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One-fifth of older women hospitalized for hip fracture become incontinent while in the hospital

One in six U.S. women experiences a hip fracture at some point, and 21 percent of older women hospitalized for hip fracture develop hospital-acquired incontinence, finds a study supported in part by the Agency for Healthcare Research and Quality (HS07322). Women with certain characteristics are at a higher risk than others for developing incontinence while in the hospital, according to the researchers who conducted the study.

They analyzed medical records of 6,516 women (aged 60 years and older) admitted to hospitals in four States for hip fracture from 1983 to 1993. They measured incontinence at discharge, cognitive and functional status, and severity of illness, and obtained demographic information.

Overall, 21 percent of women became incontinent (urinary, fecal, or both) during hospitalization and were incontinent at discharge. After adjustment for factors that might affect continence, such as age, race, malnutrition, coexisting illness, and severity of illness, women admitted to the hospital from a nursing home or other long-term care facility were nearly twice as likely to develop incontinence during hospitalization as other women. Perhaps these women had relied on caregivers to maintain continence through assistance with using the toilet or prompted voiding schedules, a level of support not available in the hospital.

Women who were confused, used a wheelchair or device for walking, and were dependent on others for walking prior to their fracture also were more likely than other women to develop hospital-acquired incontinence. Educating hospital staff about these risk factors may help reduce the incidence of hospital-acquired incontinence among this vulnerable population. Also, providing bedside commodes, urinals especially designed for women, medications to reduce instability of the bladder's detrusor muscle, and urinary and bowel regimens may help prevent or minimize hospital-acquired incontinence.

See "Risk factors for hospital-acquired incontinence in elderly female hip fracture patients," by Mary H. Palmer, Ph.D., Mona Baumgarten, Ph.D., Patrician Langenberg, Ph.D., and Jeffrey L. Carson, M.D., in the October 2002 Journal of Gerontology: Medical Sciences 57A(10), pp. M672-M677.

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