Epidemiology of Faecal Incontinence for People with Dementia Living in the Community in New Zealand: A Retrospective Cohort Study Using interRAI Home Care Assessment Data

doi:10.21203/rs.3.rs-3450254/v1

Download PDF

Research Article

Epidemiology of Faecal Incontinence for People with Dementia Living in the Community in New Zealand: A Retrospective Cohort Study Using interRAI Home Care Assessment Data

https://doi.org/10.21203/rs.3.rs-3450254/v1

This work is licensed under a CC BY 4.0 License

Journal Publication

published 10 Jun, 2024

Read the published version in Gerontology →

Version 1

posted

You are reading this latest preprint version

BACKGROUND

Globally there are few studies but wide variation in epidemiology of faecal incontinence (FI) for people living with dementia in the community. Our objectives are to identify 1-year period prevalence, 5-year incidence, and risks for faecal incontinence (FI) for people living with dementia.

METHODS

A retrospective cohort study comprising International Residential Assessment Instrument Home Care version (interRAI-HC) assessments in a 5-year period in New Zealand (N = 109964). For prevalence analysis, we selected a dementia cohort for a 1-year period from 1 Aug 2020 to 31 July 2021 (n = 7775). For the incidence analysis, participants in the dementia cohort were followed up from the day of the first dementia diagnosis during the period 1 Aug 2016 and 31 July 2021. Dementia was identified by combining diagnosis of “Alzheimer's disease” and “Dementia other than Alzheimer's disease”. Participants were coded with faecal incontinence if they were continent with a stoma, seldom incontinent, occasionally incontinent, often incontinent and incontinent.

RESULTS

1 year period (1 Aug 2020-31 July 2021) prevalence of FI was 26.7% (2082/7775) of PLWD. 5-year incident FI rate was 19.0 per 100 person years for PLWD and 12.3 per 100 person years for people without dementia. Controlling for risk factors for FI in both groups the hazard ratio for FI was 1.7 for PLWD.

CONCLUSIONS

FI affects a significant proportion of people with dementia in NZ. interRAI-HC data could facilitate global epidemiological studies to estimate service or intervention need for people with dementia to redress or manage FI.

Geriatrics & Gerontology

Māori

Pacific

toilet use

activities of daily living

prevalence

incidence

dementia

There were an estimated 69713 people living with dementia in New Zealand in 2020. It is anticipated that this number will increase to 167483 by 2050, including 12030 Māori (Indigenous people of New Zealand).¹ More than 50 million people live with dementia worldwide; and its prevalence will increase to 152 million in 2050.² Dementia has frequently been described in terms of its global financial burden³ with the costs primarily falling on families rather than health or long term care sectors.^4,5 Providing unpaid support and care for a person living with dementia in the community can be rewarding, however, there are also often negative effects which are referred to as caregiver burden.⁶ Major risks for increased caregiver burden are declines in functional status and independence in basic activities of daily living (ADL) of the care-recipient living with dementia.⁶

Caregivers have rated independent toilet use as the most important ADL for the person living with dementia to retain.⁷ Caregivers supporting a person with incontinence (the involuntary loss of urine or faecal matter⁸) experience greater burdens than caregivers who do not manage incontinence.⁸ Incontinence and dementia can be stigmatizing, affecting self-image and quality of life ^9,10 and distressing for people living with dementia and their caregivers. People with dementia have greater rates of entry into residential care than older people without dementia and incontinence is a significant predictor of admission to residential care within this population.¹¹ Together this evidence suggests that interventions that help caregivers promote continence or manage incontinence may reduce the financial and social costs associated with dementia, by delaying entry into residential care and/or relieving caregiver stress associated with managing continence issues for people living with dementia in the community. Despite potential gains, a recent critical review noted a dearth of research in this field.¹²

FI is a particularly debilitating condition for which older people are often reluctant to seek help.^13,14 There are few studies that have estimated prevalence of FI for people with dementia living in the community. Overall, in studies (conducted since 2005) suggest a prevalence of FI between 0–27%.^15–17 The large range in prevalence is likely due to differences in the definitions and measurement of FI (e.g. type of stool and frequency of episodes) and cognitive impairment or dementia, methods of data collection and small sample sizes.^12,18 Despite dementia being a risk for FI,¹⁸ there are very few incidence studies. In the UK, the rate of a first diagnosis of FI in a primary care setting was three times higher for people with dementia than in those without dementia.¹⁹

