Chassagne P, Landrin I, Neveu C, Czernichow P, Bouaniche M, Doucet J, Denis P, Bercoff E
Département de Gérontologie Clinique, Centre Hospitalier et Universitaire de Rouen, France.
Am J Med. 1999 Feb;106(2):185-90. doi: 10.1016/s0002-9343(98)00407-0.
This study was conducted to evaluate the incidence, identify the risk factors, and assess the prognosis of elderly institutionalized patients who develop fecal incontinence.
We enrolled 1,186 patients 60 years of age and older living in long-term care facilities who did not have fecal incontinence. We assessed their medical history, treatment, mobility, and cognitive function. Patients were followed up for 10 months to determine the incidence of fecal incontinence, defined as at least one involuntary loss of feces. Independent risk factors associated with fecal incontinence were identified using Cox proportional hazards models. The prognosis of incontinent patients was assessed by comparing their survival rate with that in the continent patients.
Fecal incontinence occurred in 234 patients (20%), and was usually associated with acute diarrhea or fecal impaction. We identified five risk factors for the development of fecal incontinence: a history of urinary incontinence (rate ratio [RR]: 2.0, 95% confidence interval [CI] 1.5 to 2.6); neurological disease (RR: 1.9, 95% CI 1.0 to 3.4); poor mobility (RR: 1.7, 95% CI 1.2 to 2.4); severe cognitive decline (RR: 1.4, 95% CI 1.1 to 1.9); and age older than 70 years (RR: 1.7, 95% CI 1.0 to 2.8). Ten-month mortality in the 89 patients with long-term (> or = 8 days) incontinence was 26%, significantly greater than that observed in the continent group (6.7%) or in the 145 patients with transient incontinence (10%).
Long-lasting or permanent fecal incontinence was associated with increased mortality, suggesting that this symptom is a marker of poor health in older patients. Actions that improve mobility might help prevent fecal incontinence in elderly patients.
本研究旨在评估老年机构化患者发生大便失禁的发生率，确定危险因素，并评估其预后。
我们纳入了1186名居住在长期护理机构、年龄在60岁及以上且无大便失禁的患者。我们评估了他们的病史、治疗情况、活动能力和认知功能。对患者进行了10个月的随访，以确定大便失禁的发生率，大便失禁定义为至少有一次非自愿的粪便失禁。使用Cox比例风险模型确定与大便失禁相关的独立危险因素。通过比较失禁患者与大便正常患者的生存率来评估失禁患者的预后。
234名患者（20%）发生了大便失禁，且通常与急性腹泻或粪便嵌塞有关。我们确定了大便失禁发生的五个危险因素：尿失禁病史（率比[RR]：2.0，95%置信区间[CI] 1.5至2.6）；神经系统疾病（RR：1.9，95%CI 1.0至3.4）；活动能力差（RR：1.7，95%CI 1.2至2.4）；严重认知功能下降（RR：1.4，95%CI 1.1至1.9）；以及年龄大于70岁（RR：1.7，95%CI 1.0至2.8）。89名长期（≥8天）失禁患者的10个月死亡率为26%，显著高于大便正常组（6.7%）或145名短暂性失禁患者（10%）。
长期或永久性大便失禁与死亡率增加有关，这表明该症状是老年患者健康状况不佳的一个标志。改善活动能力的措施可能有助于预防老年患者的大便失禁。
