Ouslander J G, Palmer M H, Rovner B W, German P S
Jewish Home for the Aging, Reseda, CA 91335.
J Am Geriatr Soc. 1993 Oct;41(10):1083-9. doi: 10.1111/j.1532-5415.1993.tb06456.x.
To determine the incidence and remission rates of daytime urinary incontinence (UI) in a cohort of newly admitted nursing home (NH) residents.
Prospective cohort study.
Eight proprietary NHs in Maryland.
Four hundred thirty new admissions age 65 or older who were participants in a larger prospective study of mental morbidity and adjustment to the NH.
Nurses aides' reports of continence status, psychiatric examinations, and nursing staff assessments of mobility at 2 weeks, 2 months, and 1 year after NH admission.
The prevalence of daytime UI at admission was 39% in both females and males. Among the 293 members (68%) of the admission cohort remaining in the NHs 2 months after admission, the incidence of daytime UI was 27% (21% in females, 51% in males); daytime UI resolved in 23% (24% in females, 20% in males). Among the 178 members (41%) of the admission cohort remaining in the NHs 1 year after admission, the incidence of daytime UI between 2 months and 1 year after admission was 19% (16% in females, 46% in males); daytime UI resolved in 22% (23% in females, 14% in males). The continence status of about two-thirds of residents remaining in the NH at 1 year after admission was stable over time: 22% had daytime UI, and 42% were continent at all three data collection points. The development of daytime UI was associated with male sex, the diagnosis of dementia, fecal incontinence, and the inability to ambulate or transfer independently. Resolution of daytime UI was associated with the absence of these characteristics.
Despite limitations attributable to the method of defining UI and potential biases related to the attrition of the admission cohort over time, this is the first large prospective study to examine the incidence and remission patterns of daytime UI among NH residents. The strong association between UI and dementia was validated for the first time by direct psychiatric examinations. Sex and mobility are also closely associated with the development and remission of UI in this setting. This study provides some valuable data that can be used to assess the impacts of the recently developed Resident Assessment Protocol for UI and Agency for Health Care Policy and Research Clinical Practice Guidelines.
确定一组新入住养老院（NH）居民的日间尿失禁（UI）发病率和缓解率。
前瞻性队列研究。
马里兰州的八家私立养老院。
430名65岁及以上的新入住者，他们参与了一项关于精神疾病和对养老院适应情况的大型前瞻性研究。
在入住养老院后2周、2个月和1年时，护士助理报告的尿失禁状况、精神科检查以及护理人员对活动能力的评估。
入院时，男性和女性的日间UI患病率均为39%。在入院2个月后仍留在养老院的293名（68%）入院队列成员中，日间UI的发病率为27%（女性为21%，男性为51%）；日间UI缓解的比例为23%（女性为24%，男性为20%）。在入院1年后仍留在养老院的178名（41%）入院队列成员中，入院后2个月至1年期间日间UI的发病率为19%（女性为16%，男性为46%）；日间UI缓解的比例为22%（女性为23%，男性为14%）。入院1年后仍留在养老院的约三分之二居民的尿失禁状况随时间保持稳定：22%有日间UI，42%在所有三个数据收集点均无尿失禁。日间UI的发生与男性、痴呆症诊断、大便失禁以及无法独立行走或转移有关。日间UI的缓解与不存在这些特征有关。
尽管由于定义UI的方法存在局限性以及入院队列随时间的损耗可能存在潜在偏差，但这是第一项大型前瞻性研究，旨在研究养老院居民日间UI的发病率和缓解模式。通过直接的精神科检查首次验证了UI与痴呆症之间的强关联。在这种情况下，性别和活动能力也与UI的发生和缓解密切相关。本研究提供了一些有价值的数据，可用于评估最近制定的《居民尿失禁评估协议》以及医疗保健政策与研究机构临床实践指南的影响。
