Login to Access Video or Poster Abstract: MP31-10
Sources of Funding: Department of Health and Human Services Centers for Medicare & Medicaid Services Grant #1C1CMS331006

Introduction

The etiology of and disease burden associated with incontinence in the elderly is multifactorial. We aimed to investigate the association between health literacy and cognition and urinary incontinence in a geriatric inpatient population transitioning to a skilled nursing facility (SNF).

Methods

Health literacy, depression and cognition were assessed via the Brief Health Literacy Screen (BHLS), Geriatric Depression Scale 5-item (GDS) and Brief Interview for Mental Status (BIMS), respectively. Multivariate logistic regression controlling for demographic and clinical factors was performed to determine the association between BHLS score and incontinence by: 1) nursing report of urinary incontinence during hospitalization and 2) patient self-reported “bladder accidents� in the post-enrollment study interview.

Results

1556 hospitalized patients aged 65 and older met inclusion criteria, of whom 922 (59.3%) were women and 1480 had available BHLS scores. 464/1556 (29.8%) patients had urinary incontinence by nursing report and 515 (33.1%) by patient report. On average, incontinent patients by nursing report were older (p<0.001) and had higher GDS scores (p<0.001), fewer years of education (p=0.034) and lower BHLS (8.8 vs. 10.9, p<0.001) and BIMS scores (12.2 vs. 13.6, p<0.001) relative to continent patients. On multivariate analysis, nursing-reported incontinence was significantly associated with lower BHLS (i.e. poorer health literacy) (OR 0.93, 95% CI 0.89-0.99) and BIMS (i.e. poorer cognition) (OR 0.90, 95% CI 0.83-0.97) total scores and need for assistance with toileting (OR 7.08, 95% CI 2.16-23.21). Patient-reported incontinence was significantly associated with female sex (OR 1.62, 95% CI 1.19-2.21), increased GDS score (i.e. greater likelihood of depression) (OR 1.22, 95% CI 1.10-1.36) and need for assistance with toileting (OR 2.46, 95% CI 1.26-4.79). Nursing and patient-reported incontinence were discordant in 25.8% of patients.

Conclusions

Poorer health literacy and cognition are independently associated with an increased likelihood of nursing-reported urinary incontinence among geriatric inpatients transitioning to a SNF. Practitioners should consider routine assessment of health literacy and cognition in frail patients at risk for urinary incontinence and consider that both patient and nursing assessment may be required to capture the diagnosis.

Funding

Department of Health and Human Services Centers for Medicare & Medicaid Services Grant #1C1CMS331006