We urgently need to draw attention to the extent of the challenge posed by FI by increasing the volume of research in this area. One method to rapidly map community epidemiology is to draw on routinely collected data. The interRAI Home Care Assessment System (interRAI-HC) is a comprehensive geriatric assessment with good inter-rater reliability²⁰ that is used in 35 countries to plan care and services for older and functionally impaired persons in community-based settings.

In New Zealand an interRAI-HC assessment is mandated for all older people who require public funding and services in the community. Health professionals or non-professionals involved in the care of an older person can make a referral for an assessment. Trained assessors conduct the assessments. For people deemed eligible for services appraisals are repeated every 6 months, or more frequently if a change in need for support is identified. In this article we examine the prevalence, incidence and risks for FI among people with dementia in the community who have had an interRAI-HC assessment in New Zealand.

Study design and data source

We conducted a retrospective cohort study using the interRAI-HC instrument, comprising 236 items in more than 20 domains including physical, mental, social, and cognitive domains of health. Technical Advisory Services interRAI data warehouse provided interRAI-HC data completed anywhere in New Zealand between 1 Aug 2016 and 31 July 2021 and for all older people (65 + years) that had consented for their data to be used for research. There were assessments for 109964 unique individuals during the 5-year study period (Fig. 1).

Study cohorts

Dementia and non-dementia cohorts were identified using the diagnosis of “Alzheimer's disease” and “Dementia other than Alzheimer's disease” that are routinely recorded in an interRAI-HC assessment.²¹ We combined these two diagnoses as one diagnostic category “Dementia”.

Cohort entry and exit

For the prevalence analysis, we selected a dementia cohort for a 1-year period from 1 Aug 2020 to 31 July 2021 (n = 7775). For the incidence analysis, participants in the dementia cohort were followed up from the day of the first dementia diagnosis during the period 1 Aug 2016 and 31 July 2021. The non-dementia cohort comprised all eligible older people without a dementia diagnosis during the 5-year period and were followed up from the first assessment during the 5-year study period. For both cohorts, participants with no follow-up assessment and prevalent FI (i.e., FI recorded on the first assessment during the 5-year period) were excluded from the analysis. All participants exited the study on the date of their last assessment or 31 July 2021.

Primary outcome

The primary outcome FI was measured in interRAI-HC, section H3 (continent, continent with a stoma, seldom incontinent (not incontinent during the last 3 days, but has episodes of incontinence), occasionally incontinent (more seldom than daily), often incontinent (daily, but has some control), incontinent (no control), and did not occur (absence of bowel movement during the past 7 days)). For the univariate and multivariable analyses, participants were re-coded as “incontinent” if they were continent with a stoma, seldom incontinent, occasionally incontinent, often incontinent and incontinent. A decision to include ‘continent with a stoma’ as incontinent was informed by the role that caregivers (to people with dementia) would likely have relating to ostomy care and the disposal of faecal matter.²² Participants rated as ‘absence of bowel movement during the past 7 days’ were coded as continent, which is consistent with other international studies using interRAI-HC data.²³

