Fecal Incontinence Is Associated With Mortality Among Older Adults With Complex Needs: An Observational Cohort Study

Jamieson HA1,2, Schluter PJ3,4, Pyun J1, Arnold T5, Scrase R6, Nisbet-Abey R1, Mor V7, Deely JM1,6, Gray L8. Am J Gastroenterol. 2017 Aug 1. doi: 10.1038/ajg.2017.200. [Epub ahead of print]
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1 Department of Medicine, University of Otago-Christchurch, Christchurch, New Zealand. 2 Older Persons Inpatient Health Services, Burwood Hospital, Christchurch, New Zealand. 3 Department of Health Sciences, University of Canterbury, Christchurch, New Zealand. 4 School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Queensland, Australia. 5 Department of Surgery, University of Otago-Christchurch, Christchurch, New Zealand. 6 Canterbury District Health Board, Christchurch, New Zealand. 7 Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island, USA. 8 Academic Unit of Geriatric Medicine, University of Queensland, Brisbane, Queensland, Australia.


OBJECTIVES: Fecal incontinence (FI) is a problem in growing older populations. Validating a suspected association between FI and mortality in community dwelling older adults could lead to improved planning for and management of the increasing complex older population. In a large cohort of New Zealand older adults, we assessed the prevalence of FI, urinary incontinence (UI), combined FI and UI, and their associations with mortality.

METHODS: This study consisted of a retrospective analysis of international standardized geriatric assessment-home care (InterRAI-HC) data from community-dwelling adults aged 65 years or older, who met the criteria required for the InterRAI-HC, having complex needs and being under consideration for residential care. The prevalence of UI and FI was analyzed. Data were adjusted for demography and 25 confounding factors. Mortality was the primary outcome measure.

RESULTS: The total cohort consisted of 41,932 older adults. Both UI and FI were associated with mortality (P<0.001), and risk of mortality increased with increased frequency of incontinence. In the adjusted model, FI remained significantly related to survival (P<0.001), whereas UI did not (P=0.31). Increased frequency of FI was associated with an increased likelihood of death (hazard ratio 1.28).

CONCLUSIONS: This large national study is the first study to prove a statistically significant relationship between FI and mortality in a large, old and functionally impaired community. These findings will help improve the management of increasingly complex older populations.

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