title: The association of fecal incontinence with institutionalization and mortality in older adults.
abstract: OBJECTIVE
  Fecal incontinence is a growing problem in the aging population. Little is known about the association of fecal incontinence with institutionalization and mortality in community-dwelling older adults. The aim of this study was to determine the prevalence of fecal incontinence among older adults in Canada and whether it is associated with increased risk of institutionalization and mortality, independent of the effect of potential confounders.
  
  
  METHODS
  This study consisted of a secondary analysis of data from 9,008 community-dwelling participants in the Canadian Study of Health and Aging, aged 65 years or older. The measures used in the study are age, gender, self-reported loss of bowel control, cognition, impairment in activities of daily living (ADL), and self-reported health. Outcomes were death or institutionalization over the 10 years of follow-up.
  
  
  RESULTS
  Fecal incontinence was found in 354 (4%) of the 8,917 subjects. Those with incontinence were older, with a mean age of 75.5 years, compared with 72.9 years in the continent group (P<0.001). Fecal incontinence was more common among women (4.7%) than among men (3.0 %), and among people who were single at the time of the study (4.9%) compared with those who lived with partners (3.3%). The prevalence of fecal incontinence in the Canadian population aged 65 years and above at the time of data collection was estimated to be 4%. Although mortality was significantly higher among those with fecal incontinence, independent of age, sex, cognition, and functional independence (hazard ratio 1.19; 95% confidence interval (CI): 1.00-1.41; P=0.05), this association was not statistically significant after adjusting for self-reported health. Although individuals with fecal incontinence had higher odds of institutionalization independent of age and sex (odds ratio 1.79, 95% CI: 1.00-3.20, P=0.05), this association was not statistically significant after adjusting for cognition, ADL dependence, and self-reported health.
  
  
  CONCLUSIONS
  Although fecal incontinence was associated with increased mortality and institutionalization, independent of age and gender, these associations were largely explained by other potential confounders such as poor self-assessed health, cognitive impairment, and ADL dependence.
authors.affiliation: Division of Gastroenterology, The University of Western Ontario, London Health Sciences Centre, Victoria Hospital , London, Ontario, Canada. talameel@uwo.ca
authors.forename: Turki
authors.initials: T
authors.lastname: AlAmeel
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Andrew
authors.forename: Chris
authors.initials: C
authors.lastname: MacKnight
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D003704:Dementia / Q000453:epidemiology; D005242:Fecal Incontinence / Q000150:complications* / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D007326:Institutionalization / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence; D012307:Risk Factors