Incontinence and Healthcare Utilization of Medicare Patients

AbstractPurposeClaims data are used to directly measure the prevalence of incontinence and incontinence-related events within a large Medicare population.DesignRetrospective analysis.Subjects and SettingsThe study relied on administrative claims data from the CMS Medicare Limited Data Set (5% sample) in 2018. The analysis was limited to fee-for-service (FFS) Medicare beneficiaries with minimum of 3-month enrollment in Parts A & B and at least 65 years old.MethodsWe used diagnosis codes to identify members with incontinence in their 2018 claims experience and grouped these members into 3 categories (urinary incontinent only, fecal incontinent only, and dual incontinent (DI)) and four sites-of-service (nursing home, Skilled-nursing Facility (SNF), home health, and self-care). We then determined the incidence of four types of incontinence-related events for each cohort: 1) Urinary Tract Infections (UTIs), 2) Incontinence-Associated Dermatitis (IAD), 3) Slips and falls, and 4) Behavioral disruptions.ResultsWe found that 11.2 percent of Medicare members had a claims-based diagnosis of incontinence in 2018. This result falls below the estimated share of the over-65 population who are incontinent, as reported in the literature. The prevalence of the four incontinence-related events is significantly higher (between 2 percentage points to 17 percentage points) for members who experience dual incontinence relative to those with only urinary incontinence. On average, those diagnosed with incontinence experienced 5 times more UTIs, two times as many dermatitis events, more than twice as many slips and falls, and 2.8 times more behavior disruptions compared to those without an incontinence diagnosis.ConclusionsAlthough we find that the prevalence of incontinence is under-reported relative to the literature, our results show that those who are diagnosed as incontinent experience a much higher prevalence of UTIs, IAD, slips and falls, and behavioral deterioration compared to those who are not diagnosed as incontinent. Our results suggest that incontinence may be an important indicator diagnosis of many other conditions and, if not well-managed, may challenge the desire for those who are incontinent to age at home.