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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: incontinence
85 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 1593 | Read | H/O: stress incontinence | diagnostic | res11: incontinence | |||
| 16F..00 | Read | Double incontinence | diagnostic | res11: incontinence | |||
| 19E3.00 | Read | Incontinent of faeces | diagnostic | res11: incontinence | |||
| 19E3.11 | Read | Incontinent of faeces symptom | diagnostic | res11: incontinence | |||
| 1A23.00 | Read | Incontinence of urine | diagnostic | res11: incontinence | |||
| 1A24.00 | Read | Stress incontinence | diagnostic | res11: incontinence | |||
| 1A24.11 | Read | Stress incontinence - symptom | diagnostic | res11: incontinence | |||
| 1A25.00 | Read | Urgency | diagnostic | res11: incontinence | |||
| 1A25.11 | Read | Urgency of micturition | diagnostic | res11: incontinence | |||
| 1A26.00 | Read | Urge incontinence of urine | diagnostic | res11: incontinence | |||
| 1A27.00 | Read | Urge to pass urine again shortly after finishing voiding | diagnostic | res11: incontinence | |||
| 1A27.11 | Read | Pis en deux | diagnostic | res11: incontinence | |||
| 1A36.00 | Read | Terminal dribbling of urine | diagnostic | res11: incontinence | |||
| 1A37.00 | Read | Dribbling of urine | diagnostic | res11: incontinence | |||
| 222K.00 | Read | Smells of urine | diagnostic | res11: incontinence | |||
| 3930 | Read | Bowels: incontinent | diagnostic | res11: incontinence | |||
| 3931 | Read | Bowels: occasional accident | diagnostic | res11: incontinence | |||
| 393..11 | Read | Bowels - continence | diagnostic | res11: incontinence | |||
| 393..12 | Read | Bowels-incontinence assessment | diagnostic | res11: incontinence | |||
| 3940 | Read | Bladder: incontinent | diagnostic | res11: incontinence | |||
| 3941 | Read | Bladder: occasional accident | diagnostic | res11: incontinence | |||
| 394..11 | Read | Bladder-incontinence assessmnt | diagnostic | res11: incontinence | |||
| 394..12 | Read | Bladder- continence assessment | diagnostic | res11: incontinence | |||
| 39H..00 | Read | Continence assessment | diagnostic | res11: incontinence | |||
| 39H0.00 | Read | Continence reassessment | diagnostic | res11: incontinence | |||
| 679H.00 | Read | Health education - continence | diagnostic | res11: incontinence | |||
| 679H.11 | Read | Promotion of continence | diagnostic | res11: incontinence | |||
| 7B31200 | Read | Colposuspension of bladder neck | diagnostic | res11: incontinence | |||
| 7B31211 | Read | Burch colposuspension | diagnostic | res11: incontinence | |||
| 7B33800 | Read | Insertion retropubic device stress urinary incontinence NEC | diagnostic | res11: incontinence | |||
| 7B33C00 | Read | Insertion retropubic dev fem stress urinary incontinence NEC | diagnostic | res11: incontinence | |||
| 7B42100 | Read | Insertion of bulbar urethral prosthesis | diagnostic | res11: incontinence | |||
| 7B42111 | Read | Insertion of Kaufman prosthesis for male incontinence | diagnostic | res11: incontinence | |||
| 7B42112 | Read | Insertion of prosthesis for compression bulb of male urethra | diagnostic | res11: incontinence | |||
| 7B42113 | Read | Insertion of Rosen prosthesis for male incontinence | diagnostic | res11: incontinence | |||
| 7D17.11 | Read | Colporrhaphy and amputation of cervix uteri | diagnostic | res11: incontinence | |||
| 8C14.00 | Read | Incontinence care | diagnostic | res11: incontinence | |||
| 8C14.11 | Read | Continence care | diagnostic | res11: incontinence | |||
| 8D7..00 | Read | Urinary bladder control | diagnostic | res11: incontinence | |||
| 8D71.00 | Read | Incontinence control | diagnostic | res11: incontinence | |||
| 8D7..11 | Read | Bladder control | diagnostic | res11: incontinence | |||
