Original studyIs Drug Therapy for Urinary Incontinence Used Optimally in Long-Term Care Facilities?
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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Cited by (17)
Restorative medicine in the aging genitourinary system
2022, Beauty, Aging and AntiAgingOutcomes of Sacral Neuromodulation for Overactive Bladder in Octogenarian Females
2015, Urology PracticeCitation Excerpt :However, elderly patients continue to be under treated with intolerance of antimuscarinic side effects and polypharmacy as contributing factors.5 In a study of incontinent but mobile and cognitively capable nursing home residents only 7% received antimuscarinics.7 With an aging population an increase in the number of elderly patients with refractory OAB will likely be seen.14
Efficacy of oral extended-release oxybutynin in cognitively impaired older nursing home residents with urge urinary incontinence: A randomized placebo-controlled trial
2011, Journal of the American Medical Directors AssociationCitation Excerpt :In a post hoc stratified exploratory analysis, the median percent change from baseline and between group differences in median percent change in urinary incontinent episodes, urinary frequency, and total dryness between those with adequate mobility and/or cognitive function to toilet, ie, physical function score on the Minimum Data Set (MDS)15 2.0 of 0, 1, or 2, and/or an MMSE score of 15 or higher (approximates the previously used Cognitive Performance Scale [CPS] score of ≤3 on a scale of 0 to 6 for these criteria)16 were compared with individuals with a low physical function score on the MDS 2.0 of 3 to 4 and an MMSE of less than 15.6 This stratification, different from that used for study randomization to achieve similar between-group severity of cognitive function between the groups for analyzing the primary end point of between-group difference in change in mean Confusion Assessment Method for cognitive change, was chosen based on a previous study that used cognitive and physical function parameters to identify potentially suitable nursing home residents for antimuscarinic drug therapy.6 In the stratified analysis, the Wilcoxon rank-sum test was used to test for differences in median percent change from baseline in urinary incontinence and urinary frequency, both between treatment groups within each cognitive and physical function stratum and between strata within each treatment group.
Medical Care in the Nursing Home
2011, Medical Clinics of North AmericaClinical Practice Guidelines, Process Improvement Teams, and Performance on a Quality Indicator for Urinary Incontinence: A Pilot Study
2008, Journal of the American Medical Directors AssociationCitation Excerpt :Second, the prevalence of pharmacotherapy for urinary incontinence in our study (7.2% to 7.9%) is consistent with other reports. Descriptive, cross-sectional 2002 to 2003 MDS database analyses of almost 30,000 nursing facility residents reported that 7.0% to 8.7% of incontinent residents were receiving pharmacotherapy.23,24 Third, the prevalence of PITs for UI in this cohort of 34 nursing facilities (12/34 or 35%) is consistent with survey findings in a national study of 942 physicians, nurses practitioners, nurses, and nursing assistants in which the prevalence of UI PITs was estimated to be 32%.11
Urinary incontinence in the elderly
2022, Female Urinary Incontinence
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.