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Risk Factors for Hospital-Acquired Incontinence in Elderly Female Hip Fracture Patients

^a School of Nursing, University of North Carolina, Chapel Hill
^b Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore
^c Division of General Internal Medicine, UMDNJ—Robert Wood Johnson Medical School, New Brunswick, NJ

Mary H. Palmer, University of North Carolina Chapel Hill, Carrington Hall, CB#7460, Chapel Hill, NC 27599 E-mail: mhpalmer{at}email.unc.edu.

Background. The objective of this study was to estimate the incidence of, and identify risk factors for, incontinence in female hip fracture patients. The study was a secondary analysis of data abstracted from medical records in hospitals in Pennsylvania, Texas, New Jersey, and Virginia.

Methods. The study included women aged 60 years and older who were admitted to one of the study hospitals with hip fracture. Measurements included incontinence at discharge as recorded in the medical records, demographic information, cognitive and functional status, and two measures of severity of illness (Charlson Comorbidity Index and Sickness at Admission Scale score).

Results. Data from 6516 women were analyzed. Twenty-one percent (n = 1365) became incontinent during hospitalization. After adjusting for confounders (i.e., age, race, malnutrition, comorbidity, and severity of illness), admission from a nursing home or other long-term care facility (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.29–2.19), confusion (OR 3.44, 95% CI 2.79–4.24), use of a wheelchair or device for walking (OR 1.53, 95% CI 1.29–1.83), and prefracture dependence on others for ambulation (OR 2.51, 95% CI 1.64–3.85) significantly increased the odds of developing incontinence during hospitalization.

Conclusion. Hospital-acquired incontinence affects 21% of female hip fracture patients. Certain easily identifiable patient characteristics place female hip fracture patients at high risk. Interventions to increase staff awareness of this vulnerable population need to be tested to minimize the incidence of hospital-acquired incontinence.

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