Co-variates

Several potential risk factors that may predict the onset of FI assessed at baseline were investigated. These were selected based on evidence from previous studies of adult populations and availability within the interRAI-HC dataset and were grouped as socio-demographics (age,^18,24,25 gender,^18,24 ethnicity²⁶), lifestyle factors (physical exercise,^25,27 smoking^18,25), functional variables (independence in ADLs^18,25), comorbidities (depression,²⁶ stroke,⁹ diabetes,^9,24 Parkinson’s disease,²⁵ and urinary incontinence^24,28) and environmental characteristics (access to rooms in the home²⁹). Variables were coded as follows: age dichotomized at the median (equal or less than 83 years, equal or more than 84 years), gender (male, female), ethnicity (Māori versus non-Māori, and Pacific versus non-Pacific), hours of exercise dichotomized at the median (less than 1 hour per week, equal to or more than 1–2 hours per week), (usually) smokes tobacco daily (yes, no). Limited access to home or rooms in the home e.g., difficulty entering or leaving home, climbing stairs or manoeuvring within rooms (yes, no). The six-item scale of hierarchy in ADLs (ranging from independence to complete dependence) was dichotomized as independent, and not independent. Comorbidities were indicated by a diagnosis (primary diagnosis, diagnosis with active treatment, diagnosis with no active treatment) versus no diagnosis for depression, stroke or cerebrovascular accident (CVA), diabetes and Parkinson’s disease (no, yes). Urinary incontinence was coded as continent (yes, no): categories (managed with catheter/ostomy, infrequently incontinent, occasionally incontinent, frequently incontinent, incontinent) were categorised as ‘no’.

Statistical analysis

Logistic regression analyses were carried out in SPSS version 28 to determine the combination of risk factors that best predicted the incidence of FI. Univariate analyses were used to select variable associated with incident FI separately for the dementia and non-dementia cohorts. Variables that were significantly associated with the dependent variable (P < .25) were entered into multivariate logistic regression models and were removed using the Stepwise Backward Selection process (Wald statistic) until only significant variables (P < .05) remained in the models.³⁰

Survival curves of the dementia cohort versus the non-dementia cohort were compared with Cox regression analysis, adjusted for all variables which were significantly associated with incident FI in either cohort in the multivariate logistic regression models.

The study was conducted in accordance with the Declaration of Helsinki and was approved by Auckland Health Research Ethics Committee (AH23238).

Sample characteristics

A total of 20759 people without dementia and 7722 people with dementia were included in the 5-year incidence study (Fig. 1). The mean age of all participants (N = 28481) was 82.2 years (SD 7.5). A majority (20865/28481, 73.3%) of the sample were of New Zealand European ethnicity, 6.0% (1715/28481) identified as Māori, 3.4% (977/28481) as Pacific Peoples and 3.1% (894/28481) as Asian, 14.1% (4030/28481) identified with other ethnicities. The mean age of participants in the dementia and non-dementia cohorts was 80.9 years (SD 6.8) and 82.6 years (SD 7.7) respectively. Compared to the non-dementia cohort, a significantly greater proportion of the dementia cohort were male (χ²₁ = 103.1, P < .001), Māori (χ²₁ = 33.3, P < .001), ADL dependent (χ²₁ = 497.3, P < .001), and had a diagnosis of depression (χ²₁ = 24.9, P < .001). A significantly greater proportion of the non-dementia cohort were 84 + years (χ²₁ = 318.9, P < .001), had limited access to rooms in the home (χ²₁ = 94.2, P < .001), exercised less than 1 hour per week (χ²₁ = 450.6, P < .001), a diagnosis of stroke or CVA (χ²₁ = 126.9, P < .001), Parkinson’s disease (χ²₁ = 17.4, P < .001), or diabetes (χ²₁ = 85.4, P < .001) or experienced urinary incontinence at baseline (χ²₁ = 138.0, P < .001) compared to the dementia cohort (Table 1).

Table 1

Sample characteristics.
	Dementia cohort n (%) n = 7722	Non-dementia cohort n (%) n = 20759	P value^a
Sociodemographic
Age (84 + years)	2933 (38.0)	10350 (49.9)	< .001
Gender (Male)	3396 (44.0)	7758 (37.4)	< .001
Ethnicity (Māori)	568 (7.4)	1147 (5.5)	< .001
Ethnicity (Pacific)	283 (3.7)	694 (3.3)	.185
Lifestyle
Exercise (< 1 hr per week)	3775 (48.9)	13037 (62.8)	< .001
Smoking (daily)	351 (4.5)	1052 (5.1)	.07
Function
ADLs (not independent)	2869 (37.2)	4958 (23.9)	< .001
Co-morbidity
Depression	1141 (14.8)	2601 (12.5)	< .001
Stroke/CVA	873 (11.3)	3467 (16.7)	< .001
Diabetes	1268 (16.4)	4432 (21.3)	< .001
Parkinson’s disease	282 (3.7)	997 (4.8)	< .001
Urinary incontinence	2398 (31.1)	8012 (38.6)	< .001
Environment
Limited access to rooms	356 (4.6)	1643 (7.9)	< .001

Figure 1. Flowchart of the study sample.

