Prevalence and correlates of fecal incontinence in community-dwelling older adults.

OBJECTIVES

To determine prevalence and correlates of fecal incontinence in older community-dwelling adults.

DESIGN

A cross-sectional, population-based survey.

SETTING

Participants interviewed at home in three rural and two urban counties in Alabama from 1999 to 2001.

PARTICIPANTS

The University of Alabama at Birmingham Study of Aging enlisted 1,000 participants from the state Medicare beneficiary lists. The sample was selected to include 25% black men, 25% white men, 25% black women, and 25% white women.

MEASUREMENTS: The survey included sociodemographic information, medical conditions, health behaviors, life-space assessment (mobility), and self-reported health status. Fecal incontinence was defined as an affirmative response to the question "In the past year, have you had any loss of control of your bowels, even a small amount that stained the underwear?" Severity was classified as mild if reported less than once a month and moderate to severe if reported once a month or greater.

RESULTS

The prevalence of fecal incontinence in the sample was 12.0% (12.4% in men, 11.6% in women; P=.33). Mean age+/-standard deviation was 75.3+/-6.7 and ranged from 65 to 106. In a forward stepwise logistic regression analysis, the following factors were significantly associated with the presence of fecal incontinence in women: chronic diarrhea (odds ratio (OR)=4.55, 95% confidence interval (CI)=2.03-10.20), urinary incontinence (OR=2.65, 95% CI=1.34-5.25), hysterectomy with ovary removal (OR=1.93, 95% CI=1.06-3.54), poor self-perceived health status (OR=1.88, 95% CI=1.01-3.50), and higher Charlson comorbidity score (OR=1.29, 95% CI=1.07-1.55). The following factors were significantly associated with fecal incontinence in men: chronic diarrhea (OR=6.08, 95% CI=2.29-16.16), swelling in the feet and legs (OR=3.49, 95% CI=1.80-6.76), transient ischemic attack/ministroke (OR=3.11, 95% CI=1.30-7.41), Geriatric Depression Scale score greater than 5 (OR=2.83, 95% CI=1.27-6.28), living alone (OR=2.38, 95% CI=1.23-4.62), prostate disease (OR=2.29, 95% CI=1.04-5.02), and poor self-perceived health (OR=2.18, 95% CI=1.13-4.20). The following were found to be associated with increased frequency of fecal incontinence in women: chronic diarrhea (OR=6.39, 95% CI=2.25-18.14), poor self-perceived health (OR=5.37, 95% CI=1.75-16.55), and urinary incontinence (OR=4.96, 95% CI=1.41-17.43). In men, chronic diarrhea (OR=5.38, 95% CI=1.77-16.30), poor self-perceived health (OR=3.91, 95% CI=1.39-11.02), lower extremity swelling (OR=2.86, 95% CI=1.20-6.81), and decreased assisted life-space mobility (OR=0.73, 95% CI=0.49-0.80) were associated with more frequent fecal incontinence.

CONCLUSION

In community-dwelling older adults, fecal incontinence is a common condition associated with chronic diarrhea, multiple health problems, and poor self-perceived health. Fecal incontinence should be included in the review of systems for older patients.