Association of urinary incontinence with impaired functional status among older people living in a long-term care setting

Are pelvic floor muscle function, quadriceps femoris muscle, gluteus medius muscle, hand grip strength and functional performance affected by incontinence types in elderly people with urinary incontinence?

AIM

The aim of this study is to examine the relationship between incontinence type and pelvic floor muscle function, gluteus medius muscle, quadriceps femoris muscle, hand grip strength, functional performance and balance in elderly people with incontinence.

MATERIALS AND METHODS

This cross-sectional study was conducted in a nursing home with 78 elderly people with stress (SUI, n: 20), urgency (UUI, n: 27) and mixed (MUI, n: 31) urinary incontinence. "Urogenital Distress Inventory-6, Incontinence Impact Questionnaire Form-7, Overactive Bladder-8" were used to evaluate incontinence symptoms and severity. Superficial electromyography was used to evaluate the function of the PFM. A hand dynamometer was used to evaluate hand grip strength, and a digital manual muscle tester was used to evaluate quadriceps femoris (QF) and gluteus medius muscle strength. Short Physical Performance Battery and Time Up and Go Test were performed for functional performance.

RESULTS

There was no significant difference between PFM contraction and relaxation functions, gluteus medius, QF muscle strength, functional performance (p > 0.05) but hand grip strength was highest in the group with UUI (ptotal: 0.022). The group with the highest rate of low hand grip strength is MUI (38.7%). A weak positive correlation was found between QF muscle strength and PFM Work Average value in the MUI group (r: 0.370, p: 0.048). In the MUI group, a moderate positive correlation was found between hand grip strength and gluteus medius muscle strength (r: 0.499, p: 0.005).

CONCLUSION

Our findings show that hand grip strength is related to the type of incontinence in the elderly people. The average hand grip strength was highest in the elderly people with UUI. Additionally, there was a positive relationship between gluteus medius and hang grip strength in MUI. It may provide guidance for evaluation and risk factors in elderly people with incontinence.

Women's Health Across the Lifespan: A Sex- and Gender-Focused Perspective

Women's health in physical therapy has historically focused on sexual and reproductive health. The biological and social constructs of sex and gender, respectively, are determinants of health, including pathophysiology of disease and therapeutic outcomes, and an expansion of the concept of "women's health" is warranted. This Perspective explores the role of sex and gender as key determinants of women's and girls' health and highlights the factors pertinent to physical therapist practice. The Scale for the Assessment for Narrative Review Articles (SANRA), a 6-point assessment to evaluate the quality of narrative reviews, was used a priori and consulted throughout. Across the lifespan, sex- and gender-based health disparities exist. These include sex-based disparities in maternal-fetal outcomes linking female fetal sex to maternal hypertensive disorders of pregnancy, along with a sex-based female advantage in birth outcomes and the emergence of gender differences in motor development. A complex interplay of biological and socially influenced factors contributes to an increased care burden for women throughout adulthood and specific risks for the development of cardiovascular and pelvic floor conditions, decreased function, and increased disability. Sex- and gender-disaggregated data are lacking in outcomes literature. A sex- and gender-informed approach in physical therapy, including analyzing data by sex and gender, may better meet the needs of patients and better prepare physical therapist professionals to contribute to women's health across the lifespan. Success will take coordinated effort involving many stakeholders within and adjacent to the physical therapist community. The influence of sex and gender are lifelong determinants of health, making them critically important to consider in physical therapist practice, education, research, advocacy, and policy. In women's health, focusing on sexual and reproductive health is limiting and insufficient.

Loneliness, functional disability and lower urinary tract symptoms suggestive of benign prostatic hyperplasia in aging men: Insights from the China health and retirement longitudinal study

BACKGROUND

Research has demonstrated that social isolation and loneliness are linked to functional disability in older adults. With the intensification of global aging, functional disability and lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) have become common public health issues affecting elderly men.

METHODS

This study utilized data from the CHARLS database. The functional status of participants was evaluated through activities of daily living (ADL) and instrumental activities of daily living (IADL). Logistic regression analyses were employed to investigate variables associated with LUTS/BPH.

