Urinary incontinence (UI) is one of the most common and distressing conditions affecting nursing home residents and their caregivers and staff. It has an adverse impact on physical health, psychosocial status, and the costs of health care. Some clinical trials have suggested proper toileting assistance could promote continence. Unfortunately, no survey to date was done to investigate prevalence and relative risk factors of incontinence and continence management strategies in Taiwan. It is not clear if residents receive proper assistance in toileting and selection of diapers are not clear. The aim of this study was to investigate the prevalence and continence care strategies among elderly population living in the long-term care institution.

A cross-sectional survey was done and 810 subjects were recruited from long-term care institutions in Eastern  Taiwan, Stratified cluster sampling to ensure representativeness of the target population.  Incontinence status and continence care strategies were investigated by trained research assistants. Clinical data were derived from a retrospective clinic medical record review and checklists including mobility, incontinence status, and continence care products use, toileting assistance, and daily fluid intakes were used to recorded the current continence care status.

Average age of the sample was 81.46yrs, 52.9% were female, average lengths of stay in the institution were 3 years, numbers of comorbidity 3.82, and average number of daily medication 11.48 tablets. Prevalence of urinary incontinence(UI) was 40%, and 7.8% for fecal incontinence and 29% with double incontinence. Elderly needed wheelchair assistance was up to 63.6%. Total dependence which classified by Barthel index less than 40 was up to 384 (47.4%), average CDR（Clinical Dementia Rating）is 2.65, 243 people had severe cognitive disabilities (30.4%) by measurement of MMSE（Mini-Mental State Examination）. 
The odd ratio between UI and related disease are stated as follow: chronic diseases as pressure sores was 10.11 (p=.03), brain vascular disease was  4.18 (p=.00), urinary infection 8.19 (p=. 00), dementia 5.74 (p=. 00). The odd ratio  between UI and lower extremity activity were analyzed and the results revealed that unable to stand or hip lifting had significantly higher risks of wearing diapers, (OR 29.86, p <.0001) . In addition,  unable to stand but able to lift hip for 30 seconds still obtain a higher risk on diaper use( OR 6.77, p <.001). The odd ratio  between UI and degree of cognitive impairment by MMSE found that severe, moderate and mild cognitive impairment was 8.94, 3.35, and 2.94 respectively.  
In related to diaper use, 639 (78.9%) of the total participants wore diaper , and use of adhesive-tape diaper is 475 (74.3%). For the people using diapers, 99 (12.2%)of them could ambulate independently without assistance but still wearing diapers.  And 247(51.5%)of the subjects who wear adhesive-tape diaper were able to stand for 30 seconds.

The results of this study discover that urinary tract infections, pressure sores, dementia and muscle strength for standing and hip lifting were risk factors in developing incontinence. Effective assessment of the related risk factors can slow down the occurrence of incontinence.

This study suggested that long term care institutions should implement an incontinence assessment system for early detection of high risk groups to improve the quality of the institutionalized elderly population by early intervention and treatment, by keeping daily physical activities, body functions and reduction of diaper use.