The aim of this original research was to measure the impact of the use of walking aids on the level of mobility, and to investigate, how the mobility status and the occurrence of urinary incontinence (UI) are correlated with each other in geriatric residents and patients in nursing homes.

The study design were two multicentre descriptive cross-sectional prevalence studies. The studies were performed in nursing homes throughout Germany in 2014 and 2015. N = 2044 patients from nursing homes were interested in participating, of whom 1951 met the inclusion criteria and were included in the study. Female sex represented 72.0%. The mean age was 82.1 years (SD 11.2), mean BMI was 26.1 (SD 5.4), and the mean care dependency was 46.0 (SD 18.2). Data was collected by trained nurses based on a standardized data collection form, which contained variables about demographics, health conditions, mobility status, and UI. The level of mobility was measured according to the Elderly Mobility Scale (EMS). The International Consultation of Incontinence Questionnaire Short Form (ICIQ-SF) was used to determine the severity and characteristics of UI.

The prevalence of UI was 69.7%. If the amount of leakage was medium (high), the mean of the impact on quality of life (QoL) was 2.2, SD 2.2 (2.4, SD 3.0). If the frequency was higher than once a day (permanent), the mean of the impact on QoL was 2.2, SD 2.1 (2.1, SD 2.8) (Table 1). According to the bivariate association of UI, the highest prevalence of 61.2% was in patients who did not use any walking aids. The CHAID tree analysis of the relation between mobility according to the Elderly Mobility Scale (EMS) and UI results in 71.1% of all patients with UI who did not use any walking aids (Fig. 1).

The overall prevalence of UI (69.7%) corresponds to available figures in nursing homes of up to 77% [1]. Considering the frequency of UI, the prevalence of those who are incontinent more than once daily was about 34%, and regarding those with an at least medium amount of leakage, the prevalence was 33%. The bivariate analysis of the overall impact of the frequency and amount of UI on QoL indicates a low impact of UI occurring once a week or less, and a medium impact of occurrences of 2–7 times a week. The impact on QoL of nursing home residents experiencing UI more than daily or permanently is medium. The medium impact on QoL of more than daily occurrences of UI corresponds to the impact of medium amount of unintended urine loss. The lower frequency and amount of unintended urine loss in nursing home residents compared to home care patients might result from a possibly higher mobility support in nursing homes since supporting nurses are available more frequently than in temporary home care rounds [2]. 
The level of mobility according to the EMS shows that about one out of four of all nursing home residents is unable to stand and walk independently. The bivariate analysis of the level of mobility and diagnosis of UI confirms the highly plausible strong association of mobility with UI in findings of other studies [3]. Surprisingly, 11.9% (11.3%) patients in need of help from two or more people when moving from lying to sitting (from sitting to lying) experienced unintended urine loss, while urine leakage was reported to occur by 41.9% (43.9%) patients able to move independently. These findings correspond to the highest UI prevalence of 61.2% in patients who did not use any walking aids. As a consequence, patients with impaired mobility who do not use any walking aids might not be able to reach the sanitary installations in time and thus, will be affected by UI much more often. The CHAID tree analysis of the relation between EMS items and UI confirms these findings, concluding that the higher the use of wheelchair and walking aids by (partly) immobile patients, the lower the risk for UI. It can be concluded that to maintain and/or restore a high level of mobility in nursing home residents has been identified in this study to be an effective prevention tool in order to minimize the risk of being affected by other geriatric syndromes, such as UI.

The prevalence of immobility in correlation with UI in nursing homes is high. Preserving or regaining residents’ mobility and supporting immobile patients with the use of walking aids plays a central role for avoiding/minimizing UI in geriatric residents and patients.

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