Interactions of Factors and Profiles of Incontinent Nursing Home Residents and Hospital Patients: A Classification Tree Analysis

Abstract

Purpose: To investigate the interactions among well-known influencing factors for urinary incontinence (UI), fecal incontinence (FI), and double urinary and fecal incontinence (DI) in the nursing home and hospital setting and to identify profiles of UI, FI, and DI residents and patients.

Subjects and setting: Data from more than 4200 residents and patients from 16 nursing homes and 36 hospitals were collected.

Design: This was a cross-sectional study.

Methods: A cross-sectional study was used for data collection. The Austrian version of the International Prevalence Measurement of Care Problems survey was used to collect data about different nursing care problems (eg, pressure ulcer and incontinence). To improve objectivity, 2 nurses assessed each resident/patient. The Care Dependency Scale (CDS) was used to measure the degree of care dependency regarding different needs such as mobility, with lower scores indicating a higher level of care dependency. A classification and regression tree analysis was used to determine the interactions among factors and develop profiles of incontinent residents and patients.

Results: Interactions between the CDS-items of states of Dress/Undress, Hygiene, Mobility, and Eat/Drink and age based on incontinence were found in nursing home residents. In contrast, interactions between the CDS-items Hygiene and Eat/Drink, as well as age and gender based on incontinence, were identified in hospitalized patients. Residents with UI were care dependent with reference to the CDS-item Dress/Undress. Patients with UI were older than 77.5 years and completely, or to a great extent, care dependent with reference to the CDS-item Hygiene. Nursing home residents with DI were completely, or to a great extent, care dependent with regard to the CDS-item Hygiene and completely care dependent with reference to the CDS-item Dress/Undress. In comparison, hospitalized DI patients were completely, or to a great extent, care dependent with regard to the CDS-item Hygiene.

Conclusions: The results of this study show that independently associated factors for incontinence also influence each other. Furthermore, these interactions increase the prevalence for incontinence and differ with regard to the type of incontinence and setting.