Predicting continence decline in institutionalized older people: A longitudinal analysis

Aims To verify the incidence of urinary continence decline and the probability of maintaining urinary continence, as well as identify the prognostic factors of urinary continence decline in institutionalized older people. Methods A 2‐year longitudinal study (with five 6‐month waves) was conducted with subjects ≥60 years old who lived in 10 nursing homes in the city of Natal‐RN (Brazil). Urinary incontinence was assessed by the Minimum Data Set version 3.0. Sociodemographic, institution‐related and health‐related variables were considered to establish the baseline. Time‐dependent variables included cognitive decline, functional decline, and incidences of falls, hospitalizations, and fractures during the period. The actuarial method, the log‐rank test, and Cox’s regression were applied as statistical methods. Results Among the cohort of 196 older adults, 105 (53.6%) individuals maintained the continence status during the period, 21 (10.7%) improved it at one or more assessments, and 76 (38.8%) subjects declined. The cumulative probability of maintaining continence status was 82.6% (confidence interval [CI], 95%: 76.5%‐87.3%), 74.7% (CI, 95%: 67.8%‐80.4%), 66.9% (CI, 95%: 59.4%‐73.2%), and 49.3% (CI, 95%: 40.1%‐57.9%) at 6, 12, 18, and 24 months, respectively. Predicting factors for continence decline were: disability (hazard ratio [HR] = 4.03; P