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

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Background:
Dementia is one of the most disabling and burdensome diseases. Incontinence in people with dementia is distressing, adds to carer burden, and influences decisions to relocate people to care homes. Successful and safe management of incontinence in people with dementia presents additional challenges. The aim of this study was to investigate the rates of first diagnosis in primary care of urinary and faecal incontinence among people aged 60–89 with dementia, and the use of medication or indwelling catheters for urinary incontinence.

Methods and Findings:
We extracted data on 54,816 people aged 60–89 with dementia and an age-gender stratified sample of 205,795 people without dementia from 2001 to 2010 from The Health Improvement Network (THIN), a United Kingdom primary care database. THIN includes data on patients and primary care consultations but does not identify care home residents. Rate ratios were adjusted for age, sex, and co-morbidity using multilevel Poisson regression.

The rates of first diagnosis per 1,000 person-years at risk (95% confidence interval) for urinary incontinence in the dementia cohort, among men and women, respectively, were 42.3 (40.9–43.8) and 33.5 (32.6–34.5). In the non-dementia cohort, the rates were 19.8 (19.4–20.3) and 18.6 (18.2–18.9). The rates of first diagnosis for faecal incontinence in the dementia cohort were 11.1 (10.4–11.9) and 10.1 (9.6–10.6). In the non-dementia cohort, the rates were 3.1 (2.9–3.3) and 3.6 (3.5–3.8).

The adjusted rate ratio for first diagnosis of urinary incontinence was 3.2 (2.7–3.7) in men and 2.7 (2.3–3.2) in women, and for faecal incontinence was 6.0 (5.1–7.0) in men and 4.5 (3.8–5.2) in women. The adjusted rate ratio for pharmacological treatment of urinary incontinence was 2.2 (1.4–3.7) for both genders, and for indwelling urinary catheters was 1.6 (1.3–1.9) in men and 2.3 (1.9–2.8) in women.

Conclusions:
Compared with those without a dementia diagnosis, those with a dementia diagnosis have approximately three times the rate of diagnosis of urinary incontinence, and more than four times the rate of faecal incontinence, in UK primary care. The clinical management of urinary incontinence in people with dementia with medication and particularly the increased use of catheters is concerning and requires further investigation.

Please see later in the article for the Editors' Summary

Vyšlo v časopise: 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 10(8): e32767. doi:10.1371/journal.pmed.1001505
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1001505

Souhrn

Zdroje

1. BrookmeyerR, JohnsonE, Ziegler-GrahamK, ArrighiHM (2007) Forecasting the global burden of Alzheimer's disease. Alzheimers Dement 3: 186–191.

2. FerriCP, PrinceM, BrayneC, BrodatyH, FratiglioniL, et al. (2005) Global prevalence of dementia: a Delphi consensus study. Lancet 366: 2112–2117.

3. KalariaRN, MaestreGE, ArizagaR, FriedlandRP, GalaskoD, et al. (2008) Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors. Lancet Neurol 7: 812–826.

4. OuslanderJG, ZaritSH, OrrNK, MuiraSA (1990) Incontinence among elderly community-dwelling dementia patients: Characteristics, management, and impact on caregivers. J Am Geriatr Soc 38: 440–445.

5. HopeT, KeeneJ, GedlingK, FairburnCG, JacobyR (1998) Predictors of institutionalization for people with dementia living at home with a carer. Int J Geriatr Psychiatry 13: 682–690.

6. ThomasP, IngrandP, LalloueF, Hazif-ThomasC, BillonR, et al. (2004) Reasons of informal caregivers for institutionalizing dementia patients previously living at home: the Pixel study. Int J Geriatr Psychiatry 19: 127–135.

7. RabinsPV, BlackerD, RovnerBW, RummansT, SchneiderLS, et al. (2007) American Psychiatric Association practice guideline for the treatment of patients with Alzheimer's disease and other dementias. 2nd edition. Am J Psychiatry 164: 5–56.

