Urinary incontinence as a marker of higher mortality in home care patients

OBJECTIVE: To evaluate urinary incontinence (UI) as a predictor of nursing home admission, hospitalization or death in patients receiving home care services. SUBJECTS/PATIENTS AND METHODS: 699 community-dwelling participants receiving home care services in Geneva were evaluated in fall 2004 using the Minimal Data Set-Home Care, a validated instrument that includes grading of UI. Data on death, hospitalization, and nursing home admission were collected through June 2007. The impact of UI on time dependant outcomes was analysed using survival analysis and multivariate regression Cox models to adjust for age, gender, body mass index, cardiac failure, cognitive impairment, delirium, depression, disability, alcohol and tobacco use, self-rated health faecal incontinence and number of medications. RESULTS: UI was present in 193 participants (27.8%). After adjustment for confounding factors, UI was associated with longer hospital length of stay (+36.7 days, (CI95%: 1.2-72.3)) and greater mortality rate (HRa 1.6; CI95%: 1.1-2.6). Hazard ratio for death was 1.5 (CI95%:0.9-2.5) for participants complaining of one episode of urinary leakage per week at most, 2.0 (CI95%:1.2-3.5) for those presenting two or more episodes per week and 4.2 (CI95%:2.3-7.7; p for trend: <0.0001) for daily incontinence compared to continent participants. Institutionalization (HRa 1.1; CI95%: 0.6-2.2) and hospitalization rates (HRa 1.0; CI95%: 0.7-1.3) were not different between patients with or without UI. CONCLUSION: In a cohort of patients receiving home care services, UI is a strong predictor of length of hospitalization and mortality, increasing with UI severity