Age-related complaints in women and their determinants based on a representative community study

Fatigue in Patients with Idiopathic/Isolated REM Sleep Behavior Disorder

Introduction: Fatigue is one of the most common and disabling symptoms of Parkinson’s Disease (PD). The occurrence and clinical features of fatigue in patients with prodromal PD remain largely elusive. This study aimed to investigate the prevalence and clinical characteristics of fatigue in patients with idiopathic/isolated REM sleep behavior disorders (iRBD). Methods: A total of 97 polysomnography-confirmed iRBD patients were enrolled in this study. A comprehensive neurological assessment (including motor and non-motor assessment) was performed. Fatigue was assessed using the Fatigue Severity Scale (FSS). Motor and non-motor characteristics were compared between iRBD patients with and without fatigue. Logistic regression was used to identify the factors associated with fatigue. Results: The prevalence of fatigue was 35.05%. Compared to the non-fatigue patients, patients with fatigue had higher non-motor symptom scale (NMSS) score (p = 0.009), higher Hamilton Depression Rating Scale (HAMD) score (p = 0.002), and a higher prevalence of orthostatic hypotension (p = 0.021). Multivariate regression analysis showed that depression (OR 4.17, 95% CI 1.13−15.49, p = 0.033) and orthostatic hypotension (OR 2.80, 95% CI 1.09−7.18, p = 0.032) were significantly associated with fatigue in iRBD patients. Additionally, both NMSS (rs = 0.310, p = 0.002) and HAMD (rs = 0.385, p < 0.001) scores were mildly correlated with fatigue severity. Conclusion: Our study showed that fatigue is common in patients with iRBD. In addition, depression and orthostatic hypotension were independently associated with fatigue in iRBD patients.

Adiponectin and Nitric Oxide Deficiency-Induced Cognitive Impairment in Fatigued Home-Resident in Mature and Older Adults: A Case-Control Study

Objective

The present study explores the underlying factors of cognitive abilities in relation to the expression of adiponectin and nitric oxide, fatigue, and other cofounder variables such as physical activity, diabetes, and adiposity status in healthy home-resident mature and older adults.

Background

Fatigue has been shown to be correlated with many metabolic and psychiatric conditions, such as cognitive, neurological, musculoskeletal, and hormonal disorders, as well as physical and unhealthy lifestyles.

Methods

A total of 85 home residents aged 50–85 years participated in this case-control study. Mental, fatigue, and pain status were assessed by the cognitive assessment (LOTCA), fatigue questionnaire (CIS20r), and pain score (0–10). VO₂ max and the prevalidated global physical activity questionnaire were used to estimate physical status. The levels of adiponectin, nitric oxide (NO), and variables related to diabetes, such as blood sugar and glycated hemoglobin (HbA1c %), were assessed using ELISA and spectrophotometric immunoassays.

Results

The participants were classified according to the CIS-fatigue score into two groups: the healthy group (n = 40) and the fatigue group (n = 45). In fatigued subjects, LOTCA scores as a measure of cognitive performance significantly decreased (65.97 ± 7.17; P = 0.01) as compared with healthy subjects (LOTCA scores, 94.2 ± 7.5). The results of cognitive performance domains (LOTCA seven-subset scores) showed a significant decrease in the scores of orientation, visual perception, spatial perception, motor praxis, vasomotor organization, thinking operations, attention, and concentration in older subjects with fatigue compared with healthy subjects. In addition, pain scores significantly increased, and the expression of both nitric oxide (NO) and adiponectin significantly reduced in older adults with fatigue as compared with healthy controls. The decline in cognitive abilities among older adults with fatigue is significantly associated with the CIS-fatigue score, sedentary lifestyle, obesity, pain status, diabetes, and reduction in the levels of nitric oxide (NO), and adiponectin. Moreover, in fatigued cases, the expression of both NO and adiponectin was significantly correlated with CIS-fatigue score, physical activity, obesity, and diabetes, which indicates its availability as diagnostic markers for cognition in mature and older adults with fatigue.

Conclusion

In the present study, the data concluded that cognitive abilities were significantly associated with the lower expression of adiponectin and NO as endothelial vascular markers in association with fatigue among home-resident older adults. In addition, the reduction in cognition was significantly affected by other parameters, such as diabetes, obesity, and unhealthy sedentary life activities. Moreover, the results might recommend the use of cellular adiponectin and NO as diagnostic indicators of cognitive abilities in fatigued mature and older adults. However, more studies on larger sample sizes are required.

