Urinary Incontinence and Its Association with Death, Nursing Home Admission, and Functional Decline

• Published in: Journal of the American Geriatrics Society (JAGS) 2004-05, Vol.52 (5), p.712-718
• Main Authors: Holroyd-Leduc, Jayna M., Mehta, Kala M., Covinsky, Kenneth E.
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Bacterial diseases; Bacterial diseases of the respiratory system; Biological and medical sciences; Body Mass Index; Community living; Death & dying; Elderly people; Female; Follow-Up Studies; Frail Elderly; Functional impairment; Health Status; Human bacterial diseases; Humans; Infectious diseases; Institutionalization; Male; Medical sciences; Mental health; Mortality; Nephrology. Urinary tract diseases; Nursing Homes; Older people; Outcome Assessment (Health Care); Patient admissions; Perceptions; Risk Factors; Smoking - adverse effects; Socioeconomic Factors; Time Factors; Urinary incontinence; Urinary Incontinence - complications; Urinary Incontinence - mortality; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; USA
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2004.52207.x

Objectives: To determine whether urinary incontinence (UI) is an independent predictor of death, nursing home admission, decline in activities of daily living (ADLs), or decline in instrumental activities of daily living (IADLs). Design: A population‐based prospective cohort study from 1993 to 1995. Setting: Community‐dwelling within the United States. Participants: Six thousand five hundred six of the 7,447 subjects aged 70 and older in the Asset and Health Dynamics Among the Oldest Old study who had complete information on continence status and did not require a proxy interview at baseline. Measurements: The predictor was UI, and the outcomes were death, nursing home admission, ADL decline, and IADL decline. Potential confounders considered were comorbid conditions, baseline function, sensory impairment, cognition, depressive symptoms, body mass index, smoking and alcohol, demographics, and socioeconomic status. Results: The prevalence of UI was 14.8% (18.5% in women; 8.5% in men). At 2‐year follow‐up, subjects incontinent at baseline were more likely to have died (10.9% vs 8.7%; unadjusted odds ratio (OR)=1.29, 95% confidence interval (CI)=1.02–1.64), be admitted to a nursing home (4.4% vs 2.6%, OR=1.77; 95% CI=1.18–2.63), and to have declined in ADL function (13.6% vs 8.1%; OR=1.78, 95% CI=1.36–2.33) and IADL function (21.2% vs 13.8%; OR 1.69, 95% CI 1.39–2.05). However, after adjusting for confounders, UI was not an independent predictor of death (adjusted OR (AOR)= 0.90, 95% CI=0.67–1.21), nursing home admission (AOR=1.33, 95% CI=0.86–2.04), or ADL decline (AOR=1.24, 95% CI=0.92–1.68). Incontinence remained a predictor of IADL decline (AOR=1.31; 95% CI=1.05–1.63), although adjustment markedly reduced the strength of this association. Conclusion: Higher levels of baseline illness severity and functional impairment appear to mediate the relationship between UI and adverse outcomes. The results suggest that, although UI appears to be a marker of frailty in community‐dwelling elderly, it is not a strong independent risk factor for death, nursing home admission, or functional decline.