Urinary Incontinence Is an Independent Risk Factor for Nursing Home Placement among Assisted Living Residents

Objectives: Prior studies suggested that urinary incontinence (UI) may be a risk factor for nursing home (NH) placement among older community-dwelling individuals. Our objectives were to evaluate if UI is an independent risk factor in NH placement among assisted living (AL) residents and assess the impact of UI on NH placement by race/ethnicity. Design: This retrospective cohort study is based on the 2019-2021 Medicare enrollment and claims data. Setting and Participants: Medicare beneficiaries residing in AL communities, and those with a new UI diagnosis, between January 1, 2020, and June 30, 2020, were identified. All residents were followed through December 31, 2021, to identify permanent NH placement (length of stay >= 90 days). Methods: Individual covariates (age, race/ethnicity, chronic conditions) and AL community factors (bed size, proportion of Medicare-Medicaid dually eligible residents) were included. We estimated logistic regression models with individual and AL random effects and robust SEs. Interaction effects were estimated to examine differences in NH placement by race/ethnicity. Results: Of 247,010 AL residents, 20.45% had UI. Overall, 15.7% of residents were permanently placed in NHs during the study period; 14.2% had no UI, and 21.7% had UI. After controlling for confounders, UI significantly (P < .01) increased the probability of NH placement, a 14% increase relative to the mean. Compared with white residents without UI, white residents with UI had 1.93 percentage point (pp) higher probability of NH placement. Although Black and Hispanic residents overall had lower risk of placement, that risk increased significantly for residents with UI: 3.43 pp higher for Black residents and 3.68 pp higher for Hispanic residents. Conclusions and Implications: This first and largest study of UI in AL communities demonstrated that UI is an independent risk factor for permanent NH placement. Education and identifying and treating UI early may allow AL residents to avoid or delay NH placement. (c) 2024 Post-Acute and Long-Term Care Medical Association.