School of Nursing, University of Minnesota, Minneapolis, Minnesota.
Division of Biostatistics, School of Public Health, Minneapolis, Minnesota.
Neurourol Urodyn. 2018 Jan;37(1):229-236. doi: 10.1002/nau.23279. Epub 2017 Apr 13.
There are few studies of nursing home residents that have investigated the development of dual incontinence, perhaps the most severe type of incontinence as both urinary and fecal incontinence occur. To determine the time to and predictors of dual incontinence in older nursing home residents.
Using a cohort design, records of older nursing home admissions who were continent or had only urinary or only fecal incontinence (n = 39,181) were followed forward for report of dual incontinence. Four national US datasets containing potential predictors at multiple levels describing characteristics of nursing home residents, nursing homes (n = 445), and socioeconomic and sociodemographic status of the community surrounding nursing homes were analyzed. A Cox proportional hazard regression with nursing home-specific random effect was used.
At 6 months after admission, 28% of nursing home residents developed dual incontinence, at 1 year 42% did so, and at 2 years, 61% had dual incontinence. Significant predictors for time to developing dual incontinence were having urinary incontinence, greater functional or cognitive deficits, more comorbidities, older age, and lesser quality of nursing home care.
The development of dual incontinence is a major problem among nursing home residents. Predictors in this study offer guidance in developing interventions to prevent and reduce the time to developing this problem which may improve the quality of life of nursing residents.
很少有研究调查养老院居民双重失禁的发展情况，因为双重失禁是最严重的失禁类型，同时存在尿失禁和粪失禁。本研究旨在确定老年养老院居民发生双重失禁的时间和预测因素。
本研究采用队列设计，对 39181 名处于尿失禁或仅存在尿失禁或仅存在粪失禁状态的老年养老院入院患者的记录进行前瞻性随访，以报告双重失禁的发生情况。分析了包含 4 个美国全国数据集，这些数据集描述了养老院居民、养老院（n=445）以及养老院周围社区的社会经济和社会人口统计学特征的多个层次的潜在预测因素。采用具有养老院特定随机效应的 Cox 比例风险回归。
在入院后 6 个月时，28%的养老院居民出现双重失禁，在 1 年时为 42%，在 2 年时为 61%。发生双重失禁的时间的显著预测因素包括存在尿失禁、更大的功能或认知缺陷、更多的合并症、更大的年龄和较差的养老院护理质量。
双重失禁是养老院居民的一个主要问题。本研究中的预测因素为制定干预措施提供了指导，以预防和减少发生这种问题的时间，从而提高养老院居民的生活质量。
