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Purpose: To determine the incidence and predictors of dual incontinence (DI) in older persons with UI only after admission to a NH.
Design: Prospective cohort
Sample: 12,386 elderly with UI only (32% female, age=83(7) (mean(SD)) years, 90% white, 6% Black, 2% Asian, 1% Hispanic, and <1% American Indian) admitted to one of 443 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 developed from individual MDS items using published scales whenever possible.
Results: Within 90 days of admission, 30% of NH residents with UI developed DI, and within one year, 60% had DI. Predictors of DI were having more deficits in activities of daily living (ADLs) (1.04 (1.04, 1.05)) (HR (95%CI)), worse scores on the Charlson comorbidity (1.05 (1.02, 1.07), MDS-COGS [cognition] (1.08 (1.07, 1.09)), and Discomfort Behavior (1.006 (1.002, 1.009) scales, and Asian (1.4 (1.2, 1.7)) and Black (1.15, 1.02, 1.3)) ethnicities. Females were less likely to develop DI (0.82 (0.77, 0.88)) than males.
Conclusions: Knowing the characteristics of residents more likely to develop DI can direct interventions of WOC nurses in NHs to prevent DI. Residents are more likely to develop DI the longer they are in a NH. Residents with UI who develop DI have poor health and functional status and minority backgrounds. Possible prevention interventions for DI in residents with UI are improving ADL function, managing discomfort and related behaviors, assisting those with memory loss, and reducing complications from comorbidities.