RESULTS

Univariate logistic regression revealed associations between loneliness (OR: 1.26; 95 % CI: 1.08-1.46) (excluding social isolation), ADL (OR: 2.17; 95 % CI: 1.86-2.52), IADL disability (OR: 1.37; 95 % CI: 1.16-1.60), and LUTS/BPH. Following rigorous adjustment for potential confounding factors, it was determined that ADL disability independently correlated with LUTS/BPH (OR: 1.92; 95 % CI: 1.17-3.17).

CONCLUSION

ADL disability is significantly linked to an elevated risk of LUTS/BPH in Chinese elderly men. These findings enhance our understanding of the relationship between functional status and LUTS/BPH.

Improving practicing nurses' knowledge of the cognitive impairment, continence, and mobility needs of older people

OBJECTIVES

To test if two e-learning modules - one on cognitive impairment, and one on continence and mobility - in older people would improve the knowledge of nurse members from the Canadian Gerontological Nurses Association and College of Licensed Practical Nurses of Alberta.

METHODS

A pre-post-test design was used to test 88 nurses' knowledge of cognitive impairment and 105 nurses' knowledge of continence and mobility and their perceptions of how the modules contributed to their learning.

RESULTS

There was a statistically significant increase in practicing nurses' knowledge about cognitive impairment (0.68 increase), continence (2.30 increase), and its relationship to mobility. Nurses' self-report on the feedback survey demonstrated increases in knowledge, confidence, and perceptions about older people.

CONCLUSION

These results suggest the modules have strong potential to enhance practicing nurses' knowledge about cognitive impairment, continence, and mobility.

Impact of Urinary Incontinence on Physical Function and Respiratory Muscle Strength in Incontinent Women: A Comparative Study between Urinary Incontinent and Apparently Healthy Women

Patients with stress urinary incontinence (SUI) may be afraid to increase intra-abdominal pressure to avoid incontinence. This could lead to weak expiratory muscles. The aim of this study was to investigate the association between respiratory muscle strength, physical function, and SUI in patients with SUI. A cross-sectional study was conducted in the Physical Medicine and Functional Rehabilitation Department. Thirty-one incontinent women (IG) and twenty-nine women in a control group (CG) were enrolled in this study. Anthropometric data, respiratory muscle strength (maximal inspiratory pressure; maximal expiratory pressure), SUI (Urogenital Distress Inventory-6; Incontinence Impact Questionnaire-7; Pad test), and physical function (waist circumference; timed-up-and-go test; abdominal muscle strength) were assessed. Body fat, body mass index, body weight, and waist circumference were higher in IG than CG (p < 0.01), while postural gait and abdominal muscles were lower (p < 0.001). Respiratory muscle strength displayed moderate correlations with SUI severity, especially for maximal expiratory pressure (p < 0.01). Maximal expiratory pressure was moderately associated with physical function. Deterioration in respiratory muscle strength is a characteristic of women with SUI. In this population, pelvic floor muscle training may be prescribed to improve continence. By feeling more confident about increasing intra-abdominal pressure, women with SUI would strengthen their expiratory muscles and eventually improve their physical function.

Pilot of Patient Engagement in Continence Care on Geriatric Rehabilitation Units

PURPOSE

The aim of this study was to pilot a process of engaging geriatric rehabilitation patients in the assessment and management of their continence concerns.

DESIGN

A descriptive study was conducted.

METHODS

The study has four phases: (1) staff education on continence with a pre-post knowledge quiz, (2) design of patient engagement process by a working group, (3) a 6-week pilot of a patient symptom questionnaire and process of engaging patients with audits of disciplinary admission histories and documentation, and (4) patient and staff feedback surveys.

RESULTS

Patients in geriatric rehabilitation identify a range of bladder and bowel symptoms. However, there was little documented evidence from the interprofessional team that corresponded to patients' reported symptoms.

CONCLUSION

Further research into symptoms bothersome to patients and engagement of both patients and the interprofessional team in addressing these in the rehabilitation setting is needed.

CLINICAL RELEVANCE TO REHABILITATION NURSING

Patients admitted to geriatric rehabilitation have a range of bladder and bowel symptoms, which need to be addressed.

