Gosch M, Talasz H, Nicholas J A, Kammerlander C, Lechleitner M
Department of Internal Medicine 2, Geriatric Medicine, Klinikum Nürnberg, Paracelsus Private Medical University, Prof. Ernst-Nathan Strasse 1, 90419, Nuremberg, Germany,
Arch Orthop Trauma Surg. 2015 Jan;135(1):59-67. doi: 10.1007/s00402-014-2113-6. Epub 2014 Nov 16.
PURPOSE/INTRODUCTION: Urinary incontinence (UI) affects some 20 % of community-dwelling older people and 30-60 % of people in institutional care. UI is known as an independent predictor of falls, and likely impacts fracture rates. The aim of the study was to measure the prevalence of UI in a typical fragility fracture population, to evaluate the relationship of UI with functional disability in the post-acute setting.
Our study is a retrospective cross-sectional study of patients admitted to rehabilitation setting after inpatient hospital management for a fragility fracture. We included all consecutively admitted fragility fracture patients aged over 65. All patients underwent standard clinical examination and Geriatric Assessment. We assessed UI using a two-stage process with a six-item UI screening questionnaire followed by an interview.
1,857 (80.7 % female) patients were available for analysis, mean age was 81.7 years. UI was identified in 59.2 % of all fragility fracture patients, and was more prevalent in females. Patients suffering from UI differed significantly in almost all measured functional and cognitive tests, with increased dependency/lower ADL scores, increased rates of immobility, and higher rates of cognitive dysfunction and depression.
This study confirms the high prevalence of UI in older fragility fracture patients, and the association between UI and functional impairments. The diagnostic work-up and treatment of patients should be focused on the special needs of these older patients. More efforts are needed to increase awareness about prevalence and consequences of UI among older fragility fracture patients.
目的/引言：尿失禁（UI）影响着约20%的社区老年居民以及30%-60%的机构照护人群。尿失禁是跌倒的独立预测因素，且可能影响骨折发生率。本研究的目的是测量典型脆性骨折人群中尿失禁的患病率，评估急性后期环境中尿失禁与功能残疾之间的关系。
我们的研究是一项回顾性横断面研究，研究对象为因脆性骨折住院治疗后入住康复机构的患者。我们纳入了所有连续收治的65岁以上脆性骨折患者。所有患者均接受了标准临床检查和老年评估。我们采用两阶段流程评估尿失禁，首先使用包含六个条目的尿失禁筛查问卷，随后进行访谈。
1857名患者（80.7%为女性）可供分析，平均年龄为81.7岁。在所有脆性骨折患者中，59.2%被诊断为尿失禁，且在女性中更为普遍。患有尿失禁的患者在几乎所有测量的功能和认知测试中均存在显著差异，其依赖程度增加/日常生活活动能力得分降低、不动率增加、认知功能障碍和抑郁发生率更高。
本研究证实了老年脆性骨折患者中尿失禁的高患病率，以及尿失禁与功能损害之间的关联。患者的诊断检查和治疗应关注这些老年患者的特殊需求。需要做出更多努力，以提高老年脆性骨折患者对尿失禁患病率及其后果的认识。
