Predictors of Institutionalization in an Older Population During a 13-Year Period: The Effect of Urge Incontinence

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Abstract
Background. Longitudinal data on predictors of institutionalization in random older populations are limited. The aim here was to identify predictors of institutionalization in an unselected older population during a period of 13 years with a special focus on the prognostic value of urge incontinence. Methods. A population-based prospective survey was conducted involving 366 men and 409 women aged 60 years and older. Age-adjusted and multivariate Cox proportional hazards models were used to examine the predictive association of urge incontinence, living arrangements, neurological, cardiovascular, musculoskeletal, and other chronic diseases, activities of daily living (ADL) disability, and depressive symptoms with institutionalization separately in men and women. Results. Adjusted for age, ADL disability and other chronic diseases predicted institutionalization in both men and women. Urge incontinence and depressive symptoms in men and living alone and cardiovascular diseases in women were also significant predictors. In multivariate analyses where all potential predictors were included simultaneously, age (RR [relative risk] 1.15; 95% CI [confidence interval] 1.10–1.19), urge incontinence (RR 3.07; 95% CI 1.24–7.59), and depressive symptoms (RR 1.22; 95% CI 1.00–1.48) remained significant predictors of institutionalization in men. In women, age (RR 1.15; 95% CI 1.12–1.19) and living alone (RR 2.02; 95% CI 1.27–3.21) were independent predictors. Conclusions. In addition to age, urge incontinence and depressive symptoms in men and living alone in women are significant prognostic indicators of institutionalization. The greater prognostic value of urge incontinence in men compared with women emphasizes the importance of interventions aimed at promoting continence and coping with the problem both at the individual and caregiver levels especially among older men.