The role of stress and self-efficacy in somatic and psychological symptoms during the climacteric period - Is there a specific association?

OBJECTIVES

To investigate the influence and specificity of sociodemographic and psychological factors on the perception of symptoms associated with menopause.

STUDY DESIGN

Data are based on a nationwide cross-sectional survey study in Germany. A representative sample of 1350 females aged 14-95 years was examined. Sociodemographic factors, perceived stress, and self-efficacy were assessed. Women were divided into three age groups (young women ≤ 44 years; perimenopausal women 45-60 years; older women ≥ 61 years), and the Menopause Rating Scale (MRS) was used over the entire life span.

MAIN OUTCOME MEASURES

Total score on the Menopause Rating Scale (MRS) and hot flushes/sweating assessed via the MRS.

RESULTS

The MRS total score increased with age. Both MRS total score and hot flushes were positively associated with perceived stress in all three age groups. The MRS total score was negatively associated with self-efficacy; for hot flushes, this association could be shown for perimenopausal women only. Furthermore, interaction effects between perceived stress and self-efficacy were found: in perimenopausal and older women, the association between perceived stress and the MRS total score was stronger the lower self-efficacy was. This interaction effect was not observed in younger women. No interaction effect was found in any age group for hot flushes.

CONCLUSIONS

Our data indicate that self-efficacy influences the severity of symptoms measured with the MRS. Interventions aimed to reduce stress and strengthen self-efficacy could lead to a lower symptom burden in perimenopausal women.

Validation of the Pittsburgh Fatigability Scale in a mixed sample of adults with and without chronic conditions

The aim of this study was to validate the Pittsburgh Fatigability Scale in three different groups: adults with multiple sclerosis (n = 65), fibromyalgia (n = 64), and healthy adults (n = 86). Participants completed the Pittsburgh Fatigability Scale and other self-report measures. While findings supported the internal consistency of the Pittsburgh Fatigability Scale (all Cronbach's alpha ⩾ 0.85), standard error of measurement estimates were larger than hypothesized. In addition, while item-level reliability was generally supported, item-total correlations for two items were lower than expected. Convergent and discriminant validity were supported, and the Pittsburgh Fatigability Scale was able to distinguish between individuals with and without chronic disease. Overall, the Pittsburgh Fatigability Scale exhibited acceptable psychometric properties.

Development of a person-centered conceptual model of perceived fatigability

PURPOSE

Perceived fatigability, reflective of changes in fatigue intensity in the context of activity, has emerged as a potentially important clinical outcome and quality of life indicator. Unfortunately, the nature of perceived fatigability is not well characterized. The aim of this study is to define the characteristics of fatigability through the development of a conceptual model informed by input from key stakeholders who experience fatigability, including the general population, individuals with multiple sclerosis (MS), and individuals with fibromyalgia (FM).

METHODS

Thirteen focus groups were conducted with 101 participants; five groups with n = 44 individuals representing the general population, four groups with n = 26 individuals with MS, and four groups with n = 31 individuals with FM. Focus group data were qualitatively analyzed to identify major themes in the participants' characterizations of perceived fatigability.

RESULTS

Seven major themes were identified: general fatigability, physical fatigability, mental fatigability, emotional fatigability, moderators of fatigability, proactive and reactive behaviors, and temporal aspects of fatigability. Relative to those in the general sample, FM or MS groups more often described experiencing fatigue as a result of cognitive activity, use of proactive behaviors to manage fatigability, and sensory stimulation as exacerbating fatigability.

CONCLUSIONS

Fatigability is the complex and dynamic process of the development of physical, mental, and/or emotional fatigue. Trait- and state-like biological, psychological, social, and environmental moderators contribute to tremendous variability in fatigability (both between and within-person variability). Future research to further characterize fatigability across populations, test treatments for fatigability, and develop new measures of this construct are greatly needed.

