Prevalence of Fecal Incontinence in Older Adults: A Systematic Review and Meta-Analysis

Fecal incontinence (FI) is a prevalent yet often overlooked condition in older adults, significantly impacting both quality of life and health care systems. This study aimed to explore the pooled prevalence of FI among older adults.

Systematic review and meta-analysis.

Ninety-five studies involving 595,019 older adults across community, hospital, and long-term care settings.

A comprehensive literature search was conducted across 6 English and 4 Chinese databases. Two reviewers independently searched records and extracted data. A random-effects meta-analysis estimated pooled prevalence, 95% confidence intervals (CIs), 95% prediction intervals (PIs), and heterogeneity. Sources of heterogeneity were investigated via multivariable meta-regression and prespecified subgroup analyses (exploring region, population setting, case definition, frequency threshold, and mode of ascertainment). All statistical analyses used Stata 18.0.

The pooled prevalence of FI was 14.1% (95% CI, 11.7%-16.7%), but this masked extreme heterogeneity (I² = 99.86%, τ² = 0.125, P < .001; 95% PI, 7.6%-24.7%). Multivariable meta-regression identified long-term care settings [adjusted odds ratio (OR), 3.55] and Australia and Oceania (adjusted OR, 2.48) as significant predictors. The model explained only 23.22% of heterogeneity, leaving extreme residual variance (Residual I² = 99.72%), strongly suggesting methodological inconsistencies (eg, definitions, ascertainment methods) are the predominant drivers of heterogeneity.

FI affects approximately 1 in 7 older adults globally, with the greatest burden in long-term care settings. Extreme residual heterogeneity limits generalizability and is strongly suggestive of methodological inconsistencies as the predominant drivers. Improving detection and comparability necessitates harmonized case definitions (International Continence Society and International Urogynecological Association) and validated instruments (Fecal Incontinence Severity Index) in research. In clinical practice, particularly long-term care, a brief 2-step screening (eg, Bristol Stool Form, International Consultation on Incontinence Questionnaire-Bowel) at admission and regular reviews is advisable, with an electronic health record flag to trigger conservative bowel management and specialist referral as needed.