Survey of Geriatricians on the Effect of Fecal Incontinence on Nursing Home Referral
- 1 June 2010
- journal article
- research article
- Published by Wiley in Journal of the American Geriatrics Society
- Vol. 58 (6), 1058-1062
- https://doi.org/10.1111/j.1532-5415.2010.02863.x
Abstract
OBJECTIVES: Determine the effect of fecal incontinence (FI) on healthcare providers' decisions to refer patients for nursing home (NH) placement. DESIGN: Survey. SETTING: Questionnaires were e‐mailed to participants' homes or offices. Participants could also volunteer at the 2008 American Geriatric Society annual meeting in Washington, DC. PARTICIPANTS: Two thousand randomly selected physician members and all 181 nurse practitioner members of the American Geriatrics Society were surveyed. MEASUREMENTS: The survey presented a clinical scenario of a 70‐year‐old woman ready for discharge from a hospital and asked about the likelihood of making a NH referral if the patient had no incontinence, urinary incontinence (UI) alone, or FI. Subsequent questions modified the clinical situation to include other conditions that might affect the decision to refer. A second survey of respondents to Survey 1 addressed possible moderators of the decision to refer (e.g., family caregiver presence, diarrhea or constipation, other physical or psychiatric limitations). Significance of differences in the relative risk (RR) for NH referral was tested using the chi‐square test. RESULTS: Seven hundred sixteen members (24.7% response rate) completed the first survey, and 686 of the 716 (96%) completed the second. FI increased the likelihood of NH referral (RR=4.71, P<.001) more than UI did (RR=1.90, P<.001). Mobility restrictions, cognitive decline, and multiple chronic illnesses increased the likelihood of NH referral more than FI alone (P<.001 for each), but in all scenarios, adding FI further increased the likelihood of referral (P<.001). Having family caregivers willing to help with toileting attenuated the likelihood of referral. CONCLUSION: FI increases the probability that geriatricians will refer to a NH. More‐aggressive outpatient treatment of FI might delay or prevent NH referral, improve quality of life, and reduce healthcare costs.Keywords
This publication has 16 references indexed in Scilit:
- Randomized Controlled Trial Shows Biofeedback to be Superior to Pelvic Floor Exercises for Fecal IncontinenceDiseases of the Colon & Rectum, 2009
- Fecal Incontinence in US Adults: Epidemiology and Risk FactorsGastroenterology, 2009
- Cholestyramine—a useful adjunct for the treatment of patients with fecal incontinenceInternational Journal of Colorectal Disease, 2007
- Geriatric syndromes as predictors of adverse outcomes of hospitalizationInternal Medicine Journal, 2007
- Characteristics Predicting Nursing Home Admission in the Program of All-Inclusive Care for Elderly PeopleThe Gerontologist, 2005
- Randomized controlled trial of biofeedback for fecal incontinenceGastroenterology, 2003
- Treatment options for fecal incontinenceDiseases of the Colon & Rectum, 2001
- Fecal incontinence in Wisconsin nursing homesDiseases of the Colon & Rectum, 1998
- Medically recognized urinary incontinence and risks of hospitalization, nursing home admission and mortalityAge and Ageing, 1997
- Predictors of Nursing Home Placement in Community‐Based Long‐term CareJournal of the American Geriatrics Society, 1995