Holroyd-Leduc Jayna M, Mehta Kala M, Covinsky Kenneth E
San Francisco VA Medical Center, San Francisco, California, USA.
J Am Geriatr Soc. 2004 May;52(5):712-8. doi: 10.1111/j.1532-5415.2004.52207.x.
To determine whether urinary incontinence (UI) is an independent predictor of death, nursing home admission, decline in activities of daily living (ADLs), or decline in instrumental activities of daily living (IADLs).
A population-based prospective cohort study from 1993 to 1995.
Community-dwelling within the United States.
Six thousand five hundred six of the 7,447 subjects aged 70 and older in the Asset and Health Dynamics Among the Oldest Old study who had complete information on continence status and did not require a proxy interview at baseline.
The predictor was UI, and the outcomes were death, nursing home admission, ADL decline, and IADL decline. Potential confounders considered were comorbid conditions, baseline function, sensory impairment, cognition, depressive symptoms, body mass index, smoking and alcohol, demographics, and socioeconomic status.
The prevalence of UI was 14.8% (18.5% in women; 8.5% in men). At 2-year follow-up, subjects incontinent at baseline were more likely to have died (10.9% vs 8.7%; unadjusted odds ratio (OR)=1.29, 95% confidence interval (CI)=1.02-1.64), be admitted to a nursing home (4.4% vs 2.6%, OR=1.77; 95% CI=1.18-2.63), and to have declined in ADL function (13.6% vs 8.1%; OR=1.78, 95% CI=1.36-2.33) and IADL function (21.2% vs 13.8%; OR 1.69, 95% CI 1.39-2.05). However, after adjusting for confounders, UI was not an independent predictor of death (adjusted OR (AOR)= 0.90, 95% CI=0.67-1.21), nursing home admission (AOR=1.33, 95% CI=0.86-2.04), or ADL decline (AOR=1.24, 95% CI=0.92-1.68). Incontinence remained a predictor of IADL decline (AOR=1.31; 95% CI=1.05-1.63), although adjustment markedly reduced the strength of this association.
Higher levels of baseline illness severity and functional impairment appear to mediate the relationship between UI and adverse outcomes. The results suggest that, although UI appears to be a marker of frailty in community-dwelling elderly, it is not a strong independent risk factor for death, nursing home admission, or functional decline.
确定尿失禁（UI）是否是死亡、入住养老院、日常生活活动能力（ADL）下降或工具性日常生活活动能力（IADL）下降的独立预测因素。
1993年至1995年基于人群的前瞻性队列研究。
美国境内的社区居住环境。
在“最年长者的资产与健康动态”研究中，7447名70岁及以上的受试者中有6506名，他们在尿失禁状态方面有完整信息，且在基线时不需要代理访谈。
预测因素为尿失禁，结局指标为死亡、入住养老院、ADL下降和IADL下降。考虑的潜在混杂因素包括共病情况、基线功能、感觉障碍、认知、抑郁症状、体重指数、吸烟和饮酒、人口统计学特征以及社会经济地位。
尿失禁的患病率为14.8%（女性为18.5%；男性为8.5%）。在2年随访时，基线时尿失禁的受试者更有可能死亡（10.9%对8.7%；未调整优势比（OR）=1.29，95%置信区间（CI）=1.02 - 1.64）、入住养老院（4.4%对2.6%，OR = 1.77；95% CI = 1.18 - 2.63），并且ADL功能下降（13.6%对8.1%；OR = 1.78，95% CI = 1.36 - 2.33）以及IADL功能下降（21.2%对13.8%；OR = 1.69，95% CI = 1.39 - 2.05）。然而，在对混杂因素进行调整后，尿失禁并非死亡（调整后OR（AOR）= 0.90，95% CI = 0.67 - 1.21）、入住养老院（AOR = 1.33，95% CI = 0.86 - 2.04）或ADL下降（AOR = 1.24，95% CI = 0.92 - 1.68）的独立预测因素。尿失禁仍然是IADL下降的预测因素（AOR = 1.31；95% CI = 1.05 - 1.63），尽管调整后显著降低了这种关联的强度。
较高水平的基线疾病严重程度和功能障碍似乎介导了尿失禁与不良结局之间的关系。结果表明，尽管尿失禁似乎是社区居住老年人虚弱的一个标志，但它并非死亡、入住养老院或功能下降的强大独立危险因素。
