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Campbell J, Hubbard R, Ostaszkiewicz J, Green T, Coyer F, Mudge A. Incontinence during and following hospitalisation: a prospective study of prevalence, incidence and association with clinical outcomes. Age Ageing 2023; 52:afad181. [PMID: 37738169 PMCID: PMC10516354 DOI: 10.1093/ageing/afad181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Incontinence is common in hospitalised older adults but few studies report new incidence during or following hospitalisation. OBJECTIVE To describe prevalence and incidence of incontinence in older inpatients and associations with clinical outcomes. DESIGN Secondary analysis of prospectively collected data from consecutive consenting inpatients age 65 years and older on medical and surgical wards in four Australian public hospitals. METHODS Participants self-reported urinary and faecal incontinence 2 weeks prior to admission, at hospital discharge and 30 days after discharge as part of comprehensive assessment by a trained research assistant. Outcomes were length of stay, facility discharge, 30-day readmission and 6-month mortality. RESULTS Analysis included 970 participants (mean age 76.7 years, 48.9% female). Urinary and/or faecal incontinence was self-reported in 310/970 (32.0%, [95% confidence interval (CI) 29.0-35.0]) participants 2 weeks before admission, 201/834 (24.1% [95% CI 21.2-27.2]) at discharge and 193/776 (24.9% [95% CI 21.9-28.1]) 30 days after discharge. Continence patterns were dynamic within the peri-hospital period. Of participants without pre-hospital incontinence, 74/567 (13.1% [95% CI 10.4-16.1) reported incontinence at discharge and 85/537 (15.8% [95% CI 12.8-19.2]) reported incontinence at 30 days follow-up. Median hospital stay was longer in participants with pre-hospital incontinence (7 vs. 6 days, P = 0.02) even in adjusted analyses and pre-hospital incontinence was significantly associated with mortality in unadjusted but not adjusted analyses. CONCLUSION Pre-hospital, hospital-acquired and new post-hospital incontinence are common in older inpatients. Better understanding of incontinence patterns may help target interventions to reduce this complication.
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Affiliation(s)
- Jill Campbell
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Australia
| | - Ruth Hubbard
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Geriatric Medicine Service, Princess Alexandra Hospital, Brisbane, Australia
| | - Joan Ostaszkiewicz
- Aged Care Division, National Ageing Research Institute, Melbourne, Australia
- Health and Innovation Transformation Centre, Federation University, Ballarat, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Theresa Green
- School of Nursing, Midwifery & Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Fiona Coyer
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Australia
- Institute for Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| | - Alison Mudge
- Internal Medicine and Aged Care Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Greater Brisbane Clinical School, Faculty of Medicine, University of Queensland, Brisbane, Australia
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Koloms K, Cox J, VanGilder CA, Edsberg LE. Incontinence Management and Pressure Injury Rates in US Acute Care Hospitals: Analysis of Data From the 2018-2019 International Pressure Injury Prevalence™ (IPUP) Survey. J Wound Ostomy Continence Nurs 2022; 49:405-415. [PMID: 36108224 PMCID: PMC9592164 DOI: 10.1097/won.0000000000000905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to identify and describe the prevalence of incontinence (urinary and/or fecal) and incontinence management practices among patients in US adult acute care settings, with and without hospital-acquired pressure injuries (HAPIs), using the data from the 2018/2019 International Pressure Ulcer Prevalence™ (IPUP) survey. DESIGN Observational, cohort study with cross-sectional data collection and retrospective data analysis. SUBJECTS AND SETTING The sample comprised 296,014 patients hospitalized in 1801 acute care facilities in the United States that participated in 2018 and/or 2019 IPUP survey. Of these, 192,852 (65%) patients had information recorded in the survey on incontinence status and were included in the analytical sample. METHODS Data from the 2018/2019 IPUP database were analyzed to evaluate the prevalence of incontinence (urinary [UI], fecal [FI], and dual [DI]), and the use of incontinence and moisture management strategies. Incontinence prevalence was analyzed between 3 groups of patients: (1) those without pressure injuries; (2) patients with stage 1 and 2 HAPIs; and (3) those with severe HAPIs (stage 3, 4, unstageable, deep tissue pressure injury). Analysis of the subgroups within acute care was also undertaken and included medical-surgical, critical care, and step-down units. RESULTS Incontinent patients were older (mean age 69-74 years depending on type of incontinence as compared to 62 years for continent patients) and had lower Braden Scale scores (range, 14.7-16.7, compared to 19.4 for continent patients). Half of the patients were female, 49.6% male, and 0.4% were unknown. Incontinence was identified in 32% of patients. Among patients with incontinence, 33% had UI, 12% had FI, and 55% had DI. Hospital-acquired pressure injuries were present in 27.4% of continent patients and 72.6% of incontinent patients, with DI having the highest rate of HAPIs. Analysis revealed a higher proportion of incontinent patients with unstageable HAPIs than continent patients (14.9% vs 9.6%, P = .00), as well as a higher proportion of incontinent patients with deep tissue HAPIs as compared to continent patients (27.0% vs 22.1%, P = .00). Significantly more incontinent patients regardless of HAPI status were using a bowel or bladder management system (P = .00). CONCLUSION Results of this study support the importance of incontinence as a risk factor in HAPI development. The prevalence of all types of incontinence was 31.7% for the entire sample. Almost three-fourths (72.6%) of patients with HAPI had UF, FI, or DI. A standardized definition of both UI and FI is needed, given that over 70% of all critical care unit patients with a urinary catheter for incontinence management were still classified as urinary incontinent.
