Urinary and fecal incontinence are independently associated with falls risk among older women and men with complex needs: a national population study

Aims: To determine the relationships between urinary incontinence (UI), fecal incontinence (FI), and falls risk among community-dwelling older women and men with complex needs, after controlling for confounders. Methods: All community care recipients in New Zealand undergo standardized needs assessments, using the Home Care International Residential Assessment Instrument (interRAI-HC), which elicits information over multiple domains, including UI and FI frequency and falls. Consenting women and men aged greater than or equal to 65 years with at least one interRAI-HC assessment undertaken between 1 July 2012 and 1 June 2018 were investigated using multilevel mixed effects ordinal regression models, stratified by sex. Results: Overall, 57 781 (61.8%) women and 35 681 (38.2%) men were eligible, contributing 138 302 interRAI-HC assessments. At first assessment, the average age was 82.0 years (range: 65-109 years); high falls risk was common, found among 8.8% of women and 12.4% of men; and 43.7% of women and 33.7% of men reported some incontinence. For women, the adjusted odds of increasing falls risk was 1.24 (95% CI: 1.18, 1.30) for those with occasional UI, 1.36 (95% CI: 1.29, 1.43) for those with frequent UI, and 1.19 (95% CI: 1.13, 1.26) for those with any FI compared with their continent counterparts. Among men, the adjusted odds were 1.49 (95% CI: 1.41, 1.58) for any UI and 1.18 (95% CI: 1.10, 1.27) for any FI. Conclusion: UI and FI are common, have separate associations with falls risk among women and men, and would benefit from routine screening in primary health care for older adults.