Fatigue in Parkinson's disease: A systematic review and meta-analysis

We conducted a systematic review and meta-analysis aimed at establishing robust prevalence estimates and identifying clinical correlates of fatigue in PD. From 2,459 titles and abstracts, we selected 44 relevant studies (n = 7427 patients). Overall, the meta-analysis showed a prevalence of fatigue of 50% in PD. This prevalence estimate, however, was significantly moderated by study heterogeneity in measurement scales and cut-off thresholds. In contrast, demographic features, disease severity, cognitive impairment, and depression did not moderate prevalence estimates. Moreover, fatigue prevalence did not differ between de novo and treated PD patients. Compared to nonfatigued patients, fatigued patients had sligthly higher age (1.44 years), disease duration (0.93 years), l-dopa equivalent daily dose (50.89 units), UPDRS-III (4.99 points), and H & Y (0.33 points), as well as risk of comorbid depression (risk ratio = 1.89) and had a little lower MMSE score (-0.66 points). Fatigue was moderately associated with apathy (Hedges' g = 0.55), anxiety (Hedges' g = 0.67), daytime somnolence (Hedges' g = 0.43), sleep disturbances (Hedges' g = 0.66), and poorer quality of life (Hedges' g = 1.23). Our analyses suggest that fatigue is a frequent, independent nonmotor symptom in PD appearing early and persisting throughout the disease course, and that establishing uniform diagnostic criteria for PD-related fatigue is critical. In addition, several nonmotor symptoms appear to be associated with fatigue and negatively impact quality of life. Pharmacological and nonpharmacological interventions targeting fatigue and associated symptoms may improve quality of life in patients with PD. © 2018 International Parkinson and Movement Disorder Society.

Are BMI and inflammatory markers independently associated with physical fatigability in old age?

Background

Obesity and chronic low-grade inflammation have both been implicated in the onset of physical fatigue. However, few studies have investigated the independence of these associations in older community-dwelling populations. We therefore aimed to investigate the associations of body mass index (BMI) and inflammatory markers at age 60–64 with perceived physical fatigability at age 68 and to assess whether any such associations were independent of each other and potential confounding factors. A secondary aim was to investigate whether any association with BMI extended back into earlier adulthood.

Methods

Participants of the MRC National Survey of Health and Development (N = 1580) had BMI and levels of interleukin-6 (IL-6) and C-reactive protein (CRP) measured during clinical assessments at age 60–64. These were related to self-perceived physical fatigability assessed at age 68 using the Pittsburgh Fatigability Scale (PFS) (total score:0 (no physical fatigue)–50 (extreme physical fatigue)).

Resuts

Women had higher mean PFS scores than men (mean (SD): 16.0 (9.1) vs 13.2 (8.9), p < 0.01). In sex-adjusted models, BMI, CRP and IL-6 were each associated with PFS scores. When all three factors were included in the same model, BMI and IL-6 remained associated with PFS scores whereas CRP did not. After adjustment for a range of potential confounders, associations of BMI and IL-6 with PFS scores were still evident; fully adjusted differences in mean PFS score = 3.41 (95% CI: 0.59, 6.24) and 1.65 (0.46, 2.84) for underweight and obese participants when compared with normal weight and, 2.78 (1.65, 3.91) when comparing those with an IL-6 of 2.51–8.49 pg/mL with levels <1.50.

Conclusions

BMI and inflammation may both be suitable targets for intervention to reduce the burden of physical fatigability in later life. Further, interventions that target both obesity and elevated levels of IL-6 are likely to be more effective than those focusing on only one.

Do negative aspects of social relations influence fatigue? A cross-sectional study on a non-clinical sample of middle-aged Danish men

OBJECTIVE

Fatigue is a common complaint among young and old adults and may be associated with negative aspects of social relations. Hence, the purpose of this study was to explore the association between demands from and conflicts with different sources of social relations and fatigue.

METHODS

The study was based on sub-populations of the 6292 members of the Danish Metropolit Cohort. The cohort comprises men born in 1953 in the Copenhagen Metropolitan area who participated in a questionnaire survey in 2004. Data were analysed using χ(2)-tests and multivariable logistic regression.

RESULTS

The results showed that demands from and conflicts with children were independently associated with fatigue in a dose-response pattern. The adjusted odds ratio for fatigue was 1.48 (95% CI: 1.01-2.17) when the men experienced frequent demands from children and 1.89 (95% CI: 1.17-3.06) when they had frequent conflicts with their children. Crude analyses of demands from or conflicts with spouse, relatives or friends, respectively showed associations with fatigue compared to no demands or no conflicts. However, adjustment for depression and physical chronic disease cancelled out these associations.

CONCLUSION

We concluded that middle-aged Danish men, who had frequent negative social interactions with their children, more frequently experienced fatigue. However, negative social interactions with spouse, relatives or friends were not associated with fatigue.

[Medically unexplained and somatoform complaints and disorders in the elderly: a systematic review of the literature]

OBJECTIVE

To provide a systematic overview of the research concerning the frequency of medically unexplained, somatoform complaints and disorders in the elderly, their risk factors, comorbidity, course, management in primary and secondary care, and psychotherapy.

