Epidemiology, progression, and predictive factors of urinary incontinence in older community‐dwelling Mexican adults: Longitudinal data from the Mexican Health and Aging Study

Factors associated with urinary incontinence among Hispanic/Latina women in the United States: Findings from The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

PURPOSE

To identify factors associated with urinary incontinence (UI) in women of various Hispanic/Latina backgrounds.

MATERIALS AND METHODS

We analyzed data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multicenter, community-based cohort study which includes a health-related questionnaire assessing presence and type of UI. Complex survey logistic regression analysis was used to assess the cross-sectional association of Hispanic/Latina backgrounds and other factors of UI. All estimates accounted for HCHS/SOL survey design.

RESULTS

Of 5027 women, 33.4% answered "yes" to UI. Rates of any UI ranged from approximately 21.9% to 40.3% in women of Dominican and Puerto-Rican background, respectively. Any UI and UI subtypes were associated with age older than 65 years, increasing body mass index, smoking status, any alcohol use, parity ≥3, and postmenopausal status. After controlling for covariates and when compared with women of Mexican background, women of Dominican background were less likely to have any UI (OR = 0.42, 95% CI 0.30-0.57), as were women of Cuban (OR = 0.48, 95% CI 0.37-0.62), Puerto-Rican (OR = 0.79, 95% CI 0.62-1.0), and mixed (OR = 0.62, 95% CI 0.39-0.99) background; and women of every other background except for South American were less likely to have stress UI. In addition, women of Cuban (OR = 0.53, 95% CI 0.32-0.86) and mixed (OR = 0.38, 95% CI 0.16-0.87) background were less likely to have urge UI than women of Mexican background.

CONCLUSIONS

Our study demonstrates differences in UI by Hispanic/Latina background, suggesting collective designation of Hispanics/Latinas as a single ethnic group does not adequately describe UI among this diverse group.

Advances in the natural history of urinary incontinence in adult females

The aim of this review is to summarise the related characteristics of the natural history of female urinary incontinence (UI) using a narrative descriptive approach. PubMed, EMBASE and Web of Science were searched for articles published from 1 January 2010 to 1 January 2020 on the natural history of female UI, which including incidence, persistence, progression, remission, and regression of a single subtype of UI and the mutual influence of different UI subtypes. This literature review includes 15 articles published, indicates that UI is highly dynamic, with symptoms varying according to disease severity and subtype and influenced by multiple factors at different disease stages. Recent studies have increased our understanding of the natural history of UI. Future research should systematically analyse the progression of each subtype of UI and interactions between subtypes to prevent the progression of UI across females life course.

Association of urinary incontinence with depression among men: a cross-sectional study

OBJECTIVE

Depression and urinary incontinence (UI) are both troubling symptoms that severely impact quality of life. The aim of this study is to evaluate the association between UI (including UI types and severity) and depression among men.

POPULATION AND METHODS

The analyzed data was collected from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) data. A total of 16,694 male participants aged ≥ 20 years with complete information about depression and UI were included in this study. Logistic regression was performed to calculate the odds ratio (OR) and 95% confidence interval (CI) to determine the association between depression and UI by adjusting for relevant covariables.

RESULTS

The prevalence of depression was 10.91% among participants with UI. Urge UI was the main type of UI and accounts for 50.53% of all UI types. The adjusted ORs for the association between depression and UI were 2.69 (95%CI, 2.20-3.28). Compared with slight UI, the adjusted ORs were 2.28 (95% CI, 1.61-3.23) for moderate UI, 2.98 (95% CI, 1.54-5.74) for severe UI, and 3.85 (95% CI, 1.83-8.12) for very severe UI. Compared with no UI, the adjusted ORs were 4.46 (95% CI, 3.16-6.29) for mixed UI, 3.15 (95% CI, 2.06-4.82) for stress UI, and 2.43 (95% CI, 1.89-3.12) for urge UI. The subgroup analyses also showed similar correlation about depression and UI.

