Predicting continence decline in institutionalized older people: A longitudinal analysis

Abstract

Aims To verify the incidence of urinary continence decline and the probability of maintaining urinary continence, as well as identify the prognostic factors of urinary continence decline in institutionalized older people. Methods A 2‐year longitudinal study (with five 6‐month waves) was conducted with subjects ≥60 years old who lived in 10 nursing homes in the city of Natal‐RN (Brazil). Urinary incontinence was assessed by the Minimum Data Set version 3.0. Sociodemographic, institution‐related and health‐related variables were considered to establish the baseline. Time‐dependent variables included cognitive decline, functional decline, and incidences of falls, hospitalizations, and fractures during the period. The actuarial method, the log‐rank test, and Cox’s regression were applied as statistical methods. Results Among the cohort of 196 older adults, 105 (53.6%) individuals maintained the continence status during the period, 21 (10.7%) improved it at one or more assessments, and 76 (38.8%) subjects declined. The cumulative probability of maintaining continence status was 82.6% (confidence interval [CI], 95%: 76.5%‐87.3%), 74.7% (CI, 95%: 67.8%‐80.4%), 66.9% (CI, 95%: 59.4%‐73.2%), and 49.3% (CI, 95%: 40.1%‐57.9%) at 6, 12, 18, and 24 months, respectively. Predicting factors for continence decline were: disability (hazard ratio [HR] = 4.03; P < 0.001), functional decline (HR = 3.02; P = 0.001) and potentially inappropriate medication (HR = 1.84; P = 0.008). Conclusions The incidence of continence decline and the cumulative probability of maintaining continence status in institutionalized older adults was approximately 39% and 49%, respectively, at the 2‐year follow‐up. Disability and potentially inappropriate drugs at baseline and functional decline across the period predicted continence decline in this cohort.

Urinary incontinence and sedentary behaviour in nursing home residents in Osona, Catalonia: protocol for the OsoNaH project, a multicentre observational study

“…9 10 However, UI is a geriatric syndrome that represents an indicator of frailty and quality of healthcare, as well as a risk factor for pressure ulcers, falls, fractures and even urinary sepsis or death. [11][12][13] NH residents are the least physically active of all older adults and spend most of their awake time sedentary. 14 15 Doing regular physical activity (PA) limits the development and progression of most prevalent chronic diseases.…”

How did the COVID‐19 pandemic affect urinary incontinence and its management in the nursing homes? A descriptive phenomenological study

“…This health professionals' perception is in line with data from the OsoNaH project comparing the pre‐pandemic baseline assessment versus the posterior 12‐month follow‐up, showing that 54.4% and 30.4% of residents suffered from functional and continence decline, respectively (pending publication). The association of low functional capacity as a risk factor for continence decline has been clearly established in several longitudinal studies conducted in NHs of different countries 22 …”

“…The association of low functional capacity as a risk factor for continence decline has been clearly established in several longitudinal studies conducted in NHs of different countries. 22 More recently, new evidence shows the effects of lockdown on cognitive capacity, depression, anxiety, frailty and disability. 20 The infection control measures led to social isolation and loneliness, psychosocial health issues that are associated with fatigue, physical inactivity, cognitive decline, depression, and early mortality.…”

“…The association of low functional capacity as a risk factor for continence decline has been clearly established in several longitudinal studies conducted in NHs of different countries. 22 …”

Symptoms of urinary incontinence and pelvic organ prolapse and physical performance in middle-aged women from Northeast Brazil: a cross-sectional study

“…The authors affirmed that could be due to the difficulty getting to the bathroom or multi-factorial causes of both immobility and incontinence [37]. Similarly, Jerez-Roig and colleagues [38] found that disability and functional decline are significant predictors of urinary continence decline after two years in a sample of institutionalized older adults. However, Krause et al (2010) [39] showed that 6-min walk test, chair stand test, and test of sit-and-reach were not significant predictors of urinary incontinence [39].…”