Absorbent incontinence pad use and the association with urinary tract infection and frailty: A retrospective cohort study

Background: Up to 40% of adults over 65 years are full-time users of absorbent incontinence padsdue to urinary incontinence. Simultaneously, urinary tract infection is amongst the most commonhospital-acquired infection in older patients.Objectives: To explore the association between (1) full-time use of absorbent incontinence padsand urinary tract infection at acute hospital admission, (2) state of frailty and becoming a paduser during hospitalization, and (3) becoming a pad user and acquiring a urinary tract infectionduring hospitalization in older patients.Design: A retrospective cohort study.Setting: Admissions in an emergency department with transfers to geriatric, cardiac, infectious, orendocrinological wards from September 7th, 2017 to February 18th, 2019.Patients: 1,958 patients aged 65 years or more, having daily homecare or moderate comorbidity,hospitalized due to acute illness, and living in the municipality of Aarhus.Methods: The study was conducted by two researchers reviewing the patients’ electronic healthrecords combined with data on frailty status from a geriatric quality database. In the electronichealth records, data on baseline characteristics, absorbent incontinence pad use at admission andduring the hospital stay, and urinary tract infection were obtained.Results: Full-time users of absorbent incontinence pads had a higher probability of being admittedwith urinary tract infection (Odds Ratio=2.00 (95% Confidence Interval: 1.61–2.49); p<.001).Patients identified as severely frail had a higher probability of becoming pad users during hospitalization (Odds Ratio=1.57 (95% Confidence Interval: 1.45–1.71); p<.001) compared to non/mild/moderate frail patients. Patients who became pad users during hospitalization had a higherrisk of a hospital-acquired urinary tract infection (Odds Ratio=4.28 (95% Confidence Interval:1.92–9.52); p<.001).Conclusions: There was an association between the use of absorbent incontinence pads and thedevelopment of urinary tract infections in older hospitalized patients, both in full-time users andthose who were frail and became pad users during hospitalization. These findings emphasize theneed for further research on preventing urinary tract infections and unnecessary pad use in olderpatients.