Urinary Incontinence and Its Association with Physical and Psycho-Cognitive Factors: A Cross-Sectional Study in Older People Living in Nursing Homes

Urinary incontinence (UI) is a common geriatric syndrome affecting bladder health and is especially prevalent in nursing homes (NHs). The aim of the study was to determine the prevalence of UI and its associated factors in five Spanish NHs. UI (measured with Minimum Data Set 3.0), sociodemographic, and health-related variables were collected. Chi-square (or Fisher's) or Student's t-test (or Mann Whitney U) for bivariate analysis were used, with Prevalence Ratio (PR) as an association measure. The prevalence of UI was 66.1% (CI:95%, 53.6-77.2) in incontinent (n = 45, mean age 84.04, SD = 7.7) and continent (n = 23, mean age 83.00, SD = 7.7) groups. UI was significantly associated with frailty (PR = 1.84; 95%CI 0.96-3.53), faecal incontinence (PR = 1.65; 95%CI 1.02-2.65), anxiety (PR = 1.64; 95%CI 1.01-2.66), physical performance (PR = 1.77; 95%CI 1.00-3.11), and cognitive state (PR = 1.95; 95%CI 1.05-3.60). Statistically significant differences were found between incontinent and continent NH residents for limitations in activities of daily living (ADL), mobility, quality of life, sedentary behaviour, and handgrip strength. It can be concluded that two out of three of the residents experienced UI, and significant associated factors were mainly physical (sedentary behaviour, frailty, physical performance, ADL limitations, mobility, faecal incontinence, and handgrip strength) followed by psycho-cognitive factors (cognition, anxiety, and quality of life).

Testing and e-learning activity designed to enhance student nurses understanding of continence and mobility

OBJECTIVES

The aim of this study was to test if the e-learning activity that we developed could improve student nurses' knowledge of continence and mobility and whether or not students would find the style of learning beneficial.

METHODS

A quasi-experimental pre-post-test design was used to test if the continence and mobility e-learning activity could improve student nurses' knowledge about assessing and managing the needs of continence and mobility. An 18-item true/false knowledge of continence quiz was completed by 116 student nurses and a Likert style feedback learning survey was completed by 135 nursing students.

RESULTS

There was a statistically significant increase in students' knowledge about continence and its relationship to mobility following the e-learning activity. The e-learning activity also enhanced students' knowledge, confidence and perceptions about older people.

CONCLUSIONS

The e-learning activity we developed has the potential to improve nursing students' knowledge about continence and mobility in an enjoyable manner.

Physical performance measures in older women with urinary incontinence: pelvic floor disorder or geriatric syndrome?

Objective:

To evaluate physical performance measures of mobility and functional impairments and assess their association with urinary incontinence (UI) severity and impact on quality of life among older women with UI.

Methods:

In a cross-sectional pilot study, 20 women aged ≥ 70 years with UI completed UI questionnaires (Global Impression of Severity, Incontinence Impact Questionnaire (IIQ-7)) and functional status evaluation. Functional status evaluation included the Modified Physical Performance Test (MPPT; range 0–36), Short Physical Performance Battery (SPPB; range 0–12), and other physical performance measures (e.g., Timed Up and Go [TUG]). MPPT and SPPB scores <32 and <10, respectively, indicated impaired mobility and function. Descriptive statistics and spearman correlation coefficients evaluated study variables and associations between UI and physical performance measures.

Results:

Women were 76.6±4.7 years old with mean body mass index 33.5±9.0 kg/m². Mixed UI was the most prevalent (n=17; 85%), and 14 (70%) participants rated their UI as moderate or severe. Low MPPT (<32) and SPPB (<10) scores were present in 65% (n=13) and 35% (n=7) of participants, respectively. Lower MPPT score (r=−0.46; P=0.04) and worse TUG performance (r=0.50; P=0.03) were associated with greater UI impact on quality of life based on IIQ-7. SPPB did not correlate (P>0.05) with UI measures.

Conclusions:

Mobility and functional impairments are common among older women with UI. Associations between MPPT score, TUG performance with UI impact on quality of life suggest these physical performance measures could be markers of mobility and functional impairments in future research on UI in older women.

