Mobility Impairment and Urinary Incontinence in Elderly Women
Abstract & Commentary
By Chiara Ghetti, MD
Associate Professor, Obstetrics and Gynecology, Division
of Female Pelvic Medicine and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO
Dr. Ghetti reports no financial relationships relevant to this field of study.
Synopsis: In a large population of older community-dwelling women, there was a strong association between limited motor and balance skills and urge incontinence.
Source: Fritel X, et al. Mobility impairment is associated with urge but not stress urinary incontinence in community-dwelling older women: Results from the Ossébo study. BJOG 2013;120:1566-1572.
The objective of this study was to evaluate the
association between urinary incontinence and mobility impairment in elderly women. This was a cross-sectional observational study of 1942 community-dwelling women and an ancillary analysis of a larger parent study, a randomized controlled trial of physical exercise for prevention of falls in elderly women. The main outcome measures were mobility, balance, and urinary incontinence symptoms. Mobility and balance were assessed using a set of standardized functional tests (validated for the prediction of falls and fractures) and incontinence symptoms measured by the International Consultation on Incontinence QuestionnaireShort Form (ICIQ-SF), which assesses frequency, quantity, and type of urine loss and degree of bother over the last 4 weeks. Mobility and balance results were compared between continent and incontinent women by severity and type of incontinence. Logistic regression modeling was used to investigate the association between mobility and balance and urinary incontinence by adjusting for age, body mass index, and testing center.
Women aged 75-85 years were recruited by mail using electoral rolls. A total of 19,360 invitations were mailed. The study recruited 1940 women who were examined at one of nine study centers between January 2008 and June 2009 in several large French cities. Participants’ mean age was 79.3 (± 2.9) years. Urinary incontinence was reported by 815 (42%), for whom 305 (37%) reported slight severity, 397 (49%) reported moderate severity, 97 (12%) reported severe, and 16 (2%) reported very severe. Of women with incontinence, 194 (24%) reported symptoms of stress incontinence, 251 (31%) reported urgency incontinence, 302 (37%) reported mixed symptoms, and the remainder reported leakage for other reasons. Bivariate analysis revealed worsening mobility and balance scores with increased urinary incontinence severity, with worse scores in women with urge or mixed incontinence compared to continent women. Multivariable logistic regression using single mobility and balance test results found a strong association between deterioration of mobility testing and presence of urgency incontinence.
Commentary
More than one-half of women will be affected by urinary incontinence over their lifetime.1 Urinary incontinence significantly decreases a woman’s quality of life and overall functional status. Estimates suggest that by 2030, 1 in 5 adults in the United States will be 65 years of age or older.2 The prevalence of incontinence increases with age, and as the population ages, urinary incontinence will be an even more significant public health issue. Elderly women are also greatly impacted by cognitive impairment, depression, gait, and balance disturbances.
This study accentuates the interrelationship between function and urinary incontinence in the elderly, a major quality-of-life issue in the aging population.3 The study reminds clinicians caring for elderly women that physical activity is one of the most important factors affecting functional ability in the elderly, and that our elderly patients should be encouraged to remain active. Asking our elderly patients with incontinence about falls and about their gait and quietly watching them as they enter or leave our exam rooms may reveal mobility deficits of which we may not be aware. Mobility is an important consideration before prescribing the anticholinergic medications used to treat urinary incontinence, as these medications can have significant cognitive and functional side effects in the elderly.
As an observational study, this study has limitations and by design cannot establish causality. While the link between impaired mobility and urge urinary incontinence is not clear, the authors do explore possible mechanisms to explain this relationship. It is possible that impaired mobility could increase leakage due to difficulty getting to the bathroom. It is also possible that the physiology leading to decline in cognitive function and to gait may be linked to the development or worsening of urgency incontinence. The small differences the authors found in mobility testing are significant enough to be predictive of physical abilities and risk of falls. These findings highlight the important role of physical and occupational therapy in our elderly patients,4 as improving mobility and balance may be beneficial in reducing falls and may play a role in decreasing symptoms of urinary urgency incontinence.
References
- Fantl JA, et al. Urinary Incontinence in Adults: Acute and Chronic Management. Clinical Practice Guideline 2. Rockville, MD: HHS, Agency for Health Care Policy and Research; 1996.
- U.S. Department of Health and Human Services. Administration on Aging AOA-Older Americans 2010: Key Indicators of Wellbeing. Available at: http://www.agingstats.gov/agingstatsdotnet/Main_Site/Data/2010_Documents/docs/OA_2010.pdf. Accessed April 28, 2014.
- Tinetti ME, Williams CS. N Engl J Med 1997;337:1279-1284.
- Gillespie LD, et al. Cochrane Database Syst Rev 2009;CD007146.
