Racial disparities in primary prevention of incontinence among older adults at nursing home admission

Abstract

Maintaining continence of nursing home (NH) residents promotes dignity and well-being and may reduce morbidity and healthcare treatment costs. Aims To determine the prevalence of older continent adults who received primary prevention of incontinence at NH admission, assess whether there were racial or ethnic disparities in incontinence prevention, and describe factors associated with any disparities. Methods The design was an observational cross-sectional study of a nation-wide cohort of older adults free of incontinence at NH admission (n=42,693). Four US datasets describing NH and NH resident characteristics, practitioner orders for NH treatment/care, and socioeconomic and sociodemographic status of the community surrounding the NHs were analyzed. Disparities were analyzed for four minority groups identified on the Minimum Data Set using the Peters-Belson method and covariates at multiple levels. Results Twelve percent of NH admissions received incontinence prevention. There was a significant disparity (2%) in incontinence prevention for Blacks (p<.05): Fewer Black admissions (8.6%) were observed to receive incontinence prevention than was expected had they been part of the White group (10.6%). The percentage of White admissions receiving incontinence prevention was 10.6%. Significant factors associated with disparity in receiving incontinence prevention were having greater deficits in ADL function and cognition and more comorbidities. No disparity disadvantaging the other minority groups was found. Conclusions Greater efforts for instituting incontinence prevention at the time of NH admission are needed. Eliminating racial disparities in incontinence prevention seems an attainable goal. Appropriate staff training, organizational commitment, and monitoring progress toward equitable outcomes can help achieve this goal.

Time to and predictors of dual incontinence in older nursing home admissions

“…Findings by our team show that preventing incontinence in older nursing home admissions who are continent is uncommon, occurring in only 12%. Nursing homes in this study had staffing levels that met federal guidelines and were in the upper tier of quality based on percentage of residents receiving Medicaid .…”

“…Furthermore, our analysis is the first to quantify the risk that a resident would develop dual incontinence and model the time from admission to developing the incontinence. Our model also adjusted for Black race and Hispanic ethnicity of nursing home residents which builds on recent knowledge about racial and ethnic disparities in incontinence prevention and cure/resolution . Another strength of our study is the consideration/screening of predictors of dual incontinence not only at the resident level but at the nursing home and community levels.…”

“…Development of potential predictors was previously described . As incontinence in nursing homes is multi‐factorial, predictors at the resident, nursing home, and community levels were identified from a review of the literature and expertise of the investigators and three clinical consultants.…”

“…Potential predictors included in the model for time to dual incontinence were age, limitations in ADLs, co‐morbidities, cognitive deficits, having only urinary or only fecal incontinence at nursing home admission (reference group was being continent), deficiencies in nursing home quality of care, and percentage of nursing home residents receiving Medicaid. Because previous analyses showed disparities for Black and Hispanic residents for other incontinence‐related outcomes, Black race, and Hispanic ethnicity were included in the model and the reference group was all other races combined (ie, White, American Indian, and Asian).…”

“…The findings of Nelson et al suggest that racial and ethnic disparities in nursing home care may contribute to the development of dual incontinence. Our team has reported racial disparities in prevention of any incontinence for older Black residents and in resolution/cure of any incontinence for older Hispanic residents . Social epidemiologists assert that analysis of individual level factors is insufficient to assess population‐level, complex problems such as incontinence in nursing homes and that group level (ie, nursing home and community) factors must be considered .…”