Incontinence during and following hospitalisation: a prospective study of prevalence, incidence and association with clinical outcomes

Jill Campbell; Ruth Hubbard; Joan Ostaszkiewicz; Theresa Green; Fiona Coyer; Alison Mudge

doi:10.1093/ageing/afad181

Incontinence during and following hospitalisation: a prospective study of prevalence, incidence and association with clinical outcomes

Age Ageing. 2023 Sep 1;52(9):afad181. doi: 10.1093/ageing/afad181.

Authors

Jill Campbell¹, Ruth Hubbard^{2

3}, Joan Ostaszkiewicz^{4

5

6}, Theresa Green⁷, Fiona Coyer^{8

9

10}, Alison Mudge^{11

12}

Affiliations

¹ 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.
² Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Australia.
³ Geriatric Medicine Service, Princess Alexandra Hospital, Brisbane, Australia.
⁴ Aged Care Division, National Ageing Research Institute, Melbourne, Australia.
⁵ Health and Innovation Transformation Centre, Federation University, Ballarat, Australia.
⁶ Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
⁷ School of Nursing, Midwifery & Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia.
⁸ School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia.
⁹ School of Nursing, Queensland University of Technology, Brisbane, Australia.
¹⁰ Institute for Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK.
¹¹ Internal Medicine and Aged Care Department, Royal Brisbane and Women's Hospital, Brisbane, Australia.
¹² Greater Brisbane Clinical School, Faculty of Medicine, University of Queensland, Brisbane, Australia.

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.

Keywords: continence care; hospital-associated complications; incontinence; inpatients; older; older people.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Australia / epidemiology
Fecal Incontinence* / diagnosis
Fecal Incontinence* / epidemiology
Fecal Incontinence* / therapy
Female
Hospitalization
Hospitals, Public
Humans
Incidence
Male
Prevalence
Prospective Studies