Prevalence of appropriate evaluation and management of urinary incontinence in Texas long-term care facilities
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The purpose of this study was to determine the prevalence of appropriate evaluation and management of urinary incontinence (UI) in elderly adults residing in Texas nursing home facilities. There were three main objectives for this study. The first objective was to determine the prevalence of residents with urinary incontinence that had documentation that their condition was evaluated using one or more of the four parts of the Agency for Health Care Policy and Research (AHCPR) basic evaluation guidelines for urinary incontinence. The second objective was to determine the prevalence of routine prescription medications administered to nursing home elderly residents that may cause or exacerbate urinary incontinence. A final objective was to compare the effectiveness of four types of oral antimuscarinic medications (tolterodine IR and ER, oxybutynin IR and ER) that are used to treat urinary incontinence. There were a total of 301 residents from 30 facilities, located in five regions of the state of Texas, included in the study. For the first two objectives, 255 residents’ medical charts were reviewed. There were 64 residents (18 of whom are also found in objectives 1 and 2 sample) that met the study criteria for the third objective. Results for Objective 1 revealed that of the 255 charts evaluated, the majority (n = 179, 70.2 percent) had no documentation of any part of the basic evaluation that is recommended for patients with urinary incontinence. Fifty-seven patients (22.3 percent) had documentation of one part of the evaluation, while less than eight percent (n = 19) had two or more parts of the basic evaluation documented. Female residents were more likely than male residents to have documentation of one or more parts of the basic evaluation. Residents residing in nursing homes located in urban areas were more likely to have documentation of one or more parts of the basic evaluation compared to residents residing in rural setting nursing homes. Results of Objective 2 found that 214 (83.9 percent) of the 255 residents received one or more routine medications that could cause or exacerbate urinary incontinence. More than one-fourth (27.4 percent) of the residents were receiving three or more of these medications. The prevalence of receiving at least one of these medications did not differ by patient or facility characteristics. For the final objective, the study results showed that residents receiving tolterodine IR or ER had a greater decrease in urinary incontinence severity level scores than residents receiving oxybutynin IR or ER. Female residents had a greater decrease in urinary incontinence level scores than male residents. The sparse documentation of basic urinary incontinence evaluations and high prevalence of patients receiving medications that could cause or exacerbate their condition indicate that health care providers and decision makers need to continue to focus on ways to improve the evaluation and management of urinary incontinence in elderly nursing home residents.