title: Potentially reversible risk factors and urinary incontinence in frail older people living in community.
abstract: BACKGROUND
  urinary incontinence is a common problem among older people living in different community settings. The multifactorial origin of urinary incontinence has been largely addressed and many previous studies have identified several reversible factors associated with incontinence. However, few data exist concerning the potentially reversible causes of this condition among frail community-dwelling older individuals.
  
  
  OBJECTIVE
  the aim of the present study is to estimate, in a large population of frail elderly people living in the community, the prevalence of urinary incontinence and to determine physical, social, and psychological factors associated with it.
  
  
  METHODS
  observational study.
  
  
  METHODS
  we analysed data from a large collaborative observational study group, the Italian Silver Network Home Care project, that collected data on patients admitted to home care programmes (n=5418). A total of 22 Home Health Agencies participated in this project evaluating the implementation of the Minimum Data Set for Home Care instrument. The main outcome measures were the prevalence and factors associated with urinary incontinence.
  
  
  RESULTS
  urinary incontinence was recorded in 51% of patients, and it was more common in women than men (52% versus 49%, respectively; P=0.01). After adjustment for each of the variables considered in this study, three potentially reversible factors were strongly associated with urinary incontinence: urinary tract infection (adjusted odds ratio, 3.46; 95% confidence interval, 2.65-4.51), use of physical restraints (adjusted odds ratio, 3.20; 95% confidence interval, 2.19-4.68), environmental barriers (adjusted odds ratio, 1.53; 95% confidence interval, 1.15-2.02). These associations were consistent in both men and women.
  
  
  CONCLUSIONS
  the major finding of our study is that potentially reversible factors were strongly and independently associated with urinary incontinence. Failure to make all reasonable efforts to assess and to treat all these factors among frail elderly people should be considered one of the most important indicators of poor quality of care.
authors.affiliation: Institute of Internal Medicine, Department of Gerontology-Geriatric and Physiatric, Catholic University of Sacred Heart, Largo Agostino Gemelli 8, I-00168 Rome, Italy. francesco_landi@m.unicatt.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Landi
authors.forename: Matteo
authors.initials: M
authors.lastname: Cesari
authors.forename: Andrea
authors.initials: A
authors.lastname: Russo
authors.forename: Graziano
authors.initials: G
authors.lastname: Onder
authors.forename: Fabrizia
authors.initials: F
authors.lastname: Lattanzio
authors.forename: Roberto
authors.initials: R
authors.lastname: Bernabei
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D011787:Quality of Health Care; D012111:Residence Characteristics; D012307:Risk Factors; D014549:Urinary Incontinence / Q000453:epidemiology*