Toileting difficulties in older people with and without dementia receiving formal in-home care-A longitudinal study.

Because the design was observational, it cannot show that dementia or nursing home admission caused toileting difficulties, or that toileting difficulties caused nursing home admission. 795 of 1,796 eligible people declined to participate, and those who declined were older and more often women than those included, so the sample may not represent all people receiving formal in-home care. Only people with a next of kin who saw them at least once a week were eligible, and toileting information came from next-of-kin and health personnel reports rather than direct patient self-report. Attrition was large: 324 participants died during follow-up, and only 456 people were included at the final assessment, which may bias the results. The measures recorded need for assistance and broad toileting difficulty but did not distinguish urinary incontinence, faecal incontinence, or specific toilet-transfer problems. The study was done in Norwegian formal in-home care, so generalising to other health systems is limited.

The authors declare having no conflict of interest.

Do not read the more than ten times higher odds for nursing home admission as proof that toileting difficulties cause admission. The study is observational, and it could not tell whether toileting difficulties came before admission or after admission.