CONCLUSION

Among men, depression was positively associated with UI status, severity and types. For clinicians, it's necessary to screen depression in patients with UI.

Construction of Progress Prediction Model of Urinary Incontinence in Elderly Women: Protocol for a Multi-Center, Prospective Cohort Study

Background: Urinary incontinence (UI) is a common health problem and seriously affects quality of life. Many women lack understanding of UI or are too ashamed to seek medical advice early, leading to a low treatment rate. The aim of this study is to establish an effective UI progress prediction model for elderly women with UI for earlier detection and better treatment. Methods: This study is conducted as a prospective, multi-center, cohort study, and recruits 800 women aged ≥60 with mild or moderate UI in China. Participants are divided into three groups: stress urinary incontinence group (SUI), urgency urinary incontinence group (UUI), and mixed urinary incontinence group (MUI). This study will investigate the general conditions of patients, after complete relevant pelvic floor function assessment, as well as after follow up at 6 months, 12 months, and 18 months by telephone. The primary endpoint is UI disease progress. Single factor and multi-factor Cox regression model analyses are undertaken to evaluate the associated risk factors affecting the progress of UI to establish a progress prediction model for elderly women. Discussion: This study will provide more predictive information for elderly women with UI, and new clinical references for the intervention and the treatment of UI for medical staff.

Factors Associated With Urgency Urinary Incontinence Among Older Mexican American Women Aged 65 years and Older

The purpose of this study was to determine which socio-demographic, clinical, or functional factors are associated with urgency urinary incontinence (UUI) over 20-years of follow-up in a community-dwelling sample of Mexican American women aged 65 years and older without UUI at baseline. We included 1,358 women participants from the Hispanic Established Population for the Epidemiologic Study of the Elderly study conducted in the southwestern of US (Arizona, California, Colorado, New Mexico, and Texas). Measures included self-reported UUI, socio-demographics, smoking status, body mass index, medical conditions, depressive symptoms, physical and cognitive function, and handgrip strength. We used generalized estimating equation models to estimate the odds ratio (OR) and 95% Confidence Interval (CI) of UUI as a function of socioeconomic, clinical, and functional factors. Self-reported UUI increased from 3.1% to 21.9% from baseline (1993/1994) to follow-up (2012/2013). Current smokers, obesity, arthritis, previous heart attacks, and depressive symptoms were factors associated with greater odds of UUI over time. Identification of these factors can help clinicians determine those at high risk of developing UUI. Preventing and/or treating the risk factors early may delay UUI and increase quality of life in this underserved population.

The impact of urinary incontinence on falls: A systematic review and meta-analysis

OBJECTIVE

Previous studies on the association between urinary incontinence (UI) and falls have reported conflicting results. We, therefore, aimed to evaluate and clarify this association through a systematic review and meta-analysis of relevant studies.

METHODS

We performed a literature search for relevant studies in databases including PubMed and EMBASE from inception up to December 13, 2020, using several search terms related to UI and falls. Based on the data reported in these studies, we calculated the pooled odds ratios (ORs) for falls and the corresponding 95% confidence intervals (CIs) using the Mantel-Haenszel method.

RESULTS

This meta-analysis included 38 articles and a total of 230,129 participants. UI was significantly associated with falls (OR, 1.62; 95% CI, 1.45-1.83). Subgroup analyses based on the age and sex of the participants revealed a significant association between UI and falls in older (≥65 years) participants (OR, 1.59; 95% CI, 1.31-1.93), and in both men (OR, 1.88; 95% CI, 1.57-2.25) and women (OR, 1.41; 95% CI, 1.29-1.54). Subgroup analysis based on the definition of falls revealed a significant association between UI and falls (≥1 fall event) (OR, 1.61; 95% CI, 1.42-1.82) and recurrent falls (≥2 fall events) (OR, 1.63; 95% CI, 1.49-1.78). According to the UI type, a significant association between UI and falls was observed in patients with urgency UI (OR, 1.76; 95% CI, 1.15-1.70) and those with stress UI (OR, 1.73; 95% CI, 1.39-2.15).

