Effect of urinary incontinence on older nursing home residents' self-reported quality of life

Abstract

Objectives: To evaluate the effect of urinary incontinence (UI) on elderly nursing home (NH) residents' self-reported quality of life (QOL), especially on the specific QOL domains most closely associated with UI.

Design: Retrospective cross-sectional study using the Minimum Data Set (MDS) and Minnesota Nursing Home Report Card data in 2010 to compare overall QOL and its domains of residents with and without UI using propensity scores and inverse probability weighting (IPW) adjustments to reduce selection bias.

Setting: All Medicare- or Medicaid-licensed NHs in Minnesota.

Participants: All residents aged 65 and older except those with conditions that could readily overwhelm the effect of UI on QOL, such as coma and cerebral palsy.

Measurements: Urinary incontinence (UI) was defined as leakage two or more times a week (score ≥ 2 on MDS 5-point scale), and continence was defined as continent or usually continent (score 0 or 1 on MDS 5-point scale). QOL was assessed using a self-reported QOL questionnaire that measured general QOL, not QOL specific to UI symptoms.

Results: Urinary incontinence (UI) prevalence was 65.8% in 10,683 older NH residents. Self-reported QOL was good (>0.7 on a scale from 0 to 1) in 8,620 eligible residents in 371 NHs. Mood and meaningful activity domains had lower scores; dignity had the highest score. UI was associated with being older and female, ADL dependence, impaired cognitive ability, Alzheimer's disease, non-Alzheimer's dementia, bowel incontinence, diabetes mellitus, and long-term NH stay. Bivariate analysis found that residents with UI had lower QOL than those without. Using IPW to reduce selection bias, it was found that, although UI was not associated with overall QOL, it decreased the QOL domains of dignity, autonomy, and mood.

Conclusion: To improve the QOL of residents with UI, attention should be paid to dignity, autonomy, and mood.

Keywords: inverse probability weighting; nursing homes; quality of life; urinary incontinence.