Risk factors for faecal incontinence and survival

Odds ratios and 95% confidence intervals (CI) for variables that were significantly associated with incident FI (P < .05) in the univariate and multivariate logistic regression models for the non-dementia and dementia cohorts are displayed in Table 2. Variables associated with a greater risk of incident FI in the multivariate logistic regression models for both cohorts were being male, exercising less than 1 hour per week, not independent in ADLs, having a diagnosis of Parkinson’s disease and presence of urinary incontinence; for the dementia cohort were or Pacific ethnicity and for the non-dementia cohort were having a diagnosis of diabetes, stroke or CVA. Protective factors were smoking (for the dementia cohort), and Māori ethnicity (for the non-dementia cohort).

Table 2

Independent risk factors for incident FI in dementia and non-dementia cohorts.
	Dementia cohort n = 7722		Non-dementia cohort n = 20759
	Univariate logistic regression model FI OR (95% CI)	Multivariate logistic regression model FI OR (95% CI)	Univariate logistic regression model FI OR (95% CI)	Multivariate logistic regression model FI OR (95% CI)
Sociodemographic
Age (84 + years)	1.1 (0.99–1.2) P = .075		1.1 (0.98–1.1) P = .156
Gender (Male)	1.3 (1.2–1.4) P < .001	1.3 (1.2–1.4) P < .001	1.3 (1.2–1.4) P < .001	1.3 (1.2–1.4) P < .001
Ethnicity (Māori)	1.0 (0.8–1.2) P = .897		0.9 (0.7-1.0) P = .043	0.8 (0.7–0.94) P = .006
Ethnicity (Pacific)	1.6 (1.2-2.0) P < .001	1.4 (1.1–1.8) P = .009	1.0 (0.8–1.2) P = .893
Lifestyle
Exercise (< 1 hr per week)	1.5 (1.3–1.6) P < .001	1.3 (1.2–1.4) P < .001	1.2 (1.1–1.3) P < .001	1.1 (1.1–1.2) P < .001
Smoking (daily)	0.7 (0.6-1.0) P = .023	0.7 (0.6–0.9) P = .021	1.0 (0.9–1.2) P = .615
Function
ADLs (not independent)	1.9 (1.7–2.1) P < .001	1.6 (1.5–1.8) P < .001	1.7 (1.5–1.8) P < .001	1.5 (1.4–1.6) P < .001
Co-morbidity
Depression	0.9 (0.8-1.0) P = .083		1.0 (0.9–1.1) P = .885
Stroke/CVA	1.1 (0.6–1.3) P = .141		1.2 (1.1–1.3) P < .001	1.1 (1.0-1.2) P = .025
Diabetes	1.3 (1.1–1.4) P = .001		1.3 (1.2–1.4) P < .001	1.2 (1.1–1.3) P < .001
Parkinson’s disease	1.7 (1.3–2.2) P < .001	1.3 (1.0-1.7) P = .045	1.3 (1.2–1.6) P < .001	1.2 (1.0-1.4) P = .029
Urinary incontinence	1.9 (1.8–2.2) P < .001	1.7 (1.5–1.9) P < .001	1.5 (1.4–1.7) P < .001	1.5 (1.4–1.6) P < .001
Environment
Limited access to rooms	1.3 (0.99–1.6) P = .057		1.3 (1.1–1.4) P < .001

ADL = Activities of daily living; CVA = cerebrovascular accident

Survival function for non-dementia and dementia cohorts for incident FI

In Cox regression analysis the incident FI model was controlled for gender, ethnicity (Māori and Pacific), smoking, level of exercise, independence in ADLs, stroke or CVA, diabetes, Parkinson’s disease, and UI at baseline. People with dementia had a 1.7 higher risk of developing FI (HR adjusted for risk factors: 1.7, 95% CI 1.6–1.8) than older people without dementia. The survival curves for dementia and non-dementia cohorts are presented in Fig. 2.