| 8D7..12 | Read | Incontinence control | diagnostic | res11: incontinence | |||
| 8D74.00 | Read | Indwelling urethral catheter | diagnostic | res11: incontinence | |||
| 8D74.11 | Read | Catheter in situ | diagnostic | res11: incontinence | |||
| 8D75.00 | Read | Penile sheath provision | diagnostic | res11: incontinence | |||
| 8D7Z.00 | Read | Urinary bladder control NOS | diagnostic | res11: incontinence | |||
| 8E97.00 | Read | Bladder training | diagnostic | res11: incontinence | |||
| 8E97000 | Read | Bladder drill | diagnostic | res11: incontinence | |||
| 8H7w.00 | Read | Referral to continence nurse | diagnostic | res11: incontinence | |||
| 8HR6.00 | Read | Refer to Urodynamic studies | diagnostic | res11: incontinence | |||
| 8HTX.00 | Read | Referral to incontinence clinic | diagnostic | res11: incontinence | |||
| 9Nl8.00 | Read | Seen by continence nurse | diagnostic | res11: incontinence | |||
| K198.00 | Read | Stress incontinence | diagnostic | res11: incontinence | |||
| K586.00 | Read | Stress incontinence - female | diagnostic | res11: incontinence | |||
| Kyu5A00 | Read | [X]Other specified urinary incontinence | diagnostic | res11: incontinence | |||
| R076.00 | Read | [D]Incontinence of faeces | diagnostic | res11: incontinence | |||
| R076100 | Read | [D]Sphincter ani incontinence | diagnostic | res11: incontinence | |||
| R076z00 | Read | [D]Incontinence of faeces NOS | diagnostic | res11: incontinence | |||
| R083.00 | Read | [D]Incontinence of urine | diagnostic | res11: incontinence | |||
| R083100 | Read | [D]Urethral sphincter incontinence | diagnostic | res11: incontinence | |||
| R083200 | Read | [D] Urge incontinence | diagnostic | res11: incontinence | |||
| R083z00 | Read | [D]Incontinence of urine NOS | diagnostic | res11: incontinence | |||
| R086200 | Read | [D] Urgency of micturition | diagnostic | res11: incontinence | |||
| Z121400 | Read | Assisting with toileting | diagnostic | res11: incontinence | |||
| Z1J..00 | Read | Procedures to aid continence | diagnostic | res11: incontinence | |||
| Z1J1.00 | Read | Taking the patient to toilet | diagnostic | res11: incontinence | |||
| Z1J2.00 | Read | Attaching penile sheath | diagnostic | res11: incontinence | |||
| Z1J3.00 | Read | Putting incontinence pad on | diagnostic | res11: incontinence | |||
| Z1J4.00 | Read | Changing incontinence pad | diagnostic | res11: incontinence | |||
| Z1S..00 | Read | Toileting regimes | diagnostic | res11: incontinence | |||
| Z1S1.00 | Read | Regular toileting | diagnostic | res11: incontinence | |||
| Z1S2.00 | Read | Planned voiding | diagnostic | res11: incontinence | |||
| Z1S2100 | Read | Planned voiding two hourly | diagnostic | res11: incontinence | |||
| Z89A.00 | Read | Ability to perform toileting activities | diagnostic | res11: incontinence | |||
| Z89A100 | Read | Does not perform toileting activities | diagnostic | res11: incontinence | |||
| Z89A200 | Read | Difficulty performing toileting activities | diagnostic | res11: incontinence | |||
| Z89AE00 | Read | Unable to use urine bottle | diagnostic | res11: incontinence | |||
| Z915.00 | Read | Urinary catheter appliance procedures | diagnostic | res11: incontinence | |||
| Z915.11 | Read | Urinary catheter care | diagnostic | res11: incontinence | |||
| ZL22400 | Read | Under care of continence nurse | diagnostic | res11: incontinence | |||
| ZL62400 | Read | Referral to continence nurse | diagnostic | res11: incontinence | |||
| ZLA2400 | Read | Seen by continence nurse | diagnostic | res11: incontinence | |||
| ZLD7400 | Read | Discharge by continence nurse | diagnostic | res11: incontinence | |||
| ZQ3C.00 | Read | Bowels incontinence assessment | diagnostic | res11: incontinence | |||
| ZRas400 | Read | OPCS continence disability scale | diagnostic | res11: incontinence |
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