THE PREVALENCE OF POTENTIALLY REMEDIABLE URINARY-INCONTINENCE IN FRAIL OLDER-PEOPLE - A STUDY USING THE MINIMUM DATA SET

OBJECTIVES: To use the Minimum Data Set (MDS) to describe the frequenc y and correlates of potentially treatable causes of urinary incontinen ce among a representative sample of American nursing home residents. T o describe current management practices of urinary incontinence in the same population. DESIGN: Cross-sectional study using the dataset that was part of the Health Care Financing Administration (HCFA) evaluatio n of the MDS. SETTING: 270 Medicaid-certified nursing homes in 10 stat es. PARTICIPANTS: A total of 2014 nursing home residents 60 years or o lder (mean = 84.3 +/- 8.7), 75.5% women, 81.9% white, who lived in a n ursing home during the fall of 1990 were randomly selected to sample a fixed number of residents for each facility based on facility size. M EASUREMENTS: Incontinence was defined as the presence of at least two episodes of urinary leakage per week in the previous 2 weeks. Manageme nt techniques (toileting, pads/briefs, catheters) were those listed in the MDS. Potentially remediable causes of urinary incontinence availa ble in the MDS were: medications (antipsychotics, antidepressants, and antianxiety/hypnotics); congestive heart failure; diabetes mellitus; pedal edema; delirium; depression; and impairments in activities of da ily living (ADLs) (transferring, locomotion, dressing, toileting; bedr ails; trunk restraints; and chair restraints). RESULTS: Forty-nine per cent of residents were incontinent. Of these, 84.0% were managed by pa ds/briefs, 38.7% by scheduled toileting, 3.5% by indwelling catheter, and 1.2% by external catheter. Of the potentially reversible causes, b ivariate analysis revealed associations (P<.1) with use of antidepress ants, antipsychotics, and antianxiety/hypnotics; delirium; bedrails; t runk restraints; chair restraints; and ADL impairment. Dementia was al so associated with incontinence (P<.1). Multivariate analysis revealed that urinary incontinence was independently associated with impairmen t in ADLs (OR = 4.2; CI = 3.2,5.6), dementia (OR = 2.3;CI = 1.8,3.0), restraints-trunk (OR = 1.7; CI = 1.5,2.0), chair (OR = 1.4; CI = 1.2,1 .6), bedrails (OR = 1.3; CI = 1.1,1.5), and use of antianxiety/hypnoti c medications (OR = .7;CI = .5,1.0) (all P<.04). CONCLUSIONS: Current management practices for urinary incontinence are inconsistent with ad vocated guidelines. These data also confirm the association between in continence and several potentially remediable conditions and suggest t hat, even in the nursing home setting, urinary incontinence may respon d to efforts to improve conditions not directly related to bladder fun ction. This study underscores the need to examine the impact on urinar y incontinence of strategies to address such conditions.