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Affiliation(s)
- Kimberly Koloms
- Correspondence: Kimberly Koloms, MS, Hillrom Inc, now a Baxter company, Deerfield, IL 60015 ()
| | - Jill Cox
- Kimberly Koloms, MS, Hillrom Inc, now a Baxter company, Deerfield, Illinois
- Jill Cox PhD, RN, APN-c, CWOCN, FAAN, Clinical Professor, Rutgers University School of Nursing, Newark, New Jersey/WOC Advanced Practice Nurse Englewood Health, Englewood, New Jersey
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
- Laura E Edsberg, PhD, Professor Natural Sciences, Center for Wound Healing Research, Natural & Health Sciences Research Center, Daemen University, Amherst, New York
| | - Catherine A. VanGilder
- Kimberly Koloms, MS, Hillrom Inc, now a Baxter company, Deerfield, Illinois
- Jill Cox PhD, RN, APN-c, CWOCN, FAAN, Clinical Professor, Rutgers University School of Nursing, Newark, New Jersey/WOC Advanced Practice Nurse Englewood Health, Englewood, New Jersey
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
- Laura E Edsberg, PhD, Professor Natural Sciences, Center for Wound Healing Research, Natural & Health Sciences Research Center, Daemen University, Amherst, New York
| | - Laura E. Edsberg
- Kimberly Koloms, MS, Hillrom Inc, now a Baxter company, Deerfield, Illinois
- Jill Cox PhD, RN, APN-c, CWOCN, FAAN, Clinical Professor, Rutgers University School of Nursing, Newark, New Jersey/WOC Advanced Practice Nurse Englewood Health, Englewood, New Jersey
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
- Laura E Edsberg, PhD, Professor Natural Sciences, Center for Wound Healing Research, Natural & Health Sciences Research Center, Daemen University, Amherst, New York
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Savas S, Saka B, Akın S, Tasci I, Tasar PT, Tufan A, Yavuzer H, Balci C, Sezgin G, Karan MA. The prevalence and risk factors for urinary incontinence among inpatients, a multicenter study from Turkey. Arch Gerontol Geriatr 2020; 90:104122. [PMID: 32610211 DOI: 10.1016/j.archger.2020.104122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the prevalence and the factors associated with urinary incontinence (UI) among inpatients in Turkey. METHOD The population of this study comprised of patients screened by the "National Prevalence Measurement of Quality of Care (LPZ)" study in 2017 and 2018. Age, gender, comorbidities, length of hospital stay, sedative medications, SARC-F score, anthropometric measurements, and care parameters such as malnutrition, falls, UI-fecal incontinence (FI), restraints, and care dependency score (CDS) were noted. The LPZ questionnaire was performed by trained researchers, and multiple logistic regression analysis was performed to determine the factors associated with UI. RESULTS The prevalence of UI was 29.4 % among 1176 inpatients, and 41.6 % in patients ≥65 years. Urinary incontinence was associated with older age (OR, 1.966, 95 % CI 1.330-2.905), female sex (OR, 2.055, 95 % CI 1.393-3.030), CDS (OR, 3.236, 95 % CI 2.080-5.035), the number of comorbidities (OR, 1.312, 95 % CI 1.106-1.556), end-of life management (OR, 3.156, 95 % CI 1.412-7.052), sedative medications (OR, 1.981, 95 % CI 1.230-3.191), and FI (OR, 12.533, 95 % CI 4.892-32.112) in all adults, where CDS (OR, 2.589, 95% CI 1.458-4.599), end-of life management (OR, 2.851, 95 % CI 1.095-7.424), sedative medications (OR, 2.529, 95 % CI 1.406-4.548), and FI (OR, 13.138, 95 % CI 4.352-39.661) were associated with UI among geriatric patients. CONCLUSIONS The factors associated with UI in geriatric and all adult inpatients are CDS, sedative medications, end-of life management, and FI plus older age, female sex, and comorbidities for the latter. The factors associated with UI vary in different age groups.
