Racial disparities in primary prevention of incontinence among older adults at nursing home admission

Racial Differences in Urinary Catheter Use Among Female Nursing Home Residents

OBJECTIVE

To assess racial differences in prevalence of indwelling urinary catheterization and intermittent catheterization among female NH residents in the United States (US).

METHODS

We performed a cross-sectional analysis using the 2019 Minimum Data Set 3.0 and developed a multivariable logistic regression model to examine the association between catheter use and race. Moderation analyses were performed to clarify significant associations.

RESULTS

Our study cohort was composed of 597,966 women, who were predominantly of White race with a median age of 80 years. Eight percent (n=47,799) of female residents had indwelling catheters, and 0.5% (n=2,876) used intermittent catheterization. Black residents had a 7% lower odds of having an indwelling catheter (aOR 0.93, 95% CI 0.90-0.96), and a 38% lower odds of utilizing intermittent catheterization (aOR 0.62, 95% CI 0.54-0.71) compared to White residents when controlling for common factors associated with catheter use. In moderation analyses, Black residents with age under 80 years and BMI of 35 kg/m2 or greater were less likely to have an indwelling catheter than age- and BMI-matched White residents.

CONCLUSION

Racial differences in both indwelling and intermittent catheterization prevalence exist in female NH residents. These disparities should be further clarified to reduce bias in NH care.

Evaluating for Racial Differences in Pain Management of Long-Bone Fractures in a Pediatric Rural Population

OBJECTIVES

The aim of this study was to determine if a racial disparity exists in the administration of an analgesic, time to receiving analgesic, and type of analgesic administered to children with long-bone fractures. Prior studies have reported the existence of racial disparity but were mostly in adult and urban populations.

METHODS

This is a retrospective chart review of 727 pediatric patients (aged 2-17 years) with International Classification of Diseases, Ninth Revision (or 10th revision) codes for long-one fractures in an emergency department that cares for a suburban and rural population between January 2013 and January 2016. Logistic regression was used to estimate the odds ratio of receiving no analgesic versus receiving an analgesic and receiving a nonopioid versus opioid drug. Linear regression analysis was performed to study the relationship between race and time to receive the analgesic, after adjusting for sex, age, insurance type, and mechanism of injury.

RESULTS

Of the 727 children, 27% of them did not receive analgesics regardless of race. 27% (164/605) of white children, 25% (8/31) of African American children, and 24% (12/49) of Hispanic children did not receive analgesics. African Americans are 12% more likely (odds ratio [OR], 1.12; 95% confidence interval [CI], 0.48-2.61) to receive an analgesic compared with whites, and Hispanics are 22% more likely (OR, 1.22; 95% CI, 0.60-2.45) to receive an analgesic than whites. African Americans are 26% less likely (OR, 0.74; 95% CI, 0.31-1.75) to receive an opioid versus a nonopioid compared with whites, and Hispanics are 92% more likely (OR, 1.92; 95% CI, 0.91-4.17). Mean wait time across all races was 69 minutes, with no statistical difference between groups.

CONCLUSIONS

This study showed no statistical significance in the receipt or type of analgesic or wait time for pediatric long-bone fractures between race in a major academic level 1 trauma children's hospital, despite previous literature citing otherwise. This study augments to the few studies conducted in a rural setting. It is also one of the few studies that analyzed pain management in a large pediatric population as well as used waiting time to receive analgesic as an outcome measure. Overall, we found a mean wait time of 69 minutes for analgesic administration regardless of race, suggesting the need for more prompt pain management across all races for the management of long-bone fracture in the pediatric population.

Prevalence and Associated Factors of Fecal Incontinence and Double Incontinence among Rural Elderly in North China

Fecal and double incontinence are known to be more prevalent among the rural elderly. Yet, there have been few studies on their epidemic condition among Chinese rural elders. This study estimated the prevalence and correlates of fecal and double incontinence in rural elderly aged 65 years and over in North China. A multisite cross-sectional survey was conducted in 10 villages, yielding a sampling frame of 1250 residents. Fecal and urinary incontinence assessments were based on the self-reported bowel health questionnaire and the International Consultation on Incontinence Questionnaire-Short Form, respectively. The concomitant presence of fecal and urinary incontinence in the same subject was defined as double incontinence. The prevalence of fecal and double incontinence was 12.3% and 9.3%, respectively. Factors associated with fecal incontinence included urinary incontinence, lack of social interaction, traumatic brain injury, cerebrovascular disease, and poverty. Physical activities of daily living dependence, traumatic brain injury, lack of social interaction, and poor sleep quality were associated with higher odds of having double incontinence, whereas tea consumption was correlated with lower odds. Individualized intervention programs should be developed targeting associated factors and high-risk populations. These intervention programs should be integrated into existing public health services for the rural elderly to facilitate appropriate prevention and management of incontinence.

Review of the 6th International Consultation on Incontinence: Primary prevention of urinary incontinence

AIMS

To report the state of the science on primary prevention of urinary incontinence (UI) in adults from the 6th International Consultation on Incontinence with an update through January 2019.

METHODS

Online databases PubMed, CINAHL, PsycInfo, and Medline were searched in March 2016 and February 2019 with a focus on literature published after 2010. The International Consultation on Urological Diseases modified Oxford Centre for Evidence-Based Medicine Levels of Evidence and grades of recommendation were used to evaluate the literature.

RESULTS

Grade B recommendations to prevent UI in pregnant and postpartum women are available and promising evidence exists for educational interventions to prevent UI up to 2 years in older women. There is little evidence for adding preoperative pelvic floor muscle exercises to postprostatectomy pelvic floor muscle exercises for men to regain continence. Insufficient evidence exists for the effectiveness of screening for UI in women. The absence of information on primary prevention remains for adolescents, nulliparous and perimenopausal women, and middle-aged and aged men and women.

CONCLUSIONS

Few primary prevention interventions for UI exist for specific populations, especially pregnant and postpartum women. Research interest in developing foundational knowledge to design these interventions is growing.

Prevention of Incontinence-Associated Skin Damage in Nursing Homes

Racial/ethnic disparities in preventing health problems have been reported in nursing homes. Incontinence is common among nursing home residents and can result in inflammatory-type skin damage, referred to as incontinence-associated skin damage (IASD). Little is known about the prevention of IASD and whether there are racial/ethnic disparities in its prevention. This study assessed the proportion of older nursing home residents receiving IASD prevention after developing incontinence after admission ( n = 10,713) and whether there were racial/ethnic disparities in IASD prevention. Predictors of preventing IASD were also examined. Four national data sets provided potential predictors at multiple levels. Disparities were analyzed using the Peters-Belson method; predictors of preventing IASD were assessed using hierarchical logistic regression. Prevention of IASD was received by 0.12 of residents and no racial/ethnic disparities were found. Predictors of preventing IASD were primarily resident-level factors including limitations in activities of daily living, poor nutrition, and more oxygenation problems.