URINARY-INCONTINENCE IN NURSING-HOMES - INCIDENCE, REMISSION AND ASSOCIATED FACTORS

Objective: To determine the incidence and remission rates of daytime u rinary incontinence (UI) in a cohort of newly admitted nursing home (N H) residents. Design: Prospective cohort study. Setting: Eight proprie tary NHs in Maryland. Subjects: Four hundred thirty new admissions age 65 or older who were participants in a larger prospective study of me ntal morbidity and adjustment to the NH. Measures: Nurses aides' repor ts of continence status, psychiatric examinations, and nursing staff a ssessments of mobility at 2 weeks, 2 months, and 1 year after NH admis sion. Results: The prevalence of daytime UI at admission was 39% in bo th females and males. Among the 293 members (68%) of the admission coh ort remaining in the NHs 2 months after admission, the incidence of da ytime UI was 27% (21% in females, 51% in males); daytime UI resolved i n 23% (24% in females, 20% in males). Among the 178 members (41%) of t he admission cohort remaining in the NHs 1 year after admission, the i ncidence of daytime UI between 2 months and 1 year after admission was 19% (16% in females, 46% in males); daytime UI resolved in 22% (23% i n females, 14% in males). The continence status of about two-thirds of residents remaining in the NH at 1 year after admission was stable ov er time: 22% had daytime UI, and 42% were continent at all three data collection points. The development of daytime UI was associated with m ale sex, the diagnosis of dementia, fecal incontinence, and the inabil ity to ambulate or transfer independently. Resolution of daytime UI wa s associated with the absence of these characteristics. Conclusions: D espite limitations attributable to the method of defining UI and poten tial biases related to the attrition of the admission cohort over time , this is the first large prospective study to examine the incidence a nd remission patterns of daytime UI among NH residents. The strong ass ociation between UI and dementia was validated for the first time by d irect psychiatric examinations. Sex and mobility are also closely asso ciated with the development and remission of UI in this setting. This study provides some valuable data that can be used to assess the impac ts of the recently developed Resident Assessment Protocol for UI and A gency for Health Care Policy and Research Clinical Practice Guidelines .