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Predictors of urinary incontinence in community-dwelling frail older adults with diabetes mellitus in a cross-sectional study.

Hsu A, Conell-Price J, Stijacic Cenzer I, Eng C, Huang AJ, Rice-Trumble K, Lee SJ - BMC Geriatr (2014)

Bottom Line: We performed multivariate mixed effects logistic regression analysis with demographic (age, gender and ethnicity), geriatric (dependence on others for ambulation or transferring; cognitive impairment), diabetes-related factors (hemoglobin A1c level; use of insulin and other glucose-lowering medications; presence of renal, ophthalmologic, neurological and peripheral vascular complications), depressive symptoms and diuretic use.Geriatric factors included: dependence on others for ambulation (OR 1.48, 95% CI: 1.19-1.84) and transferring (OR 2.02, 95% CI: 1.58-2.58) and being cognitively impaired (OR 1.41, 95% CI: 1.15-1.73).Diabetes-related factors associated included use of insulin (OR 2.62, 95% CI: 1.67-4.13) and oral glucose-lowering agents (OR 1.81, 95% CI: 1.33-2.45).

View Article: PubMed Central - PubMed

Affiliation: VA Quality Scholars Fellow, Geriatrics and Extended Care, San Francisco VA Medical Center, 4150 Clement Street, 181G, San Francisco, CA 94122, USA. Amy.Hsu@ucsf.edu.

ABSTRACT

Background: Diabetes mellitus is a potent risk factor for urinary incontinence. Previous studies of incontinence in patients with diabetes have focused on younger, healthier patients. Our objective was to characterize risk factors for urinary incontinence among frail older adults with diabetes mellitus in a real-world clinical setting.

Methods: We performed a cross-sectional analysis on enrollees at On Lok (the original Program for All-Inclusive Care of the Elderly) between October 2004 and December 2010. Enrollees were community-dwelling, nursing home-eligible older adults with diabetes mellitus (N = 447). Our outcome was urinary incontinence measures (n = 2602) assessed every 6 months as "never incontinent", "seldom incontinent" (occurring less than once per week), or "often incontinent" (occurring more than once per week). Urinary incontinence was dichotomized ("never" versus "seldom" and "often" incontinent). We performed multivariate mixed effects logistic regression analysis with demographic (age, gender and ethnicity), geriatric (dependence on others for ambulation or transferring; cognitive impairment), diabetes-related factors (hemoglobin A1c level; use of insulin and other glucose-lowering medications; presence of renal, ophthalmologic, neurological and peripheral vascular complications), depressive symptoms and diuretic use.

Results: The majority of participants were 75 years or older (72%), Asian (65%) and female (66%). Demographic factors independently associated with incontinence included older age (OR for age >85, 3.13, 95% CI: 2.15-4.56; Reference: Age <75) and African American or other race (OR 2.12, 95% CI: 1.14-3.93; Reference: Asian). Geriatric factors included: dependence on others for ambulation (OR 1.48, 95% CI: 1.19-1.84) and transferring (OR 2.02, 95% CI: 1.58-2.58) and being cognitively impaired (OR 1.41, 95% CI: 1.15-1.73). Diabetes-related factors associated included use of insulin (OR 2.62, 95% CI: 1.67-4.13) and oral glucose-lowering agents (OR 1.81, 95% CI: 1.33-2.45). Urinary incontinence was not associated with gender, hemoglobin A1c level or depressive symptoms.

Conclusions: Geriatric factors such as the inability to ambulate or transfer independently are important predictors of urinary incontinence among frail older adults with diabetes mellitus. Clinicians should address mobility and cognitive impairment as much as diabetes-related factors in their assessment of urinary incontinence in this population.

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Related in: MedlinePlus

Inclusion and exclusion criteria for participants and measurements; ESRD = End-stage renal disease.
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Fig1: Inclusion and exclusion criteria for participants and measurements; ESRD = End-stage renal disease.

Mentions: We studied all On Lok enrollees diagnosed with diabetes mellitus between October 2004 and December 2010 (N = 447 participants with n = 2602 UI measurements). On Lok, the original model for Programs for All-inclusive Care for the Elderly (PACE), requires enrollees to be nursing home-eligible, indicating that the participant requires care with full-time supervision of a licensed nurse. On Lok helps nursing home-eligible enrollees remain in the community by providing and coordinating healthcare services, including primary and specialist physician services, adult day health care, home care, hospital care, post-acute rehabilitation care and custodial nursing home care. On Lok provides enrollees with transportation between home and PACE centers where meals, medication management, help with bathing or showering and recreational activities are provided. Further, On Lok centers have physical and occupational therapists, social workers, nurses and physicians on-site. Each enrollee receives a comprehensive health assessment (medical evaluation with assessment of function and geriatric syndromes) upon enrollment and every 6 months thereafter by physicians, nurses, therapists and social workers.Enrollees were eligible for our study if they were enrolled in On Lok during the study period and had a diagnosis of diabetes mellitus on a glucose lowering medication or a hemoglobin A1c (HbA1c) level greater than 6.5% (Figure 1). Diabetes diagnosis was determined according to the International Classification of Diseases, Ninth Revision (ICD-9) code, 250.xx.Figure 1


Predictors of urinary incontinence in community-dwelling frail older adults with diabetes mellitus in a cross-sectional study.