Further research in utility of physical performance measures as markers of mobility and functional impairments in older women with urinary incontinence is warranted.

A novel early mobility bundle improves length of stay and rates of readmission among hospitalized general medicine patients

Inpatient early mobility initiatives are effective therapeutic interventions for improving patient outcomes and decreasing use of hospital resources among adult ICU and general medicine patients. To establish and demonstrate guidelines for early patient ambulation, we developed and implemented a novel multidisciplinary mobility bundle utilizing the JH-HLM (Johns Hopkins Highest Level of Mobility) scale for mobility classification, on a single adult general medicine unit of a community hospital. Our results show that patients admitted to the unit after implementation of the mobility bundle had improved mobility scores, reduced rates of 30-day hospital readmission, and a shortened length of hospital stay. This study emphasizes the importance of measuring mobility using a systematic method, easing workflow among unit practitioners, and allowing mobility initiatives to be jointly driven by nursing, physical therapy, and physicians.

The prevalence and risk factors for urinary incontinence among inpatients, a multicenter study from Turkey

OBJECTIVE

To determine the prevalence and the factors associated with urinary incontinence (UI) among inpatients in Turkey.

METHOD

The population of this study comprised of patients screened by the "National Prevalence Measurement of Quality of Care (LPZ)" study in 2017 and 2018. Age, gender, comorbidities, length of hospital stay, sedative medications, SARC-F score, anthropometric measurements, and care parameters such as malnutrition, falls, UI-fecal incontinence (FI), restraints, and care dependency score (CDS) were noted. The LPZ questionnaire was performed by trained researchers, and multiple logistic regression analysis was performed to determine the factors associated with UI.

RESULTS

The prevalence of UI was 29.4 % among 1176 inpatients, and 41.6 % in patients ≥65 years. Urinary incontinence was associated with older age (OR, 1.966, 95 % CI 1.330-2.905), female sex (OR, 2.055, 95 % CI 1.393-3.030), CDS (OR, 3.236, 95 % CI 2.080-5.035), the number of comorbidities (OR, 1.312, 95 % CI 1.106-1.556), end-of life management (OR, 3.156, 95 % CI 1.412-7.052), sedative medications (OR, 1.981, 95 % CI 1.230-3.191), and FI (OR, 12.533, 95 % CI 4.892-32.112) in all adults, where CDS (OR, 2.589, 95% CI 1.458-4.599), end-of life management (OR, 2.851, 95 % CI 1.095-7.424), sedative medications (OR, 2.529, 95 % CI 1.406-4.548), and FI (OR, 13.138, 95 % CI 4.352-39.661) were associated with UI among geriatric patients.

CONCLUSIONS

The factors associated with UI in geriatric and all adult inpatients are CDS, sedative medications, end-of life management, and FI plus older age, female sex, and comorbidities for the latter. The factors associated with UI vary in different age groups.

Exploring a Path Model of Cognitive Impairment, Functional Disability, and Incontinence Among Male Veteran Home Residents in Southern Taiwan

Most studies focusing on only one directional effect among cognitive health, physical function, and incontinence may miss potential paths. This study aimed to determine the pathway by analyzing the bidirectional effects of exposure (X) on outcome (Y) and explore the mediating effect (M) between X and Y. Secondary data analyses were performed in this study. The original data were collected from August to October 2013 in one VH in Tainan, Taiwan, and the final sample size was 144 older male veterans. Path analysis was performed to test the pathway sequence X → M → Y among the three outcome variables. Approximately 80% of the veterans were aged 81 or older, approximately 42% had a functional disability, 26% had cognitive impairment, and 20% had incontinence. The relationships between functional disability and incontinence and between functional disability and cognition impairment were bidirectional, and functional disability played a key mediating role in the relationship between cognitive impairment and incontinence. Physical more than cognitive training in order to improve or at least stabilize functional performance could be a way to prevent or reduce the process of developing incontinence.

Factors associated with poor physical performance in older adults of 11 Peruvian high Andean communities

Background: Physical performance in the older adult has been extensively studied. However, only a few studies have evaluated physical performance among older adults of high Andean populations and none have studied the factors associated with it. The objective of this study was to evaluate factors associated with poor physical performance by using the Short Physical Performance Battery (SPPB) in older adults living in 11 Peruvian high Andean communities.

