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

Authors

  • Jayna M. Holroyd-Leduc MD,

    1. From the *San Francisco VA Medical Center, San Francisco, CaliforniaDivision of Geriatrics, University of California, San Francisco, California.
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  • Kala M. Mehta DSc,

    1. From the *San Francisco VA Medical Center, San Francisco, CaliforniaDivision of Geriatrics, University of California, San Francisco, California.
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  • Kenneth E. Covinsky MD, MPH

    1. From the *San Francisco VA Medical Center, San Francisco, CaliforniaDivision of Geriatrics, University of California, San Francisco, California.
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  • This work was supported by a grant from the National Institute on Aging (R01AG19827). Dr. Holroyd-Leduc is funded as a VA National Quality Scholar fellow. Dr. Mehta is supported in part by a training grant from the National Institute on Aging (T32-AG00212-08). Dr. Covinsky is supported by an independent scientist award from the Agency for Healthcare Research and Quality (K02 HS00006-01) and is a Paul Beeson Faculty Scholar in Aging Research.An abstract of this study was presented at the 26th Annual Meeting of the Society of General Internal Medicine in Vancouver, Canada, May 2003, andatthe American Geriatrics Society 2003 Annual Scientific Meeting inBaltimore, May 2003.

Address correspondence to Dr. J. M. Holroyd-Leduc, San Francisco VA Medical Center (181G), 4150 Clement St, Bldg 1, San Francisco, CA 94121. E-mail: Jayna.Holroyd-Leduc@med.va.gov

Abstract

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.

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