SUI (odds ratio [OR] = 4.87, 95% confidence interval [CI]: 1.55–15.30) and UUI (OR = 1.97, 95% CI: 1.05–3.71), those who were immobile or used a wheelchair had higher rates of MUI (OR = 11.07, 95% CI: 4.19–29.28; OR = 3.36, 95% CI: 1.16–9.78) and other UI types (OR = 7.89, 95% CI: 1.99–31.30; OR = 14.90, 95% CI: 4.88–45.50), those with CVD had a higher rate of UUI (OR = 2.25, 95% CI: 1.17–4.34), and those with diabetes had a higher risk of UUI (OR = 2.250, 95% CI: 1.14–4.44). Use of oral antithrombotic agents increased UUI risk (OR = 4.98, 95% CI: 2.10–11.85) whereas sedative hypnotic drug use was associated with a higher risk of MUI (OR = 3.62, 95% CI: 1.25–10.45). Each UI subtype has distinct risk factors, and elderly residents of nursing homes with a history of CVD and pelvic or spinal surgery who experience constipation should be closely monitored. Reducing time spent in bed and engaging in active rehabilitation including walking and muscle strengthening may aid in UI prevention and treatment.

Nursing assistants’ knowledge, attitudes and training needs regarding urinary incontinence in nursing homes: a mixed-methods study

“…Urinary incontinence (UI), which is defined as the uncontrolled leakage of urine, has a high prevalence in the older population and among nursing home residents in particular [ 1 ]. In 2021, the prevalence of UI was approximately 24.3% among older people aged ≥75 years in Chinese nursing homes (NHs) [ 2 ]. The prevalence of UI increased from 12.0% for men aged 70–74 years old to 16.3% for those aged 90 years and older [ 3 ].…”

Proposal for a Clinical Protocol for the Conservative Treatment of Urge Urinary Incontinence

“…An overactive pelvic floor also contributes to constipation by preventing proper relaxation for evacuation. Other important conditions are fecal impaction and constipation, indicated by several studies as an important risk factor and related to incontinence [18][19][20][21] . Constipation is classified into primary and secondary, and its primary causes are associated with nonrelaxation of the anorectal PFM, inadequate fiber intake, colon inertia, incorrect diet, poor control of bowel habit; secondary causes involve neurological factors, caused by traumatic or systemic neuropathies, endocrine diseases, and drug treatments 22 .…”

Proposta De Protocolo Clínico Para Tratamento Conservador Da Incontinência Urinária De Urgência

“…Outras condições importantes são a impactação fecal e a constipação, apontadas por diversos estudos como importante fator de risco e relacionado a incontinência [18][19][20][21] . A constipação intestinal se classifica em primária e secundária, e suas causas primárias estão associadas ao não relaxamento da musculatura anorretal do assoalho pélvico, consumo inadequado de fibras, inércia colônica, alimentação incorreta, mau controle do hábito da evacuação; as causas secundárias envolvem fatores neurológicos, provocados por neuropatias traumáticas ou sistêmicas, doenças endócrinas e tratamentos medicamentosos 22 .…”