In this study we found that the 12-month period prevalence of FI was 26.7% (2082/7775) for people with dementia in the community who had an interRAI-HC assessment. This is towards the upper end of the range for prevalence of FI indicated in other community studies (0–27%).^15–17 Extrapolated to the estimated population of people with dementia living in the community in New Zealand (N = 69713),¹ 18480 may have experienced FI in 2020/2021. This may be an over-estimation as an interRAI-HC assessment is undertaken where there is a perceived need for support from home or health care services. This means that the sample of older people receiving assessments are not representative of the general population. However, the 12-month period prevalence for people with dementia assessed for care and support, is likely more robust than previous studies in Hong Kong, Republic of Ireland, and Turkey that were based on small convenience samples of participants (ranged from 82 to 197), drawn from dementia associations or geriatric out-patient clinics.^15–17

The incidence of FI was 19 per 100 person years for people with dementia and 12.3 per 100 person years for older people without dementia. Controlling for significant factors, people with dementia had a 1.7 higher risk of developing FI than older people without dementia. While the latter results is consistent with a study that indicated an increased hazard ratio of FI for people with dementia when compared to people with cancer,³¹ incident FI for people with dementia was much greater than observed in the UK: 11.1 for men and 10.1 for women per 1000 person years. Differences may be due to variations in the mean age and composition of samples: the UK sample comprised all older people (60 + years) registered with 500 General Practices in one region, whereas the interRAI dataset comprised older people (65 + years) assessed for care and support at home in New Zealand. It is also conceivable that differences are related to under-reporting of FI and the adage “if you don’t ask, they won’t tell”.³²

Studies of the general populations have indicated that only a minority of people with FI (5–27%) disclose the stigmatized condition to their general practitioners.³² We found UI significantly increased the risk of FI for people with dementia (OR = 1.7, 95% CI 1.5–1.9), but elsewhere, it has been noted that there is less disclosure of FI for people experiencing dual incontinence.³³ In Spain, introducing FI screening into a diagnostic tool used by nurses identified three times the number of people with FI within 16 months compared to the number that had been identified in the previous 3 years. The greater rate of incident FI for people with dementia in New Zealand may be due to the direct questions incorporated into the interRAI-HC assessment, whereas an absence of routine screening in primary care practices coupled with the reluctance to report FI¹⁸ may have contributed to the lower incidence rates captured by UK data.

In the multivariate analysis smoking appeared to have a protective effect reducing FI for people with dementia (OR = 0.7, 95% CI 1.2–1.5). This finding could be detrimental to public health and should be viewed with extreme caution. Even if smoking did offer a protective effect this is unlikely to outweigh the adverse health effects of smoking.

Multivariate analysis showed that the risk of developing FI for people with dementia was greatest for those who were dependent in ADLs (OR = 1.6, 95% CI 1.5–1.8), had a diagnosis or Parkinson’s disease (OR = 1.3, 95% CI 1.0-1.7), experienced urinary incontinence (OR = 1.7, 95% CI 1.5–1.9), or were of Pacific ethnicity (OR = 1.4, 95% CI 1.1–1.8). The first three factors have been reported previously as risk factors for FI in adult populations,^18,24,25 but to our knowledge these factors, along with Pacific ethnicity have yet to be identified as specific risks for FI for people with dementia. Two of these factors (dependent in ADLs and diagnosis of Parkinson’s disease) are indicators of functional limitations. The increased risk of FI for people with dementia who exercise less than 1 hour per week (OR = 1.3, 95% CI 1.2–1.5) is also consistent with this finding. Together these factors suggest that increased risk of FI is associated with functional impairment and reduced ability to reach a toilet in a timely way.²⁵ Additionally, physical activity plays a role in the neuromuscular health affecting anorectal function.²⁷ Thus, improving mobility through physiotherapy, occupational therapy or environmental interventions may reduce the risk of FI for people with dementia.³⁵

In the multivariate model Māori ethnicity was protective of FI for the non-dementia cohort but not for the dementia cohort. Research examining the barriers to diagnosing colorectal cancer suggested that privacy and cultural safety of health services were appraised by Māori when considering whether symptoms such as diarrhoea and changes in bowel habit warranted medical investigation.³⁶ The results of our study may suggest lower reporting in the non-dementia cohort in which older Māori may prefer to deal with FI privately. On the other hand, FI coupled with dementia was reported at a similar rate to the non-Māori cohort suggesting that for this population, incontinence cannot be managed privately.