CONCLUSIONS

This meta-analysis, which was based on evidence from a review of the published literature, clearly demonstrated that UI is an important risk factor for falls in both general and older populations.

Age-dependent histomorphometric evolution of the corpus spongiosum

Purpose:

To quantify the age-dependent changes in the relative volume of elastic fibers, collagen fibers and the proportion of collagen types I/III in the corpus spongiosum of rats.

Methods:

Forty-eight rats, raised under similar conditions, were divided into four groups (G1 to G4) and underwent penectomy at the ages of 6, 9, 12 and 24 months, respectively. Histological sections from the middle segment of the penis were stained with Weigert’s resorcin-fuchsin, Masson’s trichrome and Picrosirius red, the volumetric density of elastic fibers, collagen fibers and the proportion of collagen types I and III in the corpus spongiosum were determined by stereological analysis.

Results:

A reduction in the proportion of collagen I/III between the groups G3 and G4 (p < 0.048) was observed. In the volumetric analysis of elastic fiber, we observed a significant rise between the groups G2 and G3 (p < 0.03) and a reduction of the volume between the groups G3 and G4 (p < 0.01). However, there was no difference in the quantity of total collagen between the groups (p > 0.54).

Conclusions:

Aging in rats did not change the quantity of total collagen but reduced the proportion of collagen types I/III and the volume of elastic fibers.

Quality of life and mortality of Brazilian nonagenarians and centenarians with urinary incontinence

OBJECTIVES: Urinary incontinence (UI) commonly occur in elderly people and it is associated with reduced functionality, quality of life and survival in older adults (65-80 years). Little is known about its impact in nonagenarians and centenarians. Thus, this study aimed to evaluate the health and mortality of nonagenarians and centenarians with UI.METHODS: Nonagenarians and centenarians residents of Porto Alegre, Brazil, participated in this cohort study and were followed between 2016 to 2019. Survival analysis were performed using Cox Proportional Hazards Regression methods in the simple and adjusted models.RESULTS: The overall prevalence of UI was 56%, 64% among women and 38% among men (p<0.01). UI was more frequent in widowers (p <0.01), those who left home (p=0.02) and participated in social activities less frequently (p=0.07). Also they had a higher frequency of chronic diseases (p = 0.02), more symptoms of depression (p=0.08) and reduced cognitive performance (p=0.04). Participants with UI had reduced survival in the simple (HR 0.29, p=0.23) and adjusted analysis (HR 0.33%, p=0.19). The variables that influenced the most, UI and mortality, were participation in social activities, ability to leave the home, cognitive performance and lower-limb function/mobility.CONCLUSIONS: Although UI was not a direct predictor, it was associated with reduced survival. Nonagenarians and centenarians with UI will likely experience a lower risk of mortality if they continue to participate in social activities, preserve their cognitive performance and practice physical activities.

Características sociodemográficas e clínicas em nonagenários e centenários com e sem incontinência urinária

Objetivos: analisar as características sociodemográficas e clínicas em indivíduos nonagenários e centenários com e sem incontinência urinária. Métodos: trata-se de um estudo transversal e analítico, envolvendo 234 nonagenários e centenários avaliados nos seus domicílios, que foram aleatoriamente selecionados na cidade de Porto Alegre, RS. A presença de incontinência foi avaliada com relação às características clínicas e sociodemográficas cujas associações foram testadas pelo qui-quadrado e as diferenças nas médias testadas pelo t de Student usando o Programa Epi Info. Resultados: a prevalência de incontinência urinária foi de 56,41%, sendo 63,53% entre as mulheres e 37,5% entre os homens (p=0,0003). A relação entre presença de perda de urina e de estado conjugal foi significativa (p=0,0049), com maior frequência entre os viúvos. Os incontinentes saíam menos de casa, participavam menos de atividades físicas e sociais, tinham maior número de doenças crônicas e sintomas depressivos e pior pontuação na avaliação cognitiva. Em relação aos sintomas urinários, a maioria dos incontinentes referiu que a urina ou bexiga atrapalha a sua vida (p<0,0001) e, que a urina ou bexiga, causa embaraço (p<0,0001). Entre os participantes continentes, 25% relatou que a urina ou bexiga atrapalha a sua vida. Conclusões: a incontinência urinária foi mais frequente entre mulheres, participantes mais velhos, viúvos e indivíduos que moravam sozinhos. Apesar de maior prevalência entre as mulheres, chama atenção uma prevalência importante entre os homens. Ao fim, concluímos que a incontinência urinária impacta diretamente na vida social e na saúde de nonagenários e de centenários. Então, a incontinência urinária deve ser um importante componente na avaliação desse grupo. Observamos, também, que um número importante de nonagenários e de centenários apresentam incômodos relacionados à urina, mesmo sem incontinência urinária.

