Incidence and predictors of dual incontinence in older people with fecal incontinence admitted to a nursing home

Background: Older nursing home (NH) residents with fecal incontinence (FI) are considered at risk for developing dual (urinary+fecal) incontinence, but little is known about the time frame and predictors associated with its occurrence. 

Purpose: The purpose of this study was to determine the incidence and predictors of dual incontinence (DI) in older persons with FI only after admission to a NH.

Design: Prospective cohort design

Sample: 10,443 elderly with FI only (42% female, age=82(7) (mean(SD)) years, 82% White, 13% Black, 2% Asian, 2% Hispanic, and 0.5% American Indian) admitted to one of 437 proprietary NHs in 27 states.  

Methods: Minimum Data Set (MDS) v.2.0 records from years 2000-2002 were analyzed using Kaplan-Meier survival curves and Cox regression analyses.  Potential predictors of DI present at NH admission were demographic and 22 health status composite variables that were developed from individual MDS items using published scales whenever possible.

Results: Within 90 days of admission, 45% of NH residents with FI developed DI, and within one year, 72% had DI.  Significant predictors of DI when FI was already present were worse scores on the CHESS [mortality risk] (1.04 (1.004, 1.07)) (HR (95% CI) and MDS-COGS [cognition] (1.06 (1.05, 1.07)) scales and female gender (1.4 (1.3, 1.5)).  Black residents with FI were less likely to develop DI (0.90 (0.81, 0.99).

Conclusions: Knowing the characteristics of residents more likely to develop DI can direct interventions of WOC nurses in NHs to prevent DI. Older individuals admitted to a NH with FI who are female and have frail health or memory problems are at greatest risk for DI. Possible DI prevention interventions that address modifiable items constituting the CHESS and MDS-COGS scales are supporting overall health and functional status such as ADL performance and adequate nutrition and hydration.