THE ASSOCIATION OF URINARY-INCONTINENCE WITH POOR SELF-RATED HEALTH

OBJECTIVES: To assess whether urinary incontinence (UI) and its severi ty are associated with poor self-rated health in a national sample of community-living older adults and whether this relationship persists a fter controlling for confounding attributable to functional status, co morbidity, and demographic factors. DESIGN: A cross-sectional analysis using multivariate logistic regression. SETTING: Subjects were from t he 1990-1991 National Survey of Self-Care and Aging (N = 3485), a rand om sampling in geographic clusters of community-dwelling Medicare bene ficiaries 65 years of age or older in the contiguous United States. ME ASURES: The responses to an interviewer-administered questionnaire reg arding urinary incontinence, Basic Activities of Daily Living (BADL), Instrumental Activities of Daily Living (IADL), Mobility Activities of Daily Living (MADL), age, gender, place of residence, race, education , need for proxy response to the survey, and number of medical conditi ons. RESULTS: Unadjusted analysis showed the presence of urinary incon tinence to be associated with poor self-rated health (OR 2.7, 2.1-3.3) . With gender, number of comorbid conditions, race, IADL impairment, a nd interaction terms of incontinence/race and incontinence/IADL in the final model, UI was associated with poor self-rated health in certain subgroups. White subjects with no IADL impairment and mild-moderate i ncontinence had an OR of 2.0 (95% CI 1.5-2.9) and those with severe in continence had an OR of 4.5 (95% CI 2.4-8.4) of rating their health as poor, whereas those with no IADL impairment and no incontinence were the referent group. For those with a lot of difficulty performing one or more IADL activity, the association of UI and poor self-rated healt h was weak. For: non-white subjects, there was no association, or a ve ry weak association, of UI and poor self-rated health. CONCLUSION: In this national sample, urinary incontinence was independently and posit ively associated with poor self-rated health after adjustment for age, comorbidity, and frailty for most community-dwelling older adults. Th is association between UI and poor self-rated health was weaker and st atistically insignificant when IP,DL impairment was present or in non- white subjects. Further research is indicated to better understand the impact of urinary incontinence in specific cultural settings.