METHOD

We evaluated 248 clinical and randomized trials, reviews, meta-analyses and practice guidelines for adult samples identified from "PubMed" and "PsycInfo" using the search terms "somatoform" OR "medically unexplained" OR "somatization" OR "somatisation" in combination with other terms for their relevance for the elderly. Other relevant trials were identified from the references from these publications.

RESULTS

Medically unexplained, somatoform complaints and disorders occur in older persons and are more frequent in elderly women than in elderly men. Although many studies found no increased frequency of somatoform complaints in the elderly, based on present research we cannot draw final conclusions concerning the frequency of somatoform disorders and complaints in the elderly, and we cannot give evidence based recommendations for their treatment in primary and secondary care and psychotherapy.

DISCUSSION

This situation results from the special problems encountered in the diagnosis of somatoform complaints and disorders in the elderly, from problems in conceptualisation also found in younger adults, and from the lack of research concerning treatment focussed solely on the old and very old.

Six-year follow-up of patients with functional bowel disorders, with and without previous psychotherapy

Introduction: Long-term follow-up studies in patients with functional bowel disorders are rare.

Methods: Of 85 patients with functional bowel disorders diagnosed in 2000, forty-eight patients responded to a postal questionnaire 6 years later (2006).

Results: Gastrointestinal symptom severity was similar to that at the initial diagnosis. Anxiety and depression (HADS) were significantly decreased, however, depending on previous psychotherapy (PT) experience. Men but not women that had participated in PT exhibited reduced symptoms more pronounced than did patients without PT.

Discussion: Anxiety and depression may determine consulting behaviour, but this appears unrelated to intestinal symptoms and their severity. Short-term PT contributes to long-term well-being especially in men.

Fatigue in older adults: an early indicator of the aging process?

The aim of this paper is to give an overview of research on fatigue in older adults, with a focus on fatigue as an early indicator of the aging process. Fatigue is a strong predictor of functional limitations, disability, mortality, and other adverse outcomes in young-old and old-old populations, between men and women, and in different geographic localities. Several biological, physiological and social explanations are proposed: fatigue may be seen not only as a self-reported indicator of frailty, defined as a physiologic state of increased vulnerability to stressors, which results from decreased physiologic reserves and even dysregulation of multiple physiologic systems, but also this state may be accelerated because of the cumulative impact of social, mental and biological factors throughout life.

Life satisfaction, anxiety, depression and resilience across the life span of men

OBJECTIVE

To determine (a) the relationship between life satisfaction, anxiety, depression and ageing in the male community and (b) to identify the impact of vulnerability factors, personal and social resources on life satisfaction and distress.

DESIGN

A stratified random sample of the German male population (N = 2144) was investigated by standardized questionnaires of life satisfaction (FLZ(M)), depression, anxiety (PHQ), resilience (RS-11) and self-esteem (RSS).

RESULTS

No age-related change was found regarding overall life satisfaction. Satisfaction with health decreased in midlife (51-60 years), while the importance of health increased. Importance of and satisfaction with partnership and sexuality were only reduced in the oldest group (70+). Anxiety was highest around midlife (51-60 years), accompanied by reduced resilience and self-esteem. No clear age-related change was found regarding depression. Life satisfaction was strongly associated with resilience, lack of unemployment, the presence of a partnership, positive self-esteem, a good household income, the absence of anxiety and depression and living in the Eastern states.

CONCLUSIONS

Personal and social resources and the absence of anxiety and depression are of crucial importance for the maintenance of life satisfaction in ageing men. There is also evidence for a crisis around midlife manifested by health concerns, anxiety and reduced resilience.

Which gynecological and obstetric patients want to attend psychosomatic services?

OBJECTIVE

The aim of this study is to explore the wish of gynecological and obstetric inpatients to attend psychosomatic services. Predictors influencing this wish are evaluated.

METHOD

Three groups of patients participated in the study. The groups consisted of patients diagnosed with malignant gynecological diseases (n = 175), benign gynecological diseases (n = 302), and obstetric diseases (n = 238). The following domains were assessed in a cross-sectional design: symptoms of anxiety and depression (HADS), physical complaints (GBB-24), health-related quality of life (SF-12), and the wish to attend psychosomatic services.

RESULTS

34% of the participants indicated that they wanted to attend psychosomatic services during their stay in the hospital. The group of patients diagnosed with malignant gynecological diseases had the highest proportion of women who stated that wish (43%). Multiple logistic regression models showed that former psychotherapeutic experiences as well as low psychological quality of life predicted the wish to attend psychosomatic services in patients diagnosed with malignant gynecological or obstetric diseases.

