Changes in Urinary Continence After Admission to a Complex Care Setting: A Multistate Transition Model

Area of Science:

• Gerontology
• Urology
• Health Services Research

Background:

• Urinary incontinence (UI) is a significant issue for patients in post-acute care settings.
• Complex Continuing Care (CCC) hospitals manage patients with complex health needs, often involving long-term care requirements.

Purpose of the Study:

• To analyze changes in urinary continence status among CCC patients from admission to short-term follow-up.
• To identify patient characteristics associated with transitions in urinary continence states.

Main Methods:

• A retrospective cohort study utilized interRAI Minimum Data Set 2.0 and interRAI Resident Assessment Instrument Home Care data.
• A multistate transition model analyzed continence state changes (continent, sometimes continent, incontinent) in 27,896 adult patients admitted to CCC hospitals in Ontario, Canada (2009-2015).

Main Results:

• At admission, 42.6% of patients were incontinent, 34.3% continent, and 23.09% sometimes continent.
• Among continent patients at admission, 13.4% became incontinent by follow-up.
• Cognitive impairment, stroke, Parkinson's disease, Alzheimer's disease, and hip fracture were associated with continence state transitions.

Conclusions:

• Urinary incontinence is prevalent in CCC patients, with significant transitions in continence status observed.
• Standardized UI assessment is crucial for identifying patients needing intervention and for quality improvement in CCC settings.
• Patient-centered interventions informed by admission assessments can help manage UI and improve outcomes.