Prevalence of urinary and faecal incontinence in hospitals and residential and nursing homes for older people

Subjects, methods, and results

In November 1990 a census of all people aged 65 years and over in long term care was carried out in Leicestershire.4 Data were collected on health, dependency, and the use of continence aids. Residents experiencing at least one incontinent episode weekly were defined as being incontinent of urine or faeces. Physical dependency was determined by a modified dependency measure used previously in Leicestershire.5 An additive score was derived from ratings of mobility (four point scale of 0-3), washing/dressing (three point scale of 0-2), and feeding (three point scale of 0-2), with higher scores indicating greater dependency. Our measure of physical dependency excluded ratings for urinary and faecal incontinence since these were the variables of interest for comparison. A score of 4 and over was taken to indicate high dependency in line with our modification to the measure devised by Clarke et al.5

There were 6079 residents in 241 residential or nursing homes and hospitals whose mean age was 82.7 years (SD 7.8; range 65-109 years), and 79% of whom were women. Data for incontinence were recorded for 95% of residents (5758). Forty four per cent were incontinent of urine or faeces, or both (table). The remainder were continent, of whom 7% required prompting and 1% wore a continence pad as a precaution. Incontinence was associated with physical dependency in each type of home (Kruskal-Wallis test, P<0.001). For example, 67% of the incontinent in all homes had high physical dependency compared with only 18% of the fully continent. Forty nine per cent of incontinent people used continence pads or pants, 15% were catheterised, and 36% used no continence pads or pants (table). The use of continence aids among incontinent residents differed significantly between home type χ², P<0.001).

Comment

The census showed a higher prevalence of urinary incontinence in residents of homes than among older people in the community.3 About two thirds of people in psychogeriatric or geriatric wards and private nursing homes were incontinent of urine, which concurred with earlier findings.2 Around one third of residents in local authority and private residential homes were incontinent of urine, which also agreed with earlier work.1

These findings, which covered the whole range of long term care settings, showed a substantial overlap of incontinence and physical dependency between nursing and residential care. More acute and geriatric patients were catheterised which, although in some cases would have been for the management of an acute illness, could also indicate some inappropriate usage.

In conclusion, the high prevalence of urinary, faecal, and double incontinence and the widely divergent use of aids in different settings indicates the need for greater specialist attention for these problems and their management.

We thank the continence advisers and geriatricians who participated in fieldwork for the study and all the staff and residents who participated in the survey for their help.