CONCLUSION

It was shown that a considerable proportion of patients wanted to attend psychosomatic care during their hospitalization. Contrary to physical and sociodemographic variables, psychological factors were significant predictors of the inpatient's wish to attend psychosomatic services. This suggests that the subjective estimation of impairments is a major predictor of the wish to attend psychosomatic care.

A systematic comparison of fatigue levels in systemic sclerosis with general population, cancer and rheumatic disease samples

OBJECTIVES

There are no studies of fatigue levels in patients with SSc. The objective of this study was to compare fatigue in SSc to general population samples and patients with rheumatic diseases and cancer, where fatigue has been researched extensively.

METHODS

SSc patients completed the General Fatigue Index (GFI) of the Multidimensional Fatigue Inventory. A systematic review was conducted to select comparison samples. Mean GFI scores from SSc patients were compared with mean scores from comparison samples with t-tests and Bonferroni corrections (family-wise P < 0.05).

RESULTS

A total of 106 SSc patients were sampled (97 females; 28 diffuse SSc; 11.9 +/- 7.9 yrs since diagnosis). Based on comparisons from the systematic review, mean GFI scores in SSc (13.3 +/- 4.6) were significantly higher (greater fatigue; P < 0.05) than in two large population samples (8.7 and 9.6) and than in two samples of cancer patients in remission (9.4 and 10.0). Scores for the SSc sample were significantly lower (less fatigue) compared with two samples of cancer patients in palliative care (16.8 and 17.0). SSc GFI scores were similar to scores from patients with RA (13.4), AS (13.0) and SLE (13.1) and to scores from six studies of cancer patients in active treatment (11.1-13.5).

CONCLUSIONS

The high levels of fatigue reported in SSc were similar to patients with varying types and treatment stages of cancer and patients with other rheumatic diseases when assessed with the GFI, demonstrating that fatigue warrants greater attention in SSc.

Increased abdominal obesity, adverse psychosocial factors and shorter telomere length in subjects reporting early ageing; the MONICA Northern Sweden Study

BACKGROUND

The rate of biological ageing is individual and represents the steady decrease in physiological and mental functions. Adverse social factors have been shown to influence this process. Self-perceived early ageing (SEA) might be a useful indicator of early biological ageing and increased mortality risk. The aim of this population-based study was to identify markers of SEA, including telomere length.

METHODS

We studied 1502 subjects (744 men, 758 women) from Northern Sweden. These subjects underwent a physical examination, blood sampling (including telomere length) and completed a self-administered questionnaire about their subjective age, social situation, lifestyle, and self-rated health (SRH). Age- and SRH-adjusted statistical analyses were made comparing SEA subjects with same-sex controls.

RESULTS

In all, 7.9% of men and 12.1% of women reported SEA. These subjects had significantly (p<0.0001) wider waist circumference and higher body mass index than controls. SEA men showed higher fasting glucose and SEA women showed higher total cholesterol levels than controls (p=0.020 and p=0.015, respectively). In addition, SEA women more often reported infrequent physical exercise (p=0.006), mental problems (p=0.064) and worse SRH (p=0.001) than controls. In a random sub-sample, telomere length was significantly shorter in SEA subjects (n=139) than controls (n=301; p=0.02), but not after full adjustment for BMI.

CONCLUSIONS

Self-perceived early ageing is not uncommon and is associated with abdominal obesity, poor self-rated health, lower education, and shorter telomere length. This could link adverse social factors with features of the metabolic syndrome as well as with early biological ageing, of importance for targeting preventive programmes.

Welche Auswirkungen haben Flucht und Vertreibung auf Lebensqualität und Befindlichkeit? Repräsentative Erhebung mit den vor 1946 Geborenen in Deutschland

OBJECTIVES

By the end of Word War II, a substantial proportion of the German population was subjected to flight and expulsion. Severe strain and traumatization were described in individual reports. Preliminary studies based on selected samples indicated profound long-term consequences but no representative studies have been carried out to date. The purposes of the present study were to compare quality of life and well-being of former refugees and non-refugees and to identify risk factors for compromised well-being.

METHODS

A representative sample of the German population (N = 2.043) was interviewed about experiences of flight and expulsion and their present quality of life.