Methods: An analytical cross-sectional study was carried out in inhabitants aged 60 or over from 11 high-altitude Andean communities of Peru during 2013-2017. Participants were categorized in two groups according to their SPPB score: poor physical performance (0-6 points) and medium/good physical performance (7-12 points). Additionally, we collected socio-demographic, medical, functional and cognitive assessment information. Poisson regression models were constructed to identify factors associated with poor physical performance. Prevalence ratio (PR) with 95% confidence intervals (95 CI%) are presented.

Results: A total of 407 older adults were studied. The average age was 73.0 ± 6.9 years (range: 60-94 years) and 181 (44.5%) participants had poor physical performance (0-6 points). In the adjusted Poisson regression analysis, the factors associated with poor physical performance were: female gender (PR=1.29; 95%CI: 1.03-1.61), lack of social support (PR=2.10; 95%CI: 1.17-3.76), number of drugs used (PR=1.09; 95%CI: 1.01-1.17), urinary incontinence (PR=1.45; 95%CI: 1.16-1.82), exhaustion (PR=1.35; 95%CI: 1.03-1.75) and cognitive impairment (PR=1.89; 95%CI: 1.40-2.55).

Conclusions: Almost half of the population evaluated had poor physical performance based on the SPPB. Factors that would increase the possibility of suffering from poor physical performance were: female gender, lack of social support, number of drugs used, urinary incontinence, exhaustion and cognitive impairment. Future studies with a larger sample and longitudinal follow-up are needed to design beneficial interventions for the high Andean population.

Association of Geriatric Syndromes with Urinary Incontinence according to Sex and Urinary-Incontinence-Related Quality of Life in Older Inpatients: A Cross-Sectional Study of an Acute Care Hospital

Background

Geriatric syndromes are associated with morbidity and poor quality of life (QOL). Urinary incontinence (UI) is one of the most prevalent geriatric syndromes. However, there is little research on the association of UI and UI-related QOL with other geriatric syndromes. We investigated the relationship between geriatric syndromes and UI according to gender and UI-related QOL among older inpatients.

Methods

This study was conducted among 444 older inpatients (aged 65 years and older) between October 2016 and July 2017. We examined geriatric syndromes and related factors involving cognitive impairment, delirium, depression, mobility decline, polypharmacy, undernutrition, pain, and fecal incontinence. UI-related QOL was assessed using the International Consultation on Incontinence Questionnaire-Short Form. Multiple logistic regression analysis was used to evaluate these associations.

Results

Geriatric syndromes and related factors were associated with UI. Mobility decline (odds ratio [OR], 4.16; 95% confidence interval [CI], 2.29–7.56), polypharmacy (OR, 3.35; 95% CI, 1.89–5.92), and pain (OR, 6.80; 95% CI, 3.53–13.09) were related to UI in both genders. Especially, delirium (OR, 7.55; 95% CI, 1.61–35.44) and fecal incontinence (OR, 10.15; 95% CI, 2.50–41.17) were associated with UI in men, while cognitive impairment (OR, 4.19; 95% CI, 1.14–15.44) was significantly associated with UI in women. Patients with depression were more likely to have poor UI-related QOL (OR, 8.54; 95% CI, 1.43–51.15).

Conclusion

UI was associated with different geriatric syndromes and related factors according to gender. Care for patients with depression, related to poor UI-related QOL, should be considered in primary care to improve the UI-related QOL of these individuals.

Symptoms of urinary incontinence and pelvic organ prolapse and physical performance in middle-aged women from Northeast Brazil: a cross-sectional study

Background

Reproductive history and urogynecological disorders have been associated with limitations in physical function. However, little is known about the relationship between symptoms of urinary incontinence and pelvic organ prolapse, and physical performance. Therefore, the purpose of this study was to examine whether symptoms of urinary incontinence and pelvic organ prolapse are independently associated factors with indicators of lower physical performance in middle-aged women from Northeast Brazil.