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Affiliation(s)
- Sumru Savas
- Division of Geriatrics, Department of Internal Medicine, School of Medicine, Ege University, Izmir, Turkey.
| | - Bülent Saka
- Division of Geriatrics, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sibel Akın
- Division of Geriatrics, Department of Internal Medicine, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Ilker Tasci
- Gulhane Medical School & Gulhane Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Pinar Tosun Tasar
- Department of Internal Medicine, School of Medicine, Atatürk University, Erzurum, Turkey
| | - Asli Tufan
- Division of Geriatrics, Department of Internal Medicine, School of Medicine, Marmara University, Istanbul, Turkey
| | - Hakan Yavuzer
- Division of Geriatrics, Department of Internal Medicine, School of Medicine, Cerrahpaşa University, Istanbul, Turkey
| | - Cafer Balci
- Division of Geriatrics, Department of Internal Medicine, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Gülbüz Sezgin
- Division of Geriatrics, Department of Internal Medicine, School of Medicine, Maltepe University, Istanbul, Turkey
| | - Mehmet Akif Karan
- Division of Geriatrics, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Condon M, Mannion E, Molloy DW, O'Caoimh R. Urinary and Faecal Incontinence: Point Prevalence and Predictors in a University Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E194. [PMID: 30641927 PMCID: PMC6352131 DOI: 10.3390/ijerph16020194] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 01/06/2019] [Accepted: 01/08/2019] [Indexed: 01/20/2023]
Abstract
Incontinence is common and associated with adverse outcomes. There are insufficient point prevalence data for incontinence in hospitals. We evaluated the prevalence of urinary (UI) and faecal incontinence (FI) and their predictors among inpatients in an acute university hospital on a single day. Continence status was recorded using the modified Barthel Index (BI). Baseline characteristics, Clinical Frailty Scale (CFS) and ward type were recorded. In all, 435 patients were assessed, median age 72 ± 23 years and 53% were male. The median CFS score was 5 ± 3. The point prevalence of UI was 26% versus 11% for FI. While UI and FI increased with age, to 35.2% and 21.1% respectively for those ≥85, age was not an independent predictor. Incontinence also increased with frailty; CFS scores were independently associated with both UI (p = 0.006) and FI (p = 0.03), though baseline continence status was the strongest predictor. Patients on orthopaedic wards had the highest prevalence of incontinence. Continence assessments were available for only 11 (2%) patients. UI and FI are common conditions affecting inpatients; point prevalence increases with age and frailty status. Despite this, few patients receive comprehensive continence assessments. More awareness of its high prevalence is required to ensure incontinence is adequately managed in hospitals.
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Affiliation(s)
- Marie Condon
- Frailty Service, Department of Geriatric and Stroke Medicine, University Hospital Galway, Newcastle Rd, Galway City H91 YR71, Ireland.
- Physiotherapy Department, Cork University Hospital, Wilton, Cork City T12 DC4A, Ireland.
| | - Edel Mannion
- Frailty Service, Department of Geriatric and Stroke Medicine, University Hospital Galway, Newcastle Rd, Galway City H91 YR71, Ireland.
| | - D William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas road, Cork City T12 XH60, Ireland.
| | - Rónán O'Caoimh
- Frailty Service, Department of Geriatric and Stroke Medicine, University Hospital Galway, Newcastle Rd, Galway City H91 YR71, Ireland.
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas road, Cork City T12 XH60, Ireland.
- Clinical Research Facility Galway, National University of Ireland, Galway, Costello Rd, Galway City H91 V4AY, Ireland.
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The prevalence of fecal incontinence and associated risk factors in older adults participating in the SABE study. Neurourol Urodyn 2015; 35:959-964. [DOI: 10.1002/nau.22836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 07/01/2015] [Indexed: 12/17/2022]
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