In-hospital use of continence aids and new-onset urinary incontinence in adults aged 70 and older

OBJECTIVES: To describe the types of continence aids that older adults hospitalized in acute medical units use and to test the association between use of continence aids and development of new urinary incontinence (UI) at discharge. DESIGN: Prospective cohort study. SETTING: A 900-bed teaching hospital in Israel. PARTICIPANTS: Three hundred fifty-two acute medical patients aged 70 and older who were continent before admission. MEASUREMENTS: In-hospital use of continence aids was assessed according to participant self-report on use of urinary catheters (UCs) or adult diapers or of self-toileting. The development of new UI was defined as participant report of inability to control voiding at discharge. Multivariate analyses modeled the association between use of continence aids (vs self-toileting) and the development of new UI, controlling for baseline functional and cognitive status, disease severity, age, and length of stay. RESULTS: Of the 352 participants, 58 (16.5%) used adult diapers, and 27 (7.7%) had a UC during most of the hospital stay. Sixty (17.1%) participants developed new UI at discharge. The odds of developing new UI were 4.26 (95% confidence interval (CI)=1.53-11.83) times higher for UC users and 2.62 (95% CI=1.17-5.87) times higher for adult diaper users than for the self-toileting group, controlling for the above risk factors. CONCLUSION: The use of adult diapers and UCs during acute hospitalization is associated with the development of new UI at discharge. The management of continence in hospitalized older adults requires more diligence, and further investigation is needed to devise continence promotion methods in hospital settings.