Methods

This is a cross-sectional study of 381 women between 40 to 65 years old living in Parnamirim, Northeast Brazil. Physical performance was assessed by gait speed, chair stand and standing balance tests. Urinary incontinence and pelvic organ prolapse were self-reported. Multiple linear regression analyses were performed to model the effect of self-reported urinary incontinence and pelvic organ prolapse on each physical performance measure, adjusted for covariates (age, family income, education, body mass index, parity).

Results

In the analysis adjusted for confounders, women reporting urinary incontinence spent, on average, half a second longer to perform the chair stand test (β = 0.505 95% CI: 0.034: 0.976). Those reporting pelvic organ prolapse shortened the balance time with eyes open by 2.5 s on average (β = − 2.556; CI: − 4.769: − 0.343).

Conclusions

Symptoms of pelvic organ prolapse and urinary incontinence are associated to worse physical performance in middle-aged women. These seemingly small changes in physical performance levels are of clinical importance, since these conditions may influence women’s physical ability, with implications for other tasks important to daily functioning and should be addressed by health policies targeting women’s health and functionality.

Fatores de risco para incontinência urinária em idosos institucionalizados

Objetivo: Analisar os fatores de risco para incontinência urinária (IU) em idosos institucionalizados. Métodos: Estudo transversal, analítico, documental realizado por coleta em 203 prontuários de uma instituição de longa permanência no nordeste do Brasil. Foram utilizados um instrumento para caracterização sociodemográfica e de saúde e os valores do Mini Exame do Estado Mental (MEEM). Os dados foram analisados a partir da estatística descritiva, inferencial e por regressão logística múltipla. Resultados: A prevalência de IU foi de 42,36% e maior em mulheres (66,28%), mais velhos (média: 79,62 anos) e dependentes (89,53%). Houve associação entre idade (p = 0,01), sexo (p = 0,024), estado civil (p = 0,007), religião (p = 0,015), com quem residia antes da institucionalização (p = 0,033), grau de dependência (p < 0,001), valores do MEEM (p < 0,001) e doenças cardiovasculares (p < 0,001) e neurológicas (p < 0,001). Os fatores de risco para IU foram quantidade de doenças [odds ratio (OR) = 1,17; intervalo de confiança de 95% (IC95%) = 1,02-1,34], consumo de cinco a nove medicamentos (OR = 4,07; IC95% = 1,14-14,52), ser solteiro (OR = 2,09; IC95% = 1,30-8,01), dependente (OR = 3,27; IC95% = 1,33-8,04) e ter baixa pontuação no MEEM (OR = 0,88; IC95% = 0,85-0,93). Conclusão: Os resultados revelam a importância de estudar IU nessa população para identificar precocemente os fatores de risco passíveis de prevenção.

Risk factors for urinary incontinence in institutionalized elderly​

Objectives: To analyze the risk factors for urinary incontinence (UI) in institutionalized elderly. Methods: Cross-sectional, analytical, documentary study done by collection in 203 medical records of a long-stay institution in northeastern Brazil. An instrument for sociodemographic and health characterization and the values of the Mini Mental State Examination (MMSE) were used. The data were analyzed from the descriptive, inferential and multiple logistic regression. Results: The prevalence of UI was 42.36% and higher in women (66.28%), older (mean: 79.62 years) and dependent (89.53%). There was an association between age (p = 0.01), sex (p = 0.024), marital status (p = 0.007), religion (p = 0.015), with whom resided before institutionalization (p = 0.033), degree of dependency (p < 0.001), MMSE values (p < 0.001) and cardiovascular (p < 0.001) and neurological diseases (p < 0,001). The risk factors for UI were number of diseases (OR = 1.17; 95%CI = 1.02-1.34), consumption of five to nine medications (OR = 4.07, 95% CI = 1.14-14.52), single (OR = 2.09, 95% CI = 1.30-8.01),dependent (OR = 3.27, 95% CI = 1.33-8.04) and had a low MMSE score (OR = 0.88, 95% CI= 0.85-0.93). Conclusion: The results reveal the importance of studying UI in this population to identify early risk factors that can be prevented.

Predicting continence decline in institutionalized older people: A longitudinal analysis

AIMS

To verify the incidence of urinary continence decline and the probability of maintaining urinary continence, as well as identify the prognostic factors of urinary continence decline in institutionalized older people.

