January 31, 2025
In the first national study of urinary incontinence among assisted living residents, New York researchers found that the condition significantly increased the probability of those residents being moved to a nursing home.
But education for caregivers and residents and their family members, as well as early identification and treatment of the condition, may increase resident length of stay in assisted living, the researchers said.
In the study published Monday in JAMDA–The Journal of the Post-Acute and Long-Term Care Medical Association, researchers from Memorial Sloan Kettering Cancer Center and the University of Rochester Medical Center found that urinary incontinence is an independent risk factor for nursing home placement among assisted living residents, increasing the probability of a transfer to a nursing home by 14%.
The retrospective study was based on 2019-2021 Medicare data from 247,000 assisted living residents, 20.45% of whom had urinary incontinence. Overall, 15.7% of assisted living residents were moved to nursing homes during the study period, 21.7% with urinary incontinence and 14.2% without.
Compared with residents without urinary incontinence, those who had urinary incontinence were slightly older, more likely to be non-Hispanic white, and more likely to be dually eligible for Medicare and Medicaid. Among white assisted living residents, urinary incontinence was associated with a 1.93 percentage point increase in the probability of being relocated to a nursing home. Although Black and Hispanic residents had a lower risk of nursing home placement, that risk increased significantly with urinary incontinence: it was 3.43 percentage points higher for Black residents and 3.68 percentage points higher for Hispanic residents.
Overall, residents with urinary incontinence also were more likely to experience comorbid chronic conditions compared with those without the condition, including Alzheimer’s disease and related dementias (35.6% versus 18.4%), chronic heart failure (33.7% versus. 16.9%), pressure ulcers (24.2% versus 12.1%) and depression (56.2% versus 30%).
According to the study, the prevalence of urinary incontinence is as high as 70% among nursing home residents, and falls, pressure ulcers, social isolation, depression and caregiver stress are common adverse consequences of urinary incontinence. Urinary incontinence has been shown to reduce self-reported quality of life among nursing home residents, and it is associated with an increased burden on caregivers, the researchers said.
Although assisted living communities provide limited medical and health services, the availability of personal care services may be insufficient due to poor staff training and lower staffing levels, the authors said, adding that those factors often influence resident outcomes.
“Treatment options implemented in assisted living communities have the potential to change the trajectory of assisted living-to-nursing home placement for many residents with urinary incontinence, allowing them to age in place,” the study authors concluded. “Educating residents, family members and providers, and identifying and treating urinary incontinence early in the course of the disease may allow assisted living residents to avoid or delay nursing home placement.”
