A Multi-Level Analysis of Risk Factors of New Onset of Urinary Incontinence in Korean Long-Term Care Hospitals

Monday, July 11, 2011: 1:45 PM

Ju Young Yoon, MS, RN1
Ji Yun Lee, PhD, RN2
Barbara J. Bowers, RN, PhD, FAAN1
(1)School of Nursing, University of Wisconsin-Madison, Madison, WI
(2)Department of Nursing, Hoseo University, Asan, South Korea

Learning Objective 1: The learner will be able to state what risk factors are associated with new onset of urinary incontinence in long-term care settings.

Learning Objective 2: The learner will be able to understand the application of multi-level analysis when the data is nested within higher organizational level.

Purpose: Research indicates that urinary incontinence (UI) incurs high costs and increasing care dependency in long-term care settings; however, many studies have focused only on UI prevalence and management rather than prevention. As a proactive approach to UI, it is necessary to identify risk factors to develop prevention strategies of UI incidence. The purpose of this study is to identify risk factors associated with new onset of UI at the organizational level as well as at the patient-level in Korean long-term care hospitals (LTCHs).

Methods: The study population was older patients over 65 years of age without UI when they were admitted in April 2008 and who had resided in the LTCH for over three months. The final analyzed data included 1,044 patients in 345 LTCHs. Data were from monthly LTCH patient assessment reports and hospital information obtained from the Korean Health Insurance Review and Assessment Services. A multilevel logistic regression was used for analysis.

Results: Incidence rate of UI over three months was 30%. For the first model using only patient-level risk factors, limited physical function, impaired cognitive function, delirium, and older age at admission were significant risk factors increasing the probability of the new onset UI within three months. For the second model, organizational factors were added to the patient-level factors. Four patient risk factors were still significant, but no organizational factors (e.g., ownership, nursing staff level, and registered nurse ratio) were significant despite the increased model fit.

Conclusion: This study identified several risk factors that affect the development of new onset UI. The findings show that UI incidence was influenced mostly by patient risk factors at admission. Thus, identifying risk factors for new onset of UI may provide important information to develop UI prevention strategies to decrease the burden of UI in older adults in LTC settings.