METHODS

A 2-year longitudinal study (with five 6-month waves) was conducted with subjects ≥60 years old who lived in 10 nursing homes in the city of Natal-RN (Brazil). Urinary incontinence was assessed by the Minimum Data Set version 3.0. Sociodemographic, institution-related and health-related variables were considered to establish the baseline. Time-dependent variables included cognitive decline, functional decline, and incidences of falls, hospitalizations, and fractures during the period. The actuarial method, the log-rank test, and Cox's regression were applied as statistical methods.

RESULTS

Among the cohort of 196 older adults, 105 (53.6%) individuals maintained the continence status during the period, 21 (10.7%) improved it at one or more assessments, and 76 (38.8%) subjects declined. The cumulative probability of maintaining continence status was 82.6% (confidence interval [CI], 95%: 76.5%-87.3%), 74.7% (CI, 95%: 67.8%-80.4%), 66.9% (CI, 95%: 59.4%-73.2%), and 49.3% (CI, 95%: 40.1%-57.9%) at 6, 12, 18, and 24 months, respectively. Predicting factors for continence decline were: disability (hazard ratio [HR] = 4.03; P < 0.001), functional decline (HR = 3.02; P = 0.001) and potentially inappropriate medication (HR = 1.84; P = 0.008).

CONCLUSIONS

The incidence of continence decline and the cumulative probability of maintaining continence status in institutionalized older adults was approximately 39% and 49%, respectively, at the 2-year follow-up. Disability and potentially inappropriate drugs at baseline and functional decline across the period predicted continence decline in this cohort.

Assessment of cerebrovascular reserve impairment using the breath-holding index in patients with leukoaraiosis

Many studies have demonstrated that leukoaraiosis is associated with impaired cerebrovascular reserve function. However, the definitive hemodynamic changes that occur in leukoaraiosis are not clear, and there are many controversies. This study aimed to investigate hemodynamic changes in symptomatic leukoaraiosis using transcranial Doppler ultrasonography and the breath-holding test in a Chinese Han population, from northern China. A total of 203 patients who were diagnosed with ischemic stroke or clinical chronic progressive ischemic symptoms were enrolled in this study, including 97 males and 106 females, with an age range of 43–93 years. The severity of leukoaraiosis was evaluated according to the Fazekas grading scale, and patients were divided into four groups accordingly. Grade 0 was no leukoaraiosis, and grades I, II, and III were mild, moderate, and severe leukoaraiosis, respectively, with 44, 79, 44, and 36 cases in each group. Transcranial Doppler ultrasonography and the breath-holding test were performed. The mean blood flow velocity of the bilateral middle cerebral artery was measured and the breath-holding index was calculated. The breath holding index was correlated with leukoaraiosis severity and cognitive impairment. Patients with a low breath holding index presented poor performance in the Montreal Cognitive Assessment (MoCA) and executive function tests. That is, the lower the breath holding index, the lower the scores for the MoCA and the higher for the trail-making test Parts A and B. These results indicate that the breath-holding index is a useful parameter for the evaluation of cerebrovascular reserve impairment in patients with leukoaraiosis. In addition, the breath-holding index can reflect cognitive dysfunction, providing a new insight into the pathophysiology of leukoaraiosis. This study was approved by the Ethics Committee of the Fifth People’s Hospital of Shenyang, China (approval No. 20160301) and registered in the Chinese Clinical Trial Registry (registration number: ChiCTR1800014421).

Urinary Incontinence Is Associated With Physical Performance Decline in Community-Dwelling Older Women: Results From the International Mobility in Aging Study

Objective: The objective of this study is to evaluate the influence of urinary incontinence (UI) on physical performance. Method: In prospective analyses from the International Mobility in Aging Study (IMIAS), 915 women (65-74 years) from Canada, Colombia, Albania, and Brazil were evaluated in relation to self-reported UI (past week) and physical performance (Short Physical Performance Battery [SPPB]), with reevaluation after 2 years. Linear mixed models examined the influence of UI on SPPB, adjusted by covariates (age, study site, education, income sufficiency, body mass index [BMI] and parity). Results: Women reporting some UI presented lower SPPB mean (β = -0.41, p = .009) and a greater reduction (β = -0.53, p = .001) over 2 years than those reporting no UI. Discussion: Compared with no reported UI, some UI was associated with worse and more pronounced declines in physical performance over 2 years. This study highlights the importance of practices to reduce UI to contribute to healthier aging.