We have outlined some of the limitations of this analysis above. The New Zealand sample is not a general community sample, but a sample of people who have health care support needs and have undertaken an interRAI-HC assessment. About 10% and 40% of New Zealanders over the age of 65 and 85 years had an interRAI assessment, respectively. Despite this limitation, this is one of the largest studies exploring the incidence, prevalence and risks associated with FI for people with dementia. Moreover, because interRAI-HC is more likely to capture data from people with dementia (who may be less inclined or able to participate in surveys) the findings may be more representative of this particular cohort than smaller convenience samples used in previous analyses.^15–17 The routine data collected via interRAI instruments has high validity, reliability and low rates of missing data which can be considered a strength of this paper.

Health professionals need to be aware of the increased risk of FI for people with dementia. As differences observed between incident FI in the UK and New Zealand may be due to variations in eliciting information from direct questioning rather than relying on self-initiated disclosure, we suggest that health professionals should be prepared to initiate conversations about FI with people with dementia and their caregivers. The prevalence of FI and potential modifiable nature of some of the risk factors for incident FI, suggest that more research is required to demonstrate to policy makers and planners the extent of this challenge. interRAI-HC datasets potentially provide a cost-effective means of identifying dementia and incontinence in retrospective cohort studies.³⁷ Further international analyses will be valuable to predict the level of service or interventions required to delay residential care entry, or to model future costs of continence care for people with dementia in the community.

Funding sourceThiswork was supported by the Health Research Council of New Zealand [Grant number 21/117].

ACKNOWLEDGEMENTS

We would like to thank Peter Tang, Data Analyst, and Costa Karavias, Senior Analyst at Technical Advisory Services for their support in retrieving the interRAI data.

Conflicts of Interest: The authors declare no conflicts of interest.

Author Contributions: Vanessa Burholt obtained the funding for the study. Vanessa Burholt, Avinesh Pillai, and Gary Cheung designed this Phase of the study and developed the study methods. Vanessa Burholt curated the data and undertook the formal analyses and interpretation of the data, overseen by Avinesh Pillai and Gary Cheung. All authors critically reviewed and edited the manuscript for intellectual content and approved the final manuscript.

Sponsor’s Role: The sponsor had no role in the conceptualization, writing, or publication of this work.

