Abstract
Objectives
The relationship between frailty and urinary incontinence (UI) remains highly complex.
There is limited data on the impact of frailty on new-onset UI among hospitalized
older adults. Thus, we examined the ability of frailty to predict incident UI among
them.
Design
Prospective cohort study.
Setting
Acute geriatric unit at a large teaching hospital.
Participants
Older adults hospitalized for an acute medical illness.
Measurements
Premorbid frailty was defined as having 3 of 5 items, namely fatigue, resistance,
ambulation, illnesses, and loss of weight (FRAIL scale). Data on demographics, comorbidities,
severity of illness, and functional status were gathered. Premorbid UI and UI at discharge
and 6 and 12 months after hospitalization were identified. Logistic regression analysis
was performed to examine how well frailty predicted incident UI at discharge and at
6 and 12 months following hospitalization. The independent predictive value of UI
on mortality was also examined.
Results
Among 210 participants (mean age 89.4 ± 4.6 years; 69.5% female; 50.0% frail), UI
was present in 47.6%, with a higher prevalence among frail individuals (64.8% vs 30.5%,
P < .001). Incident UI was more common in frail participants (at discharge: 24.3% vs
9.6%, P = .038; 6 months: 43.2% vs 21.7%, P = .020; and 12 months: 56.8% vs 33.3%, P = .020). Death among UI patients increased over time following hospitalization (at
discharge: 6.0% vs 1.8%, P = .114; 6 months: 32.0% vs 9.1%, P < .001; and 12 months: 42.0% vs 13.6%, P < .001). Premorbid UI independently predicted mortality [6 months: odds ratio (OR)
3.10, 95% confidence interval (CI) 1.34-7.17, P = .008; 12 months: OR 3.41, 95% CI 1.59-7.32, P = .002], adjusting for age, sex, severity of illness, and frailty. Frailty predicted
incident UI and/or death over time (at discharge: OR 2.98, 95% CI 1.00-8.91, P = .050; 6 months: OR 2.86, 95% CI 1.13-7.24, P = .027; 12 months: OR 2.67, 95% CI 1.13-6.27, P = .025), adjusting for age, sex, and severity of illness.
Conclusion
Frailty is associated with UI, and predicts incident UI and/or death, even up to 12 months
following hospitalization. Hence, greater emphasis should be given to identifying
and managing UI during hospitalization and after discharge, especially among frail
older adults.
Keywords
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Article info
Publication history
Published online: February 10, 2018
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