8. Hunskaar S, Burgio K, Clark A, Lapitan M, Nelson R, et al.. (2008) Epidemiology of urinary (UI) and faecal (FI) incontinence and pelvic organ prolapse (POP). Abrams P, Cardozo L, Khoury S, Wein A, editors. Incontinence: 4th international consultation, Paris, 5–8 July 2008. Plymouth: Health Publications. pp. 255–312. Available: www.icsoffice.org/Publications/ICI_4/book.pdf. Accessed 19 July 2013.

9. StokesG (1995) Incontinent or not? Don't label: describe and assess. J Dement Care 3: 20–21.

10. DrennanVM, ColeL, IliffeS (2011) A taboo within a stigma? a qualitative study of managing incontinence with people with dementia living at home. BMC Geriatr 11: 75.

11. European Parliament (2011) European initiative on Alzheimer's disease and other dementias - P7_TA(2011)0016. Available: http://www.europarl.europa.eu/sides/getDoc.do?type=TA&reference=P7-TA-2011-0016&language=EN. Accessed 19 July 2013.

12. 112th US Congress (2011) S.3036 - National Alzheimer's Project Act. Available: http://thomas.loc.gov/cgi-bin/bdquery/z?d111:s3036:\. Accessed 19 July 2013.

13. DrennanVM, ColeL, IliffeS (2011) A taboo within a stigma? a qualitative study of managing incontinence with people with dementia living at home. BMC Geriatr 11: 75.

14. HorrocksS, SomersetM, StoddartH, PetersTJ (2004) What prevents older people from seeking treatment for urinary incontinence? A qualitative exploration of barriers to the use of community continence services. Fam Pract 21: 689–696.

15. TeunissenD, van WeelC, Lagro-JanssenT (2005) Urinary incontinence in older people living in the community: examining help-seeking behaviour. Br J Gen Pract 55: 776–782.

16. TeunissenD, van den BoschW, van WeelC, Lagro-JanssenT (2006) Urinary incontinence in the elderly: attitudes and experiences of general practitioners. A focus group study. Scand J Prim Health Care 24: 56–61.

17. WaggA, PotterJ, PeelP, IrwinP, LoweD, et al. (2008) National audit of continence care for older people: management of urinary incontinence. Age Ageing 37: 39–44.

18. WaggA, DuckettJ, McClurgD, HarariD, LoweD (2011) To what extent are national guidelines for the management of urinary incontinence in women adhered? Data from a national audit. Br J Obstet Gynaecol 118: 1592–1600.

19. PotterJ, PeelP, MianS, LoweD, IrwinP, et al. (2007) National audit of continence care for older people: management of faecal incontinence. Age Ageing 36: 268–273.

20. WimoA, WinbladB, JönssonL (2007) An estimate of the total worldwide societal costs of dementia in 2005. Alzheimers Dement 3: 81–91.

21. Knapp M, Prince M (2007) Dementia UK: report to the Alzheimer's Society. London: Dementia UK.

22. DrennanVM, ColeL, RaitG, GrantRL, IliffeS (2013) The prevalence of incontinence in people with cognitive impairment or dementia living at home. Neurourol Urodyn 32: 314–324.

23. Cegedim. The Health Improvement Network. Available: http://www.thin-uk.com. Accessed 19 July 2013.

24. Department of Health (2012) The NHS Constitution for England (2012 edition). Available: https://www.gov.uk/government/publications/the-nhs-constitution-for-england. Accessed 19 July 2013.

25. BourkeA, DattaniH, RobinsonM (2004) Feasibility study and methodology to create a quality-evaluated database of primary care data. Inform Prim Care 12: 171–177.

26. Census Dissemination Unit, University of Manchester. Deprivation scores. Available: http://cdu.mimas.ac.uk/related/deprivation.htm. Accessed 19 July 2013.

