127Frailty as a Predictor of New Onset Urinary Incontinence Among Hospitalised Adults

Abstract

Background: Incontinence is a common geriatric syndrome. Reflecting its relationship with physical and cognitive impairment, urinary incontinence (UI) is associated with increased risk of adverse healthcare outcomes including falls, mortality and costs. However, little is known about how frailty and UI are associated among hospitalised adults. The objectives of this study were to evaluate the point prevalence of UI and examine the relationship between UI and frailty among inpatients. Methods: Consecutive inpatients (≥18) in a large university hospital were assessed on one day in August 2017. Patients were assessed for their pre-admission and current continence, function using the Barthel Index (BI), and frailty status according to the Clinical Frailty Scale (CFS). Baseline characteristics and the Charlson Co-morbidity Index (CCI) were also recorded. Binary logistic regression was used to examine independent variables. Results: In all, 435 patients were included, median age 72 ± 23 years; 53% were male. Twenty-five percent were frail at baseline (CFS ≥5). The prevalence of UI was 10% preadmission and 26% on inpatient review (X2 = 33.898, p < 0.001). Those with new onset UI (n = 68/390) were more likely to be older (z = -3.3, p = 0.001), have a higher CCI (z = -2.1, p = 0.038), have a known cognitive impairment (X2 = 7.8, p = 0.005), lower BI scores (z = -4.5, p < 0.001), greater length of stay on review (p = 0.008) and be more frail at baseline (median CFS at baseline of 4/9 vs 3/9, z = -4, p < 0.001) than those without known UI. Frailty (CFS) predicted new UI (odds ratio 1.44, p < 0.001) and was a statistically significant independent predictor of its onset (X2(1) = 17.9, p < 0.001). Conclusion: This study highlights a significant increase in UI associated with hospital admission. While onset of UI is associated with older age, functional and cognitive impairment, baseline frailty status is independently associated with 44% greater odds of new UI after admission. More focus on identifying frailty on admission may help identify those likely to develop UI and its related adverse outcomes.