Mp12-03 Urinary Incontinence Is an Independent Risk Factor for Nursing Home Placement Among Assisted Living Residents

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making I (MP12)1 May 2024MP12-03 URINARY INCONTINENCE IS AN INDEPENDENT RISK FACTOR FOR NURSING HOME PLACEMENT AMONG ASSISTED LIVING RESIDENTS Divya Ajay, Wenhan Guo, Shubing Cai, and Helena Temkin-Greener Divya AjayDivya Ajay , Wenhan GuoWenhan Guo , Shubing CaiShubing Cai , and Helena Temkin-GreenerHelena Temkin-Greener View All Author Informationhttps://doi.org/10.1097/01.JU.0001009376.16371.fb.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Assisted living (AL) communities have evolved in response to older adults' needs for personal care and a preference to remain in a home-like environment when no longer independent. Prior studies suggested that urinary incontinence (UI) is an important risk factor for permanent nursing home (NH) placement, but UI in AL residents has not been examined. Our objective was to evaluate if UI is an independent risk factor in NH placement of AL residents. METHODS: We used CY2019-2021 Medicare Enrollment database, Medicare Beneficiary Summary Files, MedPAR, Minimum Dataset 3.0, outpatient and carrier claims. Following a previously developed methodology, we identified Medicare beneficiaries residing in ALs in January through June of 2020 and alive through the end of 2021. AL residents who had a new UI diagnosis in the first half of 2020 were also identified. All residents were followed through the end of 2021 to identify permanent NH placement (LOS=>90 days). Individual covariates (e.g., age, race/ethnicity, dual Medicare-Medicaid status, chronic conditions) and AL factors (bed-size, penetration of dual residents) were included. We examined bivariate associations between UI, individual and AL covariates. We then estimated logistic regression models with individual and AL random effects (individuals nested within ALs), and robust standard errors, to examine the association between UI and NH placement. Interactions effects were estimated to examine differences in NH placement by race/ethnicity. RESULTS: Of 247,010 AL residents, 20.45% had UI. Overall, 15.7% were permanently placed in NH during the 18 months study period; 14.2% among those with no IU and 21.7% among those with UI. After controlling for confounders, UI significantly (p<0.01) increased the probability of NH placement by 2.2 percentage points (pp), a 14% increase relative to the mean. Other covariates, including dual status and chronic conditions, increased placement risk. Compared to whites without UI, whites with UI had 1.93 pp higher probability of being placed in NH. While Black and Hispanic residents overall had lower risk of NH placement that risk increased significantly for those with UI; 3.43 pp higher for Blacks and 3.68 pp higher for Hispanics. NH placement risk was lower for whites with UI compared to Blacks with UI (p<0.1), but was not significantly different between Blacks and Hispanics with UI. CONCLUSIONS: This first study of UI in ALs demonstrated that it is an independent risk factor for permanent NH placement. Educating residents, family members, and providers, and identifying and treating UI early may allow AL residents to avoid or to delay NH placement. Source of Funding: Agency for Healthcare Research and Quality R01HS026893 (HTG) © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e200 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Divya Ajay More articles by this author Wenhan Guo More articles by this author Shubing Cai More articles by this author Helena Temkin-Greener More articles by this author Expand All Advertisement PDF downloadLoading ...