Urinary Tract Infections

McKnight’s had an interesting article about a new national study of urinary incontinence among assisted living residents and found that the condition is related to an increased probability of those residents being moved to a nursing home. Education for caregivers, residents, and their families, along with early detection and treatment, can increase the length of stay for these residents in assisted living.

The study, published in JAMDA: The Journal of the Post-Acute and Long-Term Care Medical Association, and the researchers from Memorial Sloan Kettering Cancer Center and the University of Rochester Medical Center, found that urinary incontinence is an “independent risk factor” for nursing home placement among assisted living residents, which increases the probability of a nursing home transfer to 14%.

This study was based on 2019-2021 Medicare data from 247,000 assisted living residents, 20.45% of whom had urinary incontinence. 15.7% of assisted living residents moved to a nursing home, 21.7% with urinary incontinence, and 14.2% without. When comparing those with and without urinary incontinence, those with urinary incontinence were slightly older, a part of the non-Hispanic white group, and were usually eligible for Medicare and Medicaid.

Among those white residents, there was a 1.93% increase in the probability of being relocated to a nursing home. Although the transfer percentage for those
in marginalized groups, black and Hispanic residents, there was an increased risk of urinary incontinence of 3.43% for black residents and 3.68% for Hispanic residents. Residents with urinary incontinence were more likely to experience comorbid chronic conditions compared to those without the urinary condition. Additionally, Alzheimer’s disease and related dementias were at 35.6% versus 18.4%, chronic heart failure at 33.7% versus 16.9%, pressure ulcers at 34.2% versus 12.1%, and depression at 56.2% versus 30%.

According to this study, urinary incontinence is very common among nursing home residents at 70%, where falls, pressure ulcers, social isolation, depression, and caregiver stress are common “adverse consequences” of urinary incontinence. This is also related to low levels of quality of life among nursing home residents and adding an “increased burden” on caregivers. Although assisted living facilities provide medical and health care services, because of differing
factors like low staffing levels and poor staff training, resources may be limited or scarce, which directly impacts the residents.

The study authors state, “Treatment options implemented in assisted living communities have the potential to change the trajectory of assisted living-to-nursing home placement for many residents with urinary incontinence, allowing them to age in place. Educating residents, family members and providers, and identifying and treating urinary incontinence early in the course of the disease may allow assisted living residents to avoid or delay nursing home placement.”