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Symposia

Urinary Incontinence in Elderly Female Hip Surgery Patients
Mona Baumgarten, Ph.D.
School of Medicine, University of Maryland, Baltimore

Urinary incontinence is a common problem among the elderly in the community, in hospitals, and in nursing home settings. Among community-dwelling older adults, the prevalence of urinary incontinence in women is twice as high as in men. The cost of caring for persons of all ages with incontinence in the U.S. is more than $15 billion per year. Yet, incontinence is often undetected or unreported in health care settings.

In 1990 in North America, more than 300,000 people aged 65 and over experienced a hip fracture. The risk of hip fracture in almost twice as high in women as in men and about 75% of hip fracture patients are women. Because of the number of elderly female patients admitted to hospitals for hip surgery is high, improvements that result in a decreased frequency of complications (such as urinary incontinence) could result in a significant decrease in patient suffering and in the costs associated with acute and postacute care.

The aims of this research are to estimate the incidence of hospital-acquired urinary incontinence among elderly women undergoing hip surgery, to identify risk factors for hospital-acquired urinary incontinence, and to develop a predictive model relating patient characteristics to individual patients' risk of hospital-acquired urinary incontinence. The study will involve the secondary analysis of data collected in the course of a retrospective cohort study on surgical blood transfusion. The study included patients aged 60 and older who underwent surgical repair of a fractured hip at any one of 20 hospitals between 1983 and 1993. The participating hospitals included university, community, and Veterans Administration medical centers and were located in New Jersey, Pennsylvania, Virginia, and Texas. Information on incontinence and other clinical and demographic characteristics were abstracted from the medical record by trained study personnel using a standardized, pretested form. A total of 9,598 patients were included in the blood transfusion study. We estimate that there are 6,564 women in the data set who did not have incontinence at admission who will be available for the proposed analysis. The following factors will be considered: body mass index, age, cognitive status, functional status, ability to transfer and walk, use of in-dwelling urinary catheter, and urinary tract infections. The cumulative incidence of hospital-acquired incontinence will be defined as the number of patients with incontinence at discharge divided by the number of patients who had no incontinence at admission. Following exploratory analyses using univariate techniques, multiple logistic regression will be used to quantify the association between each of the risk factors and urinary incontinence, while controlling form all the other risk factors. Finally, logistic regression will be used for Aim 3, which involves the creation of a simple but clinically meaningful algorithm, based on patient characteristics, that can be used to estimate the incontinence risk of the individual elderly patients admitted to hospitals for surgical repair of hip fracture.

Among hip fracture patients, women outnumber men by a ration of three to one. Furthermore, urinary incontinence is twice as prevalent in women as in men. Thus, urinary incontinence in hospitalized hip fracture patients is a problem that affects women disproportionately. The results of the proposed study will help in the development of effective methods of preventing and treating urinary incontinence in the acute care setting after hip surgery. This study, therefore, has the potential to have a significant impact on the health of elderly women undergoing surgery for hip fractures.