Abstract

BackgroundSpecific knowledge of urinary incontinence (UI) and its interrelation with physical and cognitive health is essential to working towards prevention of UI and to improving quality of treatment and care. The purpose of this study was to determine the association between UI and the activities of daily living (ADL) hierarchy scale, the cognitive performance scale (CPS) and comorbid conditions.MethodsThe cross-sectional retrospective analysis of 357 nursing homes in Switzerland was based on data of the Minimum Data Set of the Resident Assessment Instrument 2.0 (RAI-MDS). The analysis examined the effect of ADL hierarchy scale, CPS, joint motion and comorbidities on UI. Women ≥65 years were included (n = 44’811; January 2005 to September 2014) at the time of admission to a nursing home. Statistical analysis was done by means of descriptive statistics and logistic regression analysis.ResultsThe prevalence of UI was 54.7%, the mean ADL hierarchy scale (± SD) 2.42 ± 3.26 (range = 0–6), the mean CPS 1.95 ± 1.67 (range = 0–6). There was a gradual increase in the odds ratio (OR) for UI depending on the ADL hierarchy scale, from the hierarchy scales of “supervised” to “total dependence” of 1.43 – 30.25. For CPS, the OR for UI from “borderline intact” to “very severe impairment” was 1.35 – 5.99. Considering the interaction between ADL and CPS, all ADL hierarchies remained significantly associated with UI, however for CPS this was the case only in the lower hierarchies. Of the 11 examined comorbid conditions, only diabetes mellitus (OR 1.19), dementia (OR 1.01) and arthrosis/arthritis (OR 1.53) were significantly associated with UI.ConclusionThe study indicated that impairment in ADL performance is strongly associated with UI, more than CPS performance and comorbidities. Physical more than cognitive training in order to improve or at least stabilize ADL performance could be a way to prevent or reduce the process of developing UI.

Highlights

  • Specific knowledge of urinary incontinence (UI) and its interrelation with physical and cognitive health is essential to working towards prevention of Urinary incontinence (UI) and to improving quality of treatment and care

  • The prevalence of UI increased with age, higher activities of daily living (ADL) dependency and more severe cognitive impairment (Table 1, Fig. 2), as well as with higher limitation in range of joint motion / more loss of voluntary movement and the number of comorbid conditions (Table 1)

  • Management of UI should focus on modification of risk factors among nursing home residents

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Summary

Introduction

Specific knowledge of urinary incontinence (UI) and its interrelation with physical and cognitive health is essential to working towards prevention of UI and to improving quality of treatment and care. The purpose of this study was to determine the association between UI and the activities of daily living (ADL) hierarchy scale, the cognitive performance scale (CPS) and comorbid conditions. Urinary incontinence (UI) has a profound impact on an affected woman’s life. It is associated with a significantly reduced health-related quality of life [1] and depression [2, 3]. Old people with UI are more dependent on professional services [4]. US$ 5.3 billion for institutionalized old people [6]. Studies which define UI as any involuntary leakage of urine showed a prevalence between 72 and 78% in women living in nursing homes [9]

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