Risk factors and prevalence of incontinence-associated dermatitis in elderly patients: a meta-analysis and systematic review

Abstract

This systematic review aimed to evaluate the prevalence and risk factors of Incontinence-Associated Dermatitis (IAD) in elderly patients. A systematic search was conducted across 10 databases, including PubMed, Embase, Web of Science, Cochrane Library, CINAHL, Ovid MEDLINE, Scopus, VIP, WanFang, and CNKI, from inception to November 2023. Two reviewers independently performed study screening, data extraction, and risk-of-bias assessment. Prevalence meta-analysis was restricted to cross-sectional studies, whereas risk factor synthesis included all eligible observational studies, with priority given to multivariable-adjusted effect estimates. Meta-analysis was conducted using RevMan 5.3 and R 4.4.2, with random-effects models applied for all pooled analyses. This review was conducted in accordance with PRISMA 2020 and prospectively registered in PROSPERO (CRD42023442585). A total of 16 studies were included, involving 30,747 geriatric patients. For prevalence estimation (4 eligible cross-sectional studies, 18,619 incontinent geriatric patients), the pooled prevalence of IAD was 14.81% (95%CI: 4.16%-41.04%), with substantial heterogeneity (I²=98.4%, P < 0.001). For factor association analysis (11 case-control studies, 4 cross-sectional studies, 1 cohort study), 12 statistically significant factors associated with IAD were identified, including diabetes mellitus (adjusted OR = 2.17, 95%CI: 1.23–3.84), diarrhea (OR = 3.37, 95%CI: 2.38–4.78), incontinence frequency ≥ 3 times/day (OR = 4.70, 95%CI: 2.85–7.76), dual incontinence (OR = 4.03, 95%CI: 1.52–10.71); antibiotic use (OR = 3.26, 95%CI: 1.67–6.36); prolonged hospitalization (OR = 3.33, 95%CI: 2.60–4.26); presence of ≥ 3 comorbidities (OR = 2.53, 95%CI:1.48–4.32); mechanical ventilation (OR = 2.67, 95%CI: 1.20–5.93); and infection (OR = 2.93, 95%CI: 1.72–4.99) (all P <0.05). The certainty of evidence for primary outcomes ranged from very low to moderate per the GRADE framework. IAD is common among elderly patients, with a pooled prevalence of 14.81%. Individualized prevention and management strategies should be implemented according to the identified risk factors.