Evaluation and treatment of urinary incontinence in the aging male

Risk of urinary incontinence (UI) increases with age and can have detrimental effects on patients and caregivers. UI should not be considered a normal part of aging and warrants a comprehensive evaluation. Treatment of UI in the aging male requires special consideration, particularly when it comes to comorbid conditions and potential side effects of intervention. The aim of this review is to discuss the evaluation of, risk factors for, and management of UI in the aging male.

Radiotherapy for elder patients aged ≥80 with clinically localized prostate cancer - Brachytherapy enhanced late GU toxicity especially in elderly

Background and purpose

Elongation of life expectancy had led to marked increase in number of elderly patients with localized prostate cancer. However, the standard treatment for such patients is not well determined because of a high prevalence of comorbidities and slow growth of prostate cancer. The aim of this study is to examine the feasibility of radiotherapy for elderly patients aged ≥80 years.

Materials and methods

We compared 96 patients aged ≥80 years and 2333 younger patients (aged 60-79 years) using multi-institutional data included cT1-T4N0M0 prostate cancer treated with 902 external beam radiotherapy (EBRT) and 1527 brachytherapy (BT).

Results

The 5-year biochemical failure-free survival rate was similar between elderly ≥80 years and younger control (91.3% vs. 85.9%, p = 0.6171) (100%, 92.9%, 82.4% and 96.3%, 93.7%, 89% for low, intermediate and high risk group), and for the prostate cancer-specific survival rate (100% and 99.3%, p = 0.6171). The accumulated incidence of late gastrointestinal (GI) at 5 years was also similar between elderly and younger patients (3.5% vs. 2.5%, p = 0.6857). Brachytherapy improved biochemical control rate and reduced GI toxicity compared with EBRT, however, enhanced late genitourinary (GU) toxicity, especially in elderly patients. Elderly received brachytherapy showed highest rate of late GU toxicity grade ≥2 of 22.1% than the younger counterparts of 12.7% at 5 years, whereas younger patients treated with EBRT had 2.4% and elderly EBRT had 2.7% (p < 0.0001).

Conclusion

Elderly patients aged ≥80 years showed equivalent biochemical control, prostate cancer-related survival, and gastrointestinal toxicity profiles to younger patients. Meticulous care should be required for brachytherapy enhanced late GU toxicity, especially in elderly patients aged ≥80 years.

Ageing of the Diaphragm Muscle

The diaphragm muscle is the most important contractile district used for breathing. Like other muscles in the human body, it is subject to ageing and sarcopenia. Sarcopenia can be classified as primary (or age-related) when there are no local or systemic pathologies that cause a functional and morphological detriment of skeletal musculature. Secondary sarcopenia occurs when there is a cause or more pathological causes (illness, malnutrition, immobility) related or unrelated to ageing. In the elderly population, transdiaphragmatic pressure (Pdi) decreases by 20-41%, with a decline in the overall strength of 30% (the strength of the expiratory muscles also decreases). The article discusses the adaptation of the diaphragm muscle to ageing and some other ailments and co-morbidities, such as back pain, emotional alterations, motor incoordination, and cognitive disorders, which are related to breathing.