Ma’u E, Cullum S, Yates S, et al. Dementia Economic Impact Report 2020 in Aotearoa New Zealand. 2021.
Alzheimer's Disease International, Guierchet M, Prince M, Prina M. Numbers of people with dementia around the world: An update to the estimates in the World Alzheimer Report 2015. Alzheimer's Disease International. Accessed October 5, 2023 https://www.alzint.org/resource/numbers-of-people-with-dementia-worldwide/
Cantarero-Prieto D, Leon PL, Blazquez-Fernandez C, Juan PS, Cobo CS. The economic cost of dementia: a systematic review. Dementia (London). 2019:1471301219837776. doi:10.1177/1471301219837776
Jutkowitz E, Kane RL, Gaugler JE, MacLehose RF, Dowd B, Kuntz KM. Societal and family lifetime cost of dementia: implications for policy. J Am Geriatr Soc, 65: 2169–2175. doi:10.1111/jgs.15043
Kelley AS, McGarry K, Bollens-Lund E, et al. Residential setting and the cumulative financial burden of dementia in the 7 years before death. J Am Geriatr Soc. Jun 2020;68(6):1319–1324. doi:10.1111/jgs.16414
van den Kieboom RCP, Snaphaan LJAE, Mark RE, Bongers IMB. The trajectory of caregiver burden and risk factors in dementia progression: a systematic review. J Alzheimers Dis. 2020; 77(3):1107–1115. doi: 10.3233/JAD-200647
Hauber AB, Mohamed AF, Johnson FR, et al. Understanding the relative importance of preserving functional abilities in Alzheimer's disease in the United States and Germany. Qual Life Res. 2014;23(6):1813–1821. doi:10.1007/s11136-013-0620-5
Abrams P, Cardozo L, Wagg A, Wein A, eds. Incontinence 6th Edition. ICI-ICS International Continence Society; 2017.
Shaw C, Wagg A. Urinary and faecal incontinence in older adults. Medicine. 2021;49(1):44–50. doi:10.1016/j.mpmed.2020.10.012
Nguyen T, Li X. Understanding public-stigma and self-stigma in the context of dementia: A systematic review of the global literature. Dementia. 2020;19(2):148–181. doi:10.1177/1471301218800122
Luppa M, Luck T, Weyerer S, König HH, Brähler E, Riedel-Heller SG. Prediction of institutionalization in the elderly. A systematic review. Age Ageing. Jan 2010;39(1):31–8. doi:10.1093/ageing/afp202
Burholt V, Davies J, Boyd M, Mullins JM, Shoemark EZ, the Centre for Ageing, Dementia Research, Expert Review Group on Continence, Dementia. A research agenda for promoting continence for people living with dementia in the community: Recommendations based on a critical review and expert-by-experience opinion. J Clin Nurs. 2022; 31: 1933–1946. doi: 10.1111/jocn.15537
Edwards NI, Jones D. The prevalence of faecal incontinence in older people living at home. Age Ageing. 2001;30(6):503–507. doi:10.1093/ageing/30.6.503
Harari D, Husk J, Lowe D, Wagg A. National audit of continence care: Adherence to National Institute for Health and Clinical Excellence (NICE) Guidance in older versus younger adults with faecal incontinence. Age Ageing. 2014;43(6):785–793. doi:10.1093/ageing/afu056
Soysal P, Tan SG. The prevalence and co-incidence of geriatric syndromes in older patients with early-stage Alzheimer’s disease and dementia with Lewy bodies. Aging Clin Exp Res. 2021;33(9):2599–2603. doi:10.1007/s40520-020-01774-y
Chung JC. Care needs assessment of older Chinese individuals with dementia of Hong Kong. Aging Ment Health. 2006;10(6):631–7. doi:10.1080/13607860600650532
Meaney AM, Croke M, Kirby M. Needs assessment in dementia. Int J Geriatr Psychiatry. 2005;20(4):322–9. doi:10.1002/gps.1284
Bharucha AE, Knowles CH, Mack I, et al. Faecal incontinence in adults. Nat Rev Dis Primers. 2022;8(1):53. doi:10.1038/s41572-022-00381-7
Grant RL, Drennan VM, Rait G, Petersen I, Iliffe S. First diagnosis and management of incontinence in older people with and without dementia in primary care: A cohort study using the health improvement network primary care database. PLoS Med. 2013;10(8):e1001505. doi:10.1371/journal.pmed.1001505
Hirdes JP, Ljunggren G, Morris JN, et al. Reliability of the interRAI suite of assessment instruments: A 12-country study of an integrated health information system. BMC Health Serv Res. 2008;8(1):277. doi:10.1186/1472-6963-8-277
