11:29am Tuesday 17 October 2017

New study reveals the scale of continence problems among people with dementia

The research, published in the journal PLOS Medicine, analysed the records of over a quarter of a million patients in The Health Improvement Network (THIN)*, a database of nearly 500 UK primary care practices. Data captured between 2001 and 2010 relating to around 55,000 people with dementia was compared with the data from around 200,000 people without dementia.

The study showed that people with dementia experience approximately three times the rate of diagnosis of urinary incontinence, and more than four times the rate of fecal incontinence, compared to those without dementia.

Led by Robert Grant and Vari Drennan from the Faculty of Health, Social Care and Education, at Kingston University and St George’s, University of London, the study was a collaboration with Professor Steve Iliffe and colleagues at the Research Department of Primary Care and Population Health, University College London. 

Robert Grant said: “Incontinence is a common problem for people living with dementia in the community. They need good quality services, including advice and support for carers managing incontinence. With an ageing population, providers and planners of dementia services should anticipate high levels of need.

“Some aspects of clinical management of urinary incontinence are different for patients with dementia compared with those without. Further study is required to understand the clinical reasoning of health care practitioners providing care for this population, particularly in the use of indwelling catheters, given the known risks.

Notes to editors

Title of paper: 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 http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001505

Findings: Men with a diagnosis of dementia had an annual rate of first diagnosis of urinary incontinence of 42.3 (95% confidence interval, 40.9–43.8) per 1000, compared with 19.8 (19.4–20.3) per 1000 men without a dementia diagnosis. Among women, the rates of a first diagnosis of urinary incontinence were 33.5 (32.6–34.5) per 1000 women with a dementia diagnosis versus 18.6 (18.2–18.9) per 1000 women without a dementia diagnosis. Rates of a first diagnosis of fecal incontinence were 11.1 (10.4–11.9) per 1000 men with a dementia diagnosis versus 3.1 (2.9–3.3) per 1000 men without a dementia diagnosis. For women with a dementia diagnosis, 10.1 (9.6–10.6) per 1000 had a first diagnosis of fecal incontinence, versus 3.6 (3.5–3.8) per 1000 women without a dementia diagnosis. 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 fecal incontinence was 6.0 (5.1–7.0) in men and 4.5 (3.8–5.2) in women.

The rate ratio of use of pharmacological treatment for 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. Urinary catheters are known to increase the risk of urinary tract infection.

A limitation of the study was that the authors had to depend on coding of diagnoses and prescriptions in the database to determine the diagnosis of dementia and incontinence.

*THIN (http://www.thin-uk.com/) is a database of anonymised primary care consultations collected directly from general practice computers, including symptoms, diagnoses, prescriptions, referrals, etc.

St George’s, University of London, Cranmer Terrace, London SW17 0RE – Switchboard 020 8672 9944


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