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  • Title: Frailty Predicts Incident Urinary Incontinence Among Hospitalized Older Adults-A 1-Year Prospective Cohort Study.
    Author: Chong E, Chan M, Lim WS, Ding YY.
    Journal: J Am Med Dir Assoc; 2018 May; 19(5):422-427. PubMed ID: 29439853.
    Abstract:
    OBJECTIVES: The relationship between frailty and urinary incontinence (UI) remains highly complex. There is limited data on the impact of frailty on new-onset UI among hospitalized older adults. Thus, we examined the ability of frailty to predict incident UI among them. DESIGN: Prospective cohort study. SETTING: Acute geriatric unit at a large teaching hospital. PARTICIPANTS: Older adults hospitalized for an acute medical illness. MEASUREMENTS: Premorbid frailty was defined as having 3 of 5 items, namely fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL scale). Data on demographics, comorbidities, severity of illness, and functional status were gathered. Premorbid UI and UI at discharge and 6 and 12 months after hospitalization were identified. Logistic regression analysis was performed to examine how well frailty predicted incident UI at discharge and at 6 and 12 months following hospitalization. The independent predictive value of UI on mortality was also examined. RESULTS: Among 210 participants (mean age 89.4 ± 4.6 years; 69.5% female; 50.0% frail), UI was present in 47.6%, with a higher prevalence among frail individuals (64.8% vs 30.5%, P < .001). Incident UI was more common in frail participants (at discharge: 24.3% vs 9.6%, P = .038; 6 months: 43.2% vs 21.7%, P = .020; and 12 months: 56.8% vs 33.3%, P = .020). Death among UI patients increased over time following hospitalization (at discharge: 6.0% vs 1.8%, P = .114; 6 months: 32.0% vs 9.1%, P < .001; and 12 months: 42.0% vs 13.6%, P < .001). Premorbid UI independently predicted mortality [6 months: odds ratio (OR) 3.10, 95% confidence interval (CI) 1.34-7.17, P = .008; 12 months: OR 3.41, 95% CI 1.59-7.32, P = .002], adjusting for age, sex, severity of illness, and frailty. Frailty predicted incident UI and/or death over time (at discharge: OR 2.98, 95% CI 1.00-8.91, P = .050; 6 months: OR 2.86, 95% CI 1.13-7.24, P = .027; 12 months: OR 2.67, 95% CI 1.13-6.27, P = .025), adjusting for age, sex, and severity of illness. CONCLUSION: Frailty is associated with UI, and predicts incident UI and/or death, even up to 12 months following hospitalization. Hence, greater emphasis should be given to identifying and managing UI during hospitalization and after discharge, especially among frail older adults.
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