Original study
Is Drug Therapy for Urinary Incontinence Used Optimally in Long-Term Care Facilities?

https://doi.org/10.1016/j.jamda.2006.07.004Get rights and content

Objectives

To examine the management of urinary incontinence (UI) among nursing home (NH) residents in the United States, particularly drug therapy for UI in those who may be suitable candidates for such treatment based on their functional status.

Design

Retrospective analysis of admissions (between January 2, 2002, and December 31, 2003) to a total of 373 skilled nursing facilities and assisted living centers operated by a single provider of long-term care.

Participants

Residents identified as incontinent according to at least one Minimum Data Set (MDS) assessment during their NH stay who had adequate mobility and/or cognitive ability to toilet, as determined by a toileting score of ≤2 on the 5-point MDS scale, and/or a score of ≤3 on the 7-point scale, the Cognitive Performance Score (CPS).

Measurements

MDS assessments for individual residents were obtained from a central database linked to a physician order database that captured the dose, frequency, and start and stop dates of all medications prescribed. Residents were stratified into treated or untreated groups according to whether or not they were prescribed medications used to treat UI (including tolterodine, oxybutynin [oral and transdermal patch formulations], desmopressin, and flavoxate).

Results

During the study period, there were 58,216 admissions to the 373 participating facilities; 31,219 (54%) were identified as incontinent of urine on the MDS. The study population comprised 25,140 NH residents who met MDS criteria for UI (80.5% of the total identified as incontinent of urine) and who had adequate mobility to toilet and/or did not have severe cognitive impairment. They were typically over 60 years of age (95.2%), female (65.1%), and frequently or completely incontinent (63.1%). Nonpharmacologic treatment (as recorded in the MDS) included pads/briefs (76.8%), scheduled toileting (31.9%), and/or bladder retraining (2.8%). Only 1752 (7.0%) of eligible residents received medication for their UI. Using a multivariate analysis, factors that were significantly associated with drug treatment for UI included female gender, frequent or complete urinary incontinence (MDS category 3–4), constipation, and use of incontinence appliances/programs and walking aids. Older residents and those with severe cognitive impairment were less likely to receive drug therapy.

Conclusions

Only a small proportion of incontinent NH residents with mobility and cognitive function potentially suitable for specific treatment for incontinence receives drug therapy for their condition. Further research is needed to determine whether low drug use reflects an unmet need for treating UI, or appropriate prescribing practices based on the multiple and interacting factors that influence decisions on drug therapy in the NH population.

Section snippets

Study Design and Population

This study was an observational retrospective database review of NH residents considered incontinent of urine according to at least one Minimum Data Set (MDS) assessment during their stay, and the study population evaluated in this paper comprises those who had adequate mobility and/or cognitive ability to toilet, as defined below under “Data Collection and Analysis.” The study used MDS assessments and physician prescription orders made between January 2, 2002, and December 31, 2003, for

Study Population

MDS criteria for UI were met by 31,219 (54%) of the 58,216 NH admissions studied between January 2, 2002, and December 31, 2003. Of those with some level of UI, 6079 (19.5%) had limitations in both mobility (MDS score >2) and cognitive function (CPS score >3), reducing their toileting ability and suitability for UI drug treatment, and were therefore excluded from further analysis. The study population comprised the remaining 25,140 NH residents who could be considered suitable candidates for

Discussion

In accordance with previous reports,19, 20, 21 the findings of this large retrospective study confirm that the prevalence of UI in US nursing homes is high, and that many NH residents (43.2% of all admissions and 80.5% of incontinent residents) may be suitable candidates for drug therapy, based on their toileting ability (mobility and/or cognitive function). However, only a small percentage of treatment candidates in this large sample (7.0% in Table 2) received prescription medications for

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    This work was supported by Novartis Pharmaceuticals Corporation. Preparation of the manuscript was supported by Novartis Pharma AG. Editorial and project management services were provided by ACUMED.

    1

    Professor Ouslander serves as a consultant and lecturer for Novartis Pharmaceuticals Corporation and has received educational grant support from this company. He has also served as an advisor and lecturer for Pfizer. At the time of this study Siva Narayanan was an employee of Beverly Enterprises.

    2

    Kristijan Kahler and Annamaria Cerulli are employees of Novartis Pharmaceuticals Corporation.

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