Hsu A, Conell-Price J, Stijacic Cenzer I, Eng C, Huang AJ, Rice-Trumble K, Lee SJ - BMC Geriatr (2014)

Inclusion and exclusion criteria for participants and measurements; ESRD = End-stage renal disease.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4274753&req=5

Fig1: Inclusion and exclusion criteria for participants and measurements; ESRD = End-stage renal disease.
Mentions: We studied all On Lok enrollees diagnosed with diabetes mellitus between October 2004 and December 2010 (N = 447 participants with n = 2602 UI measurements). On Lok, the original model for Programs for All-inclusive Care for the Elderly (PACE), requires enrollees to be nursing home-eligible, indicating that the participant requires care with full-time supervision of a licensed nurse. On Lok helps nursing home-eligible enrollees remain in the community by providing and coordinating healthcare services, including primary and specialist physician services, adult day health care, home care, hospital care, post-acute rehabilitation care and custodial nursing home care. On Lok provides enrollees with transportation between home and PACE centers where meals, medication management, help with bathing or showering and recreational activities are provided. Further, On Lok centers have physical and occupational therapists, social workers, nurses and physicians on-site. Each enrollee receives a comprehensive health assessment (medical evaluation with assessment of function and geriatric syndromes) upon enrollment and every 6 months thereafter by physicians, nurses, therapists and social workers.Enrollees were eligible for our study if they were enrolled in On Lok during the study period and had a diagnosis of diabetes mellitus on a glucose lowering medication or a hemoglobin A1c (HbA1c) level greater than 6.5% (Figure 1). Diabetes diagnosis was determined according to the International Classification of Diseases, Ninth Revision (ICD-9) code, 250.xx.Figure 1

Bottom Line: We performed multivariate mixed effects logistic regression analysis with demographic (age, gender and ethnicity), geriatric (dependence on others for ambulation or transferring; cognitive impairment), diabetes-related factors (hemoglobin A1c level; use of insulin and other glucose-lowering medications; presence of renal, ophthalmologic, neurological and peripheral vascular complications), depressive symptoms and diuretic use.Geriatric factors included: dependence on others for ambulation (OR 1.48, 95% CI: 1.19-1.84) and transferring (OR 2.02, 95% CI: 1.58-2.58) and being cognitively impaired (OR 1.41, 95% CI: 1.15-1.73).Diabetes-related factors associated included use of insulin (OR 2.62, 95% CI: 1.67-4.13) and oral glucose-lowering agents (OR 1.81, 95% CI: 1.33-2.45).

View Article: PubMed Central - PubMed

Affiliation: VA Quality Scholars Fellow, Geriatrics and Extended Care, San Francisco VA Medical Center, 4150 Clement Street, 181G, San Francisco, CA 94122, USA. Amy.Hsu@ucsf.edu.

ABSTRACT

Background: Diabetes mellitus is a potent risk factor for urinary incontinence. Previous studies of incontinence in patients with diabetes have focused on younger, healthier patients. Our objective was to characterize risk factors for urinary incontinence among frail older adults with diabetes mellitus in a real-world clinical setting.

Methods: We performed a cross-sectional analysis on enrollees at On Lok (the original Program for All-Inclusive Care of the Elderly) between October 2004 and December 2010. Enrollees were community-dwelling, nursing home-eligible older adults with diabetes mellitus (N = 447). Our outcome was urinary incontinence measures (n = 2602) assessed every 6 months as "never incontinent", "seldom incontinent" (occurring less than once per week), or "often incontinent" (occurring more than once per week). Urinary incontinence was dichotomized ("never" versus "seldom" and "often" incontinent). We performed multivariate mixed effects logistic regression analysis with demographic (age, gender and ethnicity), geriatric (dependence on others for ambulation or transferring; cognitive impairment), diabetes-related factors (hemoglobin A1c level; use of insulin and other glucose-lowering medications; presence of renal, ophthalmologic, neurological and peripheral vascular complications), depressive symptoms and diuretic use.

Results: The majority of participants were 75 years or older (72%), Asian (65%) and female (66%). Demographic factors independently associated with incontinence included older age (OR for age >85, 3.13, 95% CI: 2.15-4.56; Reference: Age <75) and African American or other race (OR 2.12, 95% CI: 1.14-3.93; Reference: Asian). Geriatric factors included: dependence on others for ambulation (OR 1.48, 95% CI: 1.19-1.84) and transferring (OR 2.02, 95% CI: 1.58-2.58) and being cognitively impaired (OR 1.41, 95% CI: 1.15-1.73). Diabetes-related factors associated included use of insulin (OR 2.62, 95% CI: 1.67-4.13) and oral glucose-lowering agents (OR 1.81, 95% CI: 1.33-2.45). Urinary incontinence was not associated with gender, hemoglobin A1c level or depressive symptoms.

Conclusions: Geriatric factors such as the inability to ambulate or transfer independently are important predictors of urinary incontinence among frail older adults with diabetes mellitus. Clinicians should address mobility and cognitive impairment as much as diabetes-related factors in their assessment of urinary incontinence in this population.

Show MeSH
Related in: MedlinePlus