Is urinary continence considered in the assessment of older people after a fall in England and Wales? Cross-sectional clinical audit results.

Objectives: To investigate adherence to the urinary function assessments of the national falls guidelines for England and Wales.

Study Design: Secondary data analysis of the 2006 National Clinical Audit of Falls and Bone Health.

Setting: Acute hospitals in the UK.

Participants: Patients aged 65 years and older with a fragility fracture as a result of a fall.

Main Outcome Measures: Data were analysed to determine whether patients with fragility fractures received an assessment of urinary function including continence status; whether impairment was detected and if action was taken to prevent continence related falls.

Results: 63% (2009) of 3184 patients were assessed for urinary continence following a hip fracture and 41% (817) of these identified a problem. 21% (1187) of 5642 patients with nonhip fragility fractures were assessed and a problem was found in 27% (316). Hip fracture patients were more likely (p<0.0001) to receive a continence assessment and have problems detected. Only about half of those with problems had any intervention or a referral to a continence service. Admission to hospital for nonhip fracture patients was a strong predictor of being assessed (p<0.0001).

Conclusion: Rates of assessment and action for those with who fall and have continence problems are low despite current national guidelines.