Association of fecal incontinence with physical disability and impaired cognitive function

Fecal incontinence is a common health problem for older people and is associated with significant morbidity and cost. In this study, we report on the association of fecal incontinence with physical disability and impaired cognitive function in a large bi-racial population of individuals aged 65 yr and older.

Study subjects are participants of the Chicago Health and Aging Project (CHAP), an ongoing study of older Chicago residents. A total of 6,099 participants completed the baseline in-home interview and assessments used in this analysis. Physical disability was assessed using a performance-based measure of basic physical functions and three commonly used self-report measures. Impaired cognitive function was assessed using a global measure of the averaged scores of four cognitive tests. The question used to determine the presence of fecal incontinence was: "In the past few months have you ever lost control of your bowels when you didn't want to?"

In multiple logistic regression models adjusted for age, sex, and race, fecal incontinence was correlated with the presence of physical disability and impaired cognitive function on every measure. For example, using the performance-based measure of physical function, the odds of prevalent fecal incontinence were higher by 20% (OR 1.20, 95% CI 1.2-1.2) for each additional unit higher on the performance score, indicating a lower physical performance. The prevalence odds ratio for fecal incontinence was decreased by 51% for each one-point increase in the global cognitive score, indicating higher cognitive function. We found a statistically significant interaction between both race and physical disability and race and impaired cognitive function, such that the associations were stronger in blacks than in non-blacks. These associations remained after further adjustment for diabetes and stroke, and the intake of psychoactive medications.

In urban, community-dwelling, older adults, fecal incontinence may be more common among persons with physical disability and impaired cognitive function.