Multilevel Analysis of Individual and Institutional Factors associated with Urinary Incontinence in Nursing Home Residents: a cross-sectional study

Jerez-Roig J1, de Oliveira N2, Moreno-Martin P1, Casacuberta-Roca J1, de Souza D3, Goutan-Roura E1, Coll-Planas L1, Wagg A4, Gibson W4, Gómez-Batiste X5

Research Type

Pure and Applied Science / Translational

Abstract Category

Geriatrics / Gerontology

Abstract 257
Conservative 4 - Conservative Interventions Across Settings
Scientific Podium Short Oral Session 22
Saturday 20th September 2025
09:30 - 09:37
Parallel Hall 4
Incontinence Gerontology Outcomes Research Methods
1. Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC). Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain, 2. Graduate Program in Rehabilitation and Functional Performance, University of Pernambuco, Physiotherapy Department, Petrolina, PE, Brazil, 3. Department of Collective Health, Graduate Program in Collective Health, Federal University of Rio Grande do Norte, Natal, Brazil, 4. Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada, 5. Chair of Palliative Care, Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic ? Central University of Catalonia, Vic, Barcelona, Spain
Presenter
J

Javier Jerez-Roig
Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC). Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
Links

Abstract

Hypothesis / aims of study 
Previous studies have used multilevel analysis to understand the influence of individual and institutional factors in different conditions such as functional disability, falls or frailty. However, to the best of our knowledge, no studies have considered this type of analysis for UI in NH residents. Therefore, the main objective of this study was to analyse individual and institutional factors associated with urinary incontinence (UI) in older adults living in nursing homes (NHs). As secondary objective, we wanted to estimate the prevalence of urinary, faecal and double incontinence in NH residents in Catalonia (Spain).
Study design, materials and methods 
Cross-sectional study following the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. We included adults aged 65+ living in 22 NHs. UI was assessed using the Resident Assessment Instrument - Minimum Data Set. Sociodemographic and health-related variables were considered. Descriptive, bivariate, and multivariate (multilevel) analyses were performed, calculating odds ratio (OR) as a measure of effect size. Multilevel analysis included: an empty model (Model 1) with only a random intercept, Model 2 with individual-level variables, Model 3 incorporating contextual-level variables and Model 4 combined both individual and contextual-level variables with a random intercept. Figure 1 provides an overview of the models used in the multilevel analysis.
Results 
452 residents were finally included: 75.9% female (with a mean (SD) age of 87.0 (7.7) years. The prevalence of UI, faecal incontinence and double incontinence was 77.5% (95% confidence interval-CI: 72.4-82.6), 46.1% (95%CI: 40.1-52.2) and 45.7% (95%CI: 39.6-51.7), respectively. UI was statistically significantly associated with neurological conditions (OR=1.91; 95%CI=1.16–3.14), moderate cognitive impairment (OR=1.96; 95%CI=1.02–3.74), moderate dementia (OR=3.16; 95%CI=1.58-6.35), severe cognitive impairment (OR=7.21; 95%CI=3.78–13.74), very severe cognitive impairment (OR=26.37; 95%CI=10.74–64.73) and age (OR=1.03; 95%CI=1.01-1.06), independent of sex. In the final model, institutional factors were unassociated with UI. Table 1 shows the results of the multilevel analysis.
Interpretation of results 
This study underscores the significance of individual-level interventions in preventing and managing UI in NHs. In Catalonian facilities, cognitive impairment and neurological conditions were more strongly associated with UI than institutional factors. These findings emphasize the need for enhanced care strategies, particularly for older adults with dementia and neurological disorders.
Concluding message 
Around 75% of NH residents suffered from UI, while nearly half had fecal or double incontinence. Individual factors such as cognitive function, neurological conditions, and age had a greater impact on UI than institutional factors.
Figure 1 Figure 1. Models considered in the multilevel analysis for UI in NH residents, including individual and institutional factors.
Figure 2 Table 1. Multilevel analysis between individual and institutional variables for UI in 22 NHs of Catalonia, Spain (n=452).
Disclosures
Funding This study received a grant from the Agency for Management of University, and Research Grants from the University and Research Department of Catalan Government (project code 2020PANDE00184). Clinical Trial No Subjects Human Ethics Committee The Ethics and Research Committee of the University of Vic – Central University of Catalonia approved the project with code 181/2021. Helsinki Yes Informed Consent Yes
Citation

Continence 15S (2025) 102181
DOI: 10.1016/j.cont.2025.102181

27/07/2025 15:26:49