RESULTS

The refugees (18 % of the respective age group; N = 133) reported a reduced physical quality of life at the time of the study (SF-36). Furthermore, they suffered more often from panic attacks and were compromised in their health and well-being. In the regression analysis, the status as a former refugee was predictive for a reduced quality of life and anxiety, in addition to female gender, higher age and lower income.

CONCLUSIONS

The study demonstrates the long-term consequences of flight and expulsion. Further studies are needed on individual coping with the aging process and biographical exposure to traumatic experiences.

Fatigue During Head-And-Neck Radiotherapy: Prospective Study on 117 Consecutive Patients

PURPOSE

Fatigue is an underevaluated cancer-related and treatment-related symptom. We analyzed fatigue in head and neck cancer patients undergoing radiotherapy (RT).

METHODS AND MATERIALS

A total of 117 patients were enrolled (mean age, 58 years). Radiation therapy (median dose, 66 Gy) was given with either exclusive or postoperative intent in 52 and 65 patients, respectively. Chemotherapy (CT) was added before and/or during RT in 61 patients. The patients completed a 20-item questionnaire (Multidimensional Fatigue Inventory [MFI-20]) before, during (weekly), and after RT. The impact of patient-, tumor-, and treatment-related factors on fatigue was evaluated with unifactorial and multifactorial tests.

RESULTS

Fatigue level increased during RT reaching a maximum at Week 6 and then slowly decreased. In multivariate stepwise regression analysis age (inversely related, p < 0.05), psychologic disorders (p < 0.005), and previous head-and-neck surgery (inversely related, p < 0.005) were correlated with higher pre-RT fatigue level. Pre-RT fatigue score (p < 0.0001), induction and/or concomitant CT (p = 0.035), need of cortisone during RT (p = 0.005), and thyroid disorders (p = 0.032) were correlated with higher during-RT fatigue level. Pre-RT fatigue score (p < 0.0001), induction and/or concomitant CT (p < 0.001), and need of cortisone during RT (p < 0.005) were correlated with higher post-RT fatigue level. No impact of gender, performance status, comorbidities other than psychologic and thyroid, tumor stage/site, RT intent, dose, volume, duration, or toxicity was observed.

CONCLUSION

Fatigue affects all patients undergoing RT for head-and-neck cancer, reaches maximum score at the 6th week of RT, and slowly decreases thereafter. Age, thyroid dysfunction, psychologic disorders, pre-RT fatigue score, CT, and cortisone use are correlated with RT-related fatigue levels.

Husbands' involvement in housework and women's psychosocial health: findings from a population-based study in Lebanon

OBJECTIVES

We examined the association between husbands' involvement in housework and the psychosocial health of their wives using data on married couples living in poor neighborhoods in Beirut, Lebanon.

METHODS

Data were derived from a cross-sectional survey of 2797 households; 1652 married couples and their families were included in the analysis. An index of husbands' relative involvement in housework was constructed from 25 items focusing on division of housework activities. Logistic regression was used to assess associations between husbands' involvement in housework and wives' self-rated mental health status, marital dissatisfaction, and unhappiness.

RESULTS

Husbands' involvement in housework was negatively associated with wives' psychological distress, marital dissatisfaction, and overall unhappiness after adjustment for relevant risk factors. In comparison with wives whose husbands were highly involved in housework, wives whose husbands were minimally involved were 1.60 times more likely to be distressed, 2.96 times more likely to be uncomfortable with their husbands, and 2.69 times more likely to be unhappy.

CONCLUSIONS

Our results showed a significant association between husbands' involvement in housework and their wives' psychosocial health.

Pr�valenz der Urininkontinenz in der deutschen Bev�lkerung

The purpose of this study was to determine the frequency of incontinence in men and women in different age groups. In a representative survey, 883 men and 1,182 women with a mean age of 50 years (18-92 years) were studied based on standardized questionnaires on physical and psychological complaints, and quality of life. Participants suffering from involuntary loss of urine were considered "incontinent". The frequency of incontinence strongly increased with age, from 6.9% among the 18-40 year old population to 9.5% among the 41-60 year olds and 23% over the age of 60 years. Women complained more frequently of incontinence (15%) than men (9.5%; total of 12.6% in the population). The majority of the participants with incontinence also suffered from urinary urge, multiple disorders of digestion, pelvic pain and sexual dysfunction. There was also a strong increase in exhaustion, gastric pain, joint pain and cardiac complaints. The younger participants were more strongly affected by incontinence. When patients complain of incontinence, strong impairments in physical and psychological well-being, and quality of life are to be expected.