Incontinence-Associated Dermatitis in Nursing Homes: Prevalence, Severity, and Risk Factors in Residents With Urinary and/or Fecal Incontinence

Abstract

Purpose: The purpose of this study was to estimate the prevalence and severity of incontinence-associated dermatitis (IAD) in incontinent nursing home residents by using the Incontinence-Associated Dermatitis Intervention Tool-D (IADIT-D) and to identify potential risk factors.

Methods: From 2012 to 2014, 3 consecutive annual cross-sectional multicenter studies in 5785 residents in 78 German nursing homes were conducted. Secondary data analysis was performed including all incontinent residents with complete data from the German version of the IADIT-D and validated instrument to assess IAD. Logistic regression analysis was used to identify independent variables associated with IAD occurrence.

Results: The overall prevalence of any type of incontinence was 68.3%. Of the total sample, 58.8% (n = 3406) were eligible for the study. Estimated point prevalence of IAD was 5.2% (95% confidence interval [CI], 4.5%-6.0%). According to the IADIT-D, the prevalence of patients with high risk for IAD was 25.3%; early IAD, 2.1%; moderate, 2.0%; severe, 0.2%; and fungal-appearing rash, 1.0%. Body mass index (odds ratio [OR], 1.06; 95% CI, 1.03-1.09), fall risk (OR, 0.91; 95% CI, 0.86-0.97), pressure injury (OR, 2.24; 95% CI, 1.24-4.04), and female gender (OR, 0.64; 95% CI, 0.43-0.94) were statistically significantly associated with IAD in residents with urinary and/or fecal incontinence.

Conclusions: IAD is prevalent in nursing home residents. Knowledge about potential risk factors, for example higher body mass index, should be enhanced and integrated into planning of nursing interventions especially skin protection measures.