Jamieson H, Abey-Nesbit R, Nishtala PS, et al. Predictors of residential care admission in community-dwelling older people with dementia. J Am Med Dir Assoc. 2020;21(11):1665–1670. doi: 10.1016/j.jamda.2020.04.021
Lee M, Ryoo JH, Campbell C, Hollen PJ, Williams IC. Exploring the challenges of medical/nursing tasks in home care experienced by caregivers of older adults with dementia: An integrative review. J Clin Nurs. 2019;28(23–24):4177–4189. doi: 10.1111/jocn.15007
Finne-Soveri H, Sørbye LW, Jonsson PV, Carpenter GI, Bernabei R. Increased work-load associated with faecal incontinence among home care patients in 11 European countries. Eur J Public Health. 2008;18(3):323–328. doi:10.1093/eurpub/ckm085
Sievert K-D, Amend B, Toomey PA, et al. Can we prevent incontinence?: ICI-RS 2011. Neurourol Urodyn. 2012;31(3):390–399. doi: 10.1002/nau.22225
Townsend MK, Matthews CA, Whitehead WE, Grodstein F. Risk factors for fecal incontinence in older women. Am J Gastroenterol. 2013;108(1):113–9. doi:10.1038/ajg.2012.364
Berger MB, Delancey JO, Fenner DE. Racial differences in fecal incontinence in community-dwelling women from the EPI study. Female Pelvic Med Reconstr Surg. 2013;19(3):169–74. doi:10.1097/SPV.0b013e3182874709
Staller K, Song M, Grodstein F, et al. Physical Activity, BMI, and risk of fecal incontinence in the Nurses' Health Study. Clin Transl Gastroenterol. 2018;9(10):200. doi:10.1038/s41424-018-0068-6
Ng KS, Sivakumaran Y, Nassar N, Gladman MA. Fecal incontinence: Community prevalence and associated factors-a systematic review. Dis Colon Rectum. 2015;58(12):1194–1209. doi:10.1097/dcr.0000000000000514
Russell B, Buswell M, Norton C, et al. Supporting people living with dementia and faecal incontinence. Br J Community Nurs. 2017;22(3):110–114. doi:10.12968/bjcn.2017.22.3.110
Chowdhury MZI, Turin T, C. Variable selection strategies and its importance in clinical prediction modelling. Fam Med Community Health. 2020;8(1):e000262. doi:10.1136/fmch-2019-000262
Chughtai B, Thomas D, Russell D, Bowles K, Prigerson H. Prevalence of and risk factors for urinary incontinence in home hospice patients. Eur Urology. 2019;75(2):268–271. doi:10.1016/j.eururo.2018.10.027
Whitehead WE. Diagnosing and managing fecal incontinence: If You don't ask, they won't tell. Gastroenterol. 2005;129(1):6. doi:10.1053/j.gastro.2005.05.043
Cichowski SB, Komesu YM, Dunivan GC, Qualls C, Rogers RG. Written versus oral disclosure of fecal and urinary incontinence in women with dual incontinence. Int Urogynecol J. 2014;25(9):1257–62. doi:10.1007/s00192-014-2393-y
Hay-Smith EJC, Thompson SG, Weatherall M, Ranta A. Documented incontinence after stroke: A secondary analysis of a cohort study. Reducing Ethnic and Geographic Inequities to Optimise New Zealand Stroke Care (REGIONS Care). N Z Med J. 2022; 135(1567):43–53.
Bravo CV. Urinary and faecal incontinence and dementia. Rev Clin Gerontol. 2004;14(2):129–136. doi:10.1017/S0959259804001388
Blackmore T, Norman K, Kidd J, et al. Barriers and facilitators to colorectal cancer diagnosis in New Zealand: A qualitative study. BMC Fam Pract. 2020;21(1):206. doi:10.1186/s12875-020-01276-w
Wilkinson T, Ly A, Schnier C, et al. Identifying dementia cases with routinely collected health data: A systematic review. Alzheimers Dement (Amst). 2018;14(8):1038–1051. doi:10.1016/j.jalz.2018.02.016

Download PDF

Journal Publication

published 10 Jun, 2024

Read the published version in Gerontology →

Version 1

posted

You are reading this latest preprint version

Epidemiology of Faecal Incontinence for People with Dementia Living in the Community in New Zealand: A Retrospective Cohort Study Using interRAI Home Care Assessment Data

Status:

Journal Publication

Version 1

Abstract

BACKGROUND

METHODS

RESULTS

CONCLUSIONS

Figures

INTRODUCTION

METHODS

Study design and data source

Study cohorts

Cohort entry and exit

Primary outcome

Co-variates

Statistical analysis

RESULTS

Sample characteristics

Risk factors for faecal incontinence and survival

Survival function for non-dementia and dementia cohorts for incident FI

DISCUSSION

CONCLUSIONS

Declarations

References

Status:

Journal Publication

Version 1