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Incontinence alone does not increase risk of death or nursing home admission but is probably a marker of frailty

Urinary incontinence (UI) among community-dwelling elderly people does not, by itself, lead to functional dependency, nursing home admission, or death. Rather, it appears to be a marker of frailty. Although previous studies have found that people with UI have a higher risk of death, greater illness severity in people with UI explains this association, according to researchers at the San Francisco VA Medical Center and the University of California, San Francisco. In a study that was supported in part by the Agency for Healthcare Research and Quality (K02 HS00006), they examined the relationship between UI and other factors, such as coexisting medical conditions, on death, nursing home admission, and decline in functioning among 6,506 people aged 70 years and older.

The overall prevalence of UI at baseline was 15 percent. At 2-year followup, patients incontinent at baseline were 29 percent more likely than continent patients to have died (10.9 percent vs. 8.7 percent), 77 percent more likely to have been admitted to a nursing home (4.4 vs. 2.6 percent), 78 percent more likely to have declined in the ability to perform activities of daily living such as bathing and dressing (13.6 vs. 8.1 percent), and 69 percent more likely to have declined in the ability to perform other daily activities such as shopping or paying bills (21.2 vs. 13.8 percent). However, after adjusting for confounding factors—such as coexisting medical problems, baseline function, cognition, body mass index, smoking, alcohol, demographics, and socioeconomic status—UI was not an independent predictor of any of these outcomes.

See "Urinary incontinence and its association with death, nursing home admission, and functional decline," by Jayna M. Holroyd-Leduc, M.D., Kala M. Mehta, D.Sc., and Kenneth E. Covinsky, M.D., M.P.H., in the May 2004 Journal of the American Geriatrics Society 52, pp. 712-718.

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