Continence Status as a Marker of Vulnerability in Hospitalised Older Adults in a Post-Acute Rehabilitation Unit

Abstract Background Continence status is a critical yet often underrecognized factor in the care of older adults. Incontinence, both bladder and bowel, has been associated with increased frailty, more extended hospital stays, and a higher incidence of complications such as delirium. In this retrospective observational study, we aimed to explore the relationship between continence status and key outcomes, including length of stay, delirium, and living arrangements among older hospitalised adults. Methods Thirty patients admitted to a rehabilitation ward were evaluated for their continence status on admission and at discharge. Data on age, gender, living situation, delirium incidence, and hospital length of stay were collected. Kruskal-Wallis tests were used to assess differences in length of stay across continence categories, and chi-square tests were employed to evaluate associations with delirium. All analyses were conducted using R software. Results The average age (SD) was 83.3 (6.6) years, with a median (IQR) hospital length of stay of 56 (37.5) days. Bowel continence improved from 15 to 20 patients by discharge, while bladder continence improved slightly (12 to 13), though occasional incontinence increased. Patients who were fully continent had the shortest median hospital stays (48.5 days), while those with dual incontinence had the longest median (72.5 days). Delirium occurred exclusively in patients with both bowel and bladder incontinence (p = 0.0163). Additionally, continent patients were more likely to live alone versus those doubly incontinent (54.5% vs 38.5%), suggesting greater independence. Conclusion In this small cohort, incontinence was strongly associated with increased hospital length of stay and the occurrence of delirium. These findings highlight the importance of continence as a marker of vulnerability in older adults and support early continence assessment and intervention as part of comprehensive geriatric care. Larger studies are warranted to validate these trends and inform best practices in hospital-based continence management.