Jamieson Hamish A, Schluter Philip J, Pyun Juno, Arnold Ted, Scrase Richard, Nisbet-Abey Rebecca, Mor Vincent, Deely Joanne M, Gray Len
Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand.
Older Persons Inpatient Health Services, Burwood Hospital, Christchurch, New Zealand.
Am J Gastroenterol. 2017 Sep;112(9):1431-1437. doi: 10.1038/ajg.2017.200. Epub 2017 Aug 1.
Fecal incontinence (FI) is a problem in growing older populations. Validating a suspected association between FI and mortality in community dwelling older adults could lead to improved planning for and management of the increasing complex older population. In a large cohort of New Zealand older adults, we assessed the prevalence of FI, urinary incontinence (UI), combined FI and UI, and their associations with mortality.
This study consisted of a retrospective analysis of international standardized geriatric assessment-home care (InterRAI-HC) data from community-dwelling adults aged 65 years or older, who met the criteria required for the InterRAI-HC, having complex needs and being under consideration for residential care. The prevalence of UI and FI was analyzed. Data were adjusted for demography and 25 confounding factors. Mortality was the primary outcome measure.
The total cohort consisted of 41,932 older adults. Both UI and FI were associated with mortality (P<0.001), and risk of mortality increased with increased frequency of incontinence. In the adjusted model, FI remained significantly related to survival (P<0.001), whereas UI did not (P=0.31). Increased frequency of FI was associated with an increased likelihood of death (hazard ratio 1.28).
This large national study is the first study to prove a statistically significant relationship between FI and mortality in a large, old and functionally impaired community. These findings will help improve the management of increasingly complex older populations.
大便失禁（FI）是老年人群面临的一个问题。验证社区居住的老年人中FI与死亡率之间的疑似关联，可能有助于更好地规划和管理日益复杂的老年人群。在一大群新西兰老年人中，我们评估了FI、尿失禁（UI）、FI合并UI的患病率，以及它们与死亡率的关联。
本研究包括对国际标准化老年评估家庭护理（InterRAI-HC）数据的回顾性分析，这些数据来自65岁及以上的社区居住成年人，他们符合InterRAI-HC的要求标准，有复杂需求且正在考虑接受机构护理。分析了UI和FI的患病率。数据针对人口统计学和25个混杂因素进行了调整。死亡率是主要结局指标。
总队列包括41932名老年人。UI和FI均与死亡率相关（P<0.001），且失禁频率增加，死亡风险也增加。在调整模型中，FI仍与生存率显著相关（P<0.001），而UI则不然（P=0.31）。FI频率增加与死亡可能性增加相关（风险比1.28）。
这项大型全国性研究是第一项在大型、老龄且功能受损的社区中证明FI与死亡率之间存在统计学显著关系的研究。这些发现将有助于改善对日益复杂的老年人群的管理。
