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Factors Associated With Toileting Disability in Older Adults Without Dementia Living in Residential Care Facilities

Talley, Kristine M. C.; Wyman, Jean F.; Bronas, Ulf G.; Olson-Kellogg, Becky J.; McCarthy, Teresa C.; Zhao, Hong

doi: 10.1097/NNR.0000000000000017

Background: Older adults without dementia living in residential care facilities with toileting disability have increased care costs and dependency. Understanding associated factors could guide prevention and management strategies.

Objective: The aim of this study was to identify the prevalence of and factors associated with toileting disability in this population.

Methods: This was a cross-sectional analysis of the 2010 National Survey of Residential Care Facilities. A subsample (n = 2,395) of adults aged 65 years or older, without dementia, and with the potential to implement behavioral interventions was examined. Associated factors were classified according to the disablement process as pathologies, impairments, functional limitations, coexisting disabilities, and intraindividual and extraindividual factors. Logistic regression models accounting for the stratified two-stage probability sampling design were used to identify factors associated with toileting disability.

Results: Residents were mostly White women, aged 85 years and older. Prevalence of toileting disability was 15%. Associated factors included reporting fair or poor health; living in a facility with four or less residents; living in a for-profit facility; having bowel incontinence, urinary incontinence, more physical impairments, and visual and hearing impairments; and needing assistance with bathing, dressing, and transferring.

Discussion: Multicomponent and multidisciplinary prevention and management efforts should be designed for residents without dementia. Future studies testing the efficacy of prevention efforts are needed and should include treatments for incontinence; physical activity programs targeting impairments with walking, standing, sitting, stooping, reaching, and grasping; and therapy to improve dressing, bathing, and transferring skills.

Kristine M. C. Talley, PhD, is Assistant Professor; Jean F. Wyman, PhD, is Professor; and Ulf G. Bronas, PhD, is Assistant Professor, School of Nursing, University of Minnesota, Minneapolis.

Becky J. Olson-Kellogg, DPT, is Assistant Professor, Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis.

Teresa C. McCarthy, MD, is Assistant Professor, Family Medicine/Community Health, University of Minnesota, Minneapolis.

Hong Zhao, MS, is Graduate Student, Department of Biostatistics, University of Minnesota, Minneapolis.

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Accepted for publication October 24, 2013.

This study was supported partially by funds from the National Institute of Nursing Research (NIH 1R15NR010632-010).

The authors acknowledge their research was supported by the Building Interdisciplinary Research Careers in Women’s Health Grant (#K12HD055887) from the Eunice Kennedy Shriver National Institutes of Child Health and Human Development (NICHD), the Office of Research on Women’s Health, and the National Institute on Aging, NIH, administered by the University of Minnesota Deborah E. Powell Center for Women’s Health. The content is solely the responsibility of the authors and does not necessarily represent the office views of the NICHD or NIH. Parts of this project were presented at the 2012 Gerontological Society of America’s Annual Meeting in San Diego, CA.

The authors have no conflicts of interest to report.

Corresponding author: Kristine M. C. Talley, PhD, School of Nursing, University of Minnesota, Minneapolis, MN 55455 (e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.