27. DavéS, PetersenI (2009) Creating medical and drug code lists to identify cases in primary care databases. Pharmacoepidemiol Drug Safety 18: 704–707.

28. LewisJD, BilkerWB, WeinsteinRB, StromBL (2005) The relationship between time since registration and measured incidence rates in the General Practice Research Database. Pharmacoepidemiol Drug Safety 14: 443–451.

29. McBrideD, HardoonS, WaltersK, GilmourS, RaineR (2010) Explaining variation in referral from primary to secondary care: cohort study. Br Med J 341: c6267–c6267.

30. MaguireA, BlakBT, ThompsonM (2009) The importance of defining periods of complete mortality reporting for research using automated data from primary care. Pharmacoepidemiol Drug Safety 18: 76–83.

31. HorsfallL, WaltersK, PetersenI (2013) Identifying periods of acceptable computer usage in primary care research databases. Pharmacoepidemiol Drug Safety 22: 64–69.

32. Joint Formulary Committee (2011) British National Formulary (61st edition). London: BMJ Group and Pharmaceutical Press.

33. Department of Health (2001) National service framework for older people. London: Department of Health.

34. SchneeweissS, SeegerJD, MaclureM, WangPS, AvornJ, et al. (2001) Performance of comorbidity scores to control for confounding in epidemiologic studies using claims data. Am J Epidemiol 154: 854–864.

35. D'HooreW, BouckaertA, TilquinC (1996) Practical considerations on the use of the Charlson comorbidity index with administrative data bases. J Clin Epidemiol 49: 1429–1433.

36. Snijders TAB, Bosker R (2011) Multilevel analysis: an introduction to basic and advanced multilevel modeling. Thousand Oaks (California): Sage Publications Ltd.

37. RaitG, WaltersK, BottomleyC, PetersenI, IliffeS, et al. (2010) Survival of people with clinical diagnosis of dementia in primary care: cohort study. Br Med J 341: c3584.

38. LiffordKL, TownsendMK, CurhanGC, ResnickNM, GrodsteinF (2008) The epidemiology of urinary incontinence in older women: incidence, progression, and remission. J Am Geriatr Soc 56: 1191–1198.

39. NicolleLE (2012) Urinary catheter-associated infections. Infect Dis Clin North Am 26: 13–27.

40. LandiF, CesariM, OnderG, ZamboniV, BarillaroC, et al. (2004) Indwelling urethral catheter and mortality in frail elderly women living in community. Neurourol Urodyn 23: 697–701.

41. TsanL, DavisC, LangbergR, HojloC, PierceJ, et al. (2008) Prevalence of nursing home-associated infections in the Department of Veterans Affairs nursing home care units. Am J Infect Control 36: 173–179.

42. Cottenden A, Bliss D, Buckley B, Fader M, Getliffe K, et al.. (2008) Management using continence products. Incontinence: 4th international consultation, Paris, 5–8 July 2008. Plymouth: Health Publications. pp. 1519–1642. Available: http://www.icsoffice.org/Publications/ICI_4/book.pdf. Accessed 19 July 2013.

43. HobbelenJSM, TanFES, VerheyFRJ, KoopmansRTCM, de BieRA (2011) Prevalence, incidence and risk factors of paratonia in patients with dementia: a one-year follow-up study. Int Psychogeriatr 23: 1051–1060.

44. AllanLM, BallardCG, RowanEN, KennyRA (2009) Incidence and prediction of falls in dementia: a prospective study in older people. PloS One 4: e5521 doi:10.1371/journal.pone.0005521

45. SlaughterSE, EliasziwM, MorganD, DrummondN (2011) Incidence and predictors of excess disability in walking among nursing home residents with middle-stage dementia: a prospective cohort study. Int Psychogeriatr 23: 54–64.

46. ShahSM, CareyIM, HarrisT, DewildeS, CookDG (2011) Quality of chronic disease care for older people in care homes and the community in a primary care pay for performance system: retrospective study. Br Med J 342: d912.