Urinary Incontinence and Its Association with Frailty Among Men Aged 80 Years or Older in Taiwan: A Cross-Sectional Study

AIMS

To evaluate the prevalence of urinary incontinence (UI) and its association with frailty among men aged 80 years and older in Taiwan.

METHODS

Residents living in four veterans retirement communities were invited for study and 440 men aged 80 years and older were enrolled. Comprehensive geriatric assessment was performed for them, which composed of Clinical Frailty Scale, Northern Health and Social Care Trust (HSC)-Continence Assessment Form, Charlson's Comorbidity Index (CCI), Barthel Index (BI), Instrumental Activities of Daily Living (IADL), Mini-Mental State Examination (MMSE), Geriatric Depression Scale-5 (GDS-5), and Mini-Nutritional Assessment-Short Form (MNA-SF).

RESULTS

In this study, the overall prevalence of UI was 19.1% (mostly urgency incontinence and functional incontinence). Univariate analyses were performed to evaluate the associations between UI and other variables. Frailty was more common among subjects with UI than those without (60.7% vs 32.3%, p < 0.001). Besides, subjects with UI had more comorbidity (CCI: 1.40 ± 1.15 vs 0.89 ± 0.89, p < 0.001), poorer physical function (BI: 65.77 ± 33.39 vs 84.12 ± 24.08, p < 0.001; IADL: 3.46 ± 2.64 vs 4.41 ± 2.25, p = 0.003), more depressive symptoms (GDS-5: 1.83 ± 1.78 vs 1.18 ± 1.36, p = 0.02), poorer cognitive function (MMSE: 16.57 ± 7.65 vs 19.37 ± 6.82, p = 0.001), poorer nutritional status (MNA-SF: 10.0 ± 03.03 vs 11.23 ± 2.24, p = 0.001), more polypharmacy (66.7% vs 45.2%, p < 0.001) and higher chance of stool incontinence (22.6% vs 1.7%, p < 0.001). Multivariate logistic regression showed that UI was independently associated with frailty, (odds ratio [OR] = 2.1; 95% confidence interval [CI]: 1.2-3.6; p = 0.012), stool incontinence (OR = 14.4; 95% CI 5.2-39.7; p < 0.001) and depressive symptoms (OR = 1.30; 95% CI 1.10-1.54; p = 0.002).

CONCLUSIONS

About one fifth of study subjects had UI (mostly urgency and functional incontinence type), which was significantly associated with frailty, stool incontinence and depressive symptoms. Further study is needed to evaluate the possibilities of reversing these geriatric syndromes by an integrated intervention program.

White matter hyperintensities and geriatric syndrome: An important role of arterial stiffness

White matter hyperintensities (WMH) are defined as cerebral white matter changes presumed to be of vascular origin, bilateral and mostly symmetrical. They can appear as hyperintense on T2-weighted and fluid-attenuated inversion recovery sequences, and as isointense or hypointense on T1-weighted magnetic resonance imaging of the brain. WMH have been focused on because of their clinical importance as a risk factor for cerebrovascular diseases and cognitive impairment. WMH are associated with geriatric syndrome, which is defined by clinical symptoms characteristic of older adults, including cognitive and functional impairment and falls. Cerebral small vessel diseases, such as WMH, might play an important role as risk factors for cerebrovascular diseases, cognitive impairment and geriatric syndrome through the mechanism of arterial stiffness. However, the vascular, physiological and metabolic roles of arterial stiffness remain unclear. Basically, arterial stiffness indicates microvessel arteriosclerosis presenting with vascular endothelial dysfunction. These changes might arise from hemodynamic stress as a result of a "tsunami effect" on cerebral parenchyma. In the present article, we review the clinical characteristics of WMH, focusing particularly on two associations: (i) those between cerebral small vessel diseases including WMH and arterial stiffness; and (ii) those between WMH and geriatric syndrome.