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Research article:

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

Reference:

Robert L. Grant, Vari M. Drennan, Greta Rait, Irene Petersen, Steve Iliffe(2013) 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 Medicine, doi: 10.1371/journal.pmed.1001505

Link to fulltext article
Abstract
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.
Author for correspondence
Robert L. Grant
Email for correspondence
robert.grant@sgul.kingston.ac.uk

Code list: res11: Dementia

54 codes in list

Code Coding system Description Entity type List name
1461 Read H/O: dementia diagnostic res11: Dementia
E000.00 Read Uncomplicated senile dementia diagnostic res11: Dementia
E001.00 Read Presenile dementia diagnostic res11: Dementia
E001000 Read Uncomplicated presenile dementia diagnostic res11: Dementia
E00..11 Read Senile dementia diagnostic res11: Dementia
E001100 Read Presenile dementia with delirium diagnostic res11: Dementia
E00..12 Read Senile/presenile dementia diagnostic res11: Dementia
E001200 Read Presenile dementia with paranoia diagnostic res11: Dementia
E001300 Read Presenile dementia with depression diagnostic res11: Dementia
E001z00 Read Presenile dementia NOS diagnostic res11: Dementia
E002.00 Read Senile dementia with depressive or paranoid features diagnostic res11: Dementia
E002000 Read Senile dementia with paranoia diagnostic res11: Dementia
E002100 Read Senile dementia with depression diagnostic res11: Dementia
E002z00 Read Senile dementia with depressive or paranoid features NOS diagnostic res11: Dementia
E003.00 Read Senile dementia with delirium diagnostic res11: Dementia
E004.00 Read Arteriosclerotic dementia diagnostic res11: Dementia
E004000 Read Uncomplicated arteriosclerotic dementia diagnostic res11: Dementia
E004100 Read Arteriosclerotic dementia with delirium diagnostic res11: Dementia
E004.11 Read Multi infarct dementia diagnostic res11: Dementia
E004200 Read Arteriosclerotic dementia with paranoia diagnostic res11: Dementia
E004300 Read Arteriosclerotic dementia with depression diagnostic res11: Dementia
E004z00 Read Arteriosclerotic dementia NOS diagnostic res11: Dementia
E041.00 Read Dementia in conditions EC diagnostic res11: Dementia
Eu00.00 Read [X]Dementia in Alzheimer's disease diagnostic res11: Dementia
Eu00000 Read [X]Dementia in Alzheimer's disease with early onset diagnostic res11: Dementia
Eu00011 Read [X]Presenile dementia,Alzheimer's type diagnostic res11: Dementia
Eu00012 Read [X]Primary degen dementia, Alzheimer's type, presenile onset diagnostic res11: Dementia
Eu00013 Read [X]Alzheimer's disease type 2 diagnostic res11: Dementia
Eu00100 Read [X]Dementia in Alzheimer's disease with late onset diagnostic res11: Dementia
Eu00111 Read [X]Alzheimer's disease type 1 diagnostic res11: Dementia
Eu00112 Read [X]Senile dementia,Alzheimer's type diagnostic res11: Dementia
Eu00113 Read [X]Primary degen dementia of Alzheimer's type, senile onset diagnostic res11: Dementia
Eu00200 Read [X]Dementia in Alzheimer's dis, atypical or mixed type diagnostic res11: Dementia
Eu00z00 Read [X]Dementia in Alzheimer's disease, unspecified diagnostic res11: Dementia
Eu00z11 Read [X]Alzheimer's dementia unspec diagnostic res11: Dementia
Eu01.00 Read [X]Vascular dementia diagnostic res11: Dementia
Eu01000 Read [X]Vascular dementia of acute onset diagnostic res11: Dementia
Eu01100 Read [X]Multi-infarct dementia diagnostic res11: Dementia
Eu01.11 Read [X]Arteriosclerotic dementia diagnostic res11: Dementia
Eu01111 Read [X]Predominantly cortical dementia diagnostic res11: Dementia
Eu01200 Read [X]Subcortical vascular dementia diagnostic res11: Dementia
Eu01300 Read [X]Mixed cortical and subcortical vascular dementia diagnostic res11: Dementia
Eu01y00 Read [X]Other vascular dementia diagnostic res11: Dementia
Eu01z00 Read [X]Vascular dementia, unspecified diagnostic res11: Dementia
Eu02z00 Read [X] Unspecified dementia diagnostic res11: Dementia
Eu02z11 Read [X] Presenile dementia NOS diagnostic res11: Dementia
Eu02z13 Read [X] Primary degenerative dementia NOS diagnostic res11: Dementia
Eu02z14 Read [X] Senile dementia NOS diagnostic res11: Dementia
Eu02z16 Read [X] Senile dementia, depressed or paranoid type diagnostic res11: Dementia
Eu04100 Read [X]Delirium superimposed on dementia diagnostic res11: Dementia
F110.00 Read Alzheimer's disease diagnostic res11: Dementia
F110000 Read Alzheimer's disease with early onset diagnostic res11: Dementia
F110100 Read Alzheimer's disease with late onset diagnostic res11: Dementia
Fyu3000 Read [X]Other Alzheimer's disease diagnostic res11: Dementia

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