Prevalence and outcome of low ADL and incontinence among the elderly: five years follow-up in a Japanese urban community

Successful Aging Rates of Global Older Adults: A Systematic Review and Meta-analysis

OBJECTIVE

This meta-analysis aimed to qualitatively analyze the different aspects of the successful aging (SA) criteria and quantitatively assess the rate of SA and its different dimensions among people aged ≥60 years globally to provide a basis for constructing criteria for SA.

DESIGN

This is a systematic review and meta-analysis, which has been registered on PROSPERO (CRD42024585934).

SETTING AND PARTICIPANTS

Older adults (≥60 years).

METHODS

PubMed, Embase, CINAHL, Web of science, SCOPUS, and PsycINFO (inception to July 17, 2023) were used to search for relevant studies to evaluate the comprehensive level of SA. A random effects model was used to synthesize SA rates and 95% CIs. Quality assessment was conducted using the Agency for Healthcare Quality and Research criteria and the Newcastle-Ottawa Scale. Statistical analyses were conducted using Revman 5.3 and Stata 11.0.

RESULTS

A total of 546,228 older adults from 64 studies were incorporated into the meta-analysis. In the 64 studies, SA criteria mentioned 11 aspects: psychology, disease, cognitive function, physical function, social engagement, disability, independence, self-rated health, economy, memory impairment, and obesity. The meta-analysis indicated that the summary estimate of SA rate among people aged ≥60 years was 22.0% (95% CI 19.0%-25.0%) globally. A meta-analysis was conducted on the 6 aspects included more commonly in SA criteria, and the results showed that the rate of no disability was the highest (72.0%), followed by good psychological status (69%), active social engagement (65%), high cognitive function (64%), and high physical function (62%), with no major diseases being the lowest (50.0%).

CONCLUSIONS AND IMPLICATIONS

The overall estimated SA rate among people aged ≥60 years was 22% globally. The SA criteria mainly include 6 aspects: good psychological status, no major diseases, high cognitive function, high physical function, active social engagement, and no disability. Emphasizing the importance of psychological well-being and chronic disease management, the findings offer valuable insights for future research and policy making related to the welfare of aging populations.

Prevalence and Risk Factors of Urinary Incontinence Among Elderly Adults in Rural China: A Cross-Sectional Survey

PURPOSE

The purpose of this study was to explore the prevalence of urinary incontinence (UI) and several subtypes: (stress, urge, and mixed UI) and the influence of multiple factors on the likelihood of UI.

DESIGN

Epidemiological study based on cross-sectional data collection.

SUBJECTS AND SETTING

The sample comprised 1279 inhabitants 65 years and older residing in 10 villages randomly selected from the Shanxi province, located in North China.

METHODS

The presence and types of UI were assessed using the International Consultation of Incontinence Questionnaire-Short Form. Sociodemographic parameters were also recorded, along with data on lifestyle, bowel function, and medical conditions. The Activity of Daily Living Scale and Mini-Mental State Examination instruments were used to evaluate physical and cognitive functions, respectively. A multivariate logistic regression model with the backward method was employed to identify factors associated with UI.

RESULTS

The prevalence of any UI among the rural Chinese elderly 65 years and older was 46.8%, with a female predominance (56.3% in females vs 35.0% in males). The most common incontinence subtype in women was mixed UI (n = 170, 24.0%), followed by stress UI (n = 131, 18.5%) and urge UI (n = 97, 13.7%). The most prevalent form of UI in males was urge UI (n = 190, 33.2%), followed by stress UI (n = 5, 0.9%) and mixed UI (n = 5, 0.9%). Less than one quarter of respondents (17%, n = 102) of participants with UI had consulted a doctor. Multivariate analysis found that poorer physical function, poor quality of sleep, and fecal incontinence were common factors associated with UI in both women and men. In women, higher body mass index and constipation were also independent correlates, as were poor vision and heart disease in men. Poorer physical function was associated with all UI subtypes. For female stress UI, poorer cognitive status, tea drinking, and hypertension also emerged as independent risk factors. Heart disease was an independent risk factor in both female and male urge UI; as was consumption of a non-plant-based diet for female mixed and urge UI; nonfarmer and traumatic brain injury for female urge UI; and poor vision and fecal incontinence in male urge UI.

CONCLUSIONS

Chinese rural citizens showed a high UI prevalence, but only a small proportion had consulted a health care provider. Physical function decline was the most important contributor to UI among participants. Individualized intervention programs targeting modifiable risk factors among high-risk populations should be developed.

Association between multimorbidity patterns and disability among older people covered by long-term care insurance in Shanghai, China

BACKGROUND

Functional disability and multimorbidity are common among older people. However, little is known about the relationship between functional disability and different multimorbidity combinations. We aimed to identify multimorbidity patterns and explore the associations between these patterns and functional disability.

METHODS

We investigated a multi-stage random sample of 1871 participants aged ≥60 years and covered by long-term care insurance in Shanghai, China. Multimorbidity was defined as the simultaneous presence of two or more chronic diseases in an individual. Participants completed scales to assess basic and instrumental activities of daily living (BADL and IADL, respectively). Multimorbidity patterns were identified via exploratory factor analysis. Binary logistic regression models were used to determine adjusted associations between functional disability and number and patterns of multimorbidity.

RESULTS

Multimorbidity was present in 74.3% of participants. The prevalence of BADL disability was 50.7% and that of IADL disability was 90.7%. There was a strong association between multimorbidity and disability. We identified three multimorbidity patterns: musculoskeletal, cardio-metabolic, and mental-degenerative diseases. The cardio-metabolic disease pattern was associated with both BADL (OR 1.28, 95%CI 1.16-1.41) and IADL (OR 1.41, 95%CI 1.19-1.68) disability. The mental-degenerative disease pattern was associated with BADL disability (OR 1.55, 95%CI 1.40-1.72).

CONCLUSIONS

Multimorbidity and functional disability are highly prevalent among older people covered by long-term care insurance in Shanghai, and distinct multimorbidity patterns are differentially associated with functional disability. Appropriate long-term healthcare and prevention strategies for older people may help reduce multimorbidity, maintain functional ability, and improve health-related quality of life.

Fecal Incontinence Is Associated With Mortality Among Older Adults With Complex Needs: An Observational Cohort Study

OBJECTIVES

Fecal incontinence (FI) is a problem in growing older populations. Validating a suspected association between FI and mortality in community dwelling older adults could lead to improved planning for and management of the increasing complex older population. In a large cohort of New Zealand older adults, we assessed the prevalence of FI, urinary incontinence (UI), combined FI and UI, and their associations with mortality.

METHODS

This study consisted of a retrospective analysis of international standardized geriatric assessment-home care (InterRAI-HC) data from community-dwelling adults aged 65 years or older, who met the criteria required for the InterRAI-HC, having complex needs and being under consideration for residential care. The prevalence of UI and FI was analyzed. Data were adjusted for demography and 25 confounding factors. Mortality was the primary outcome measure.

RESULTS

The total cohort consisted of 41,932 older adults. Both UI and FI were associated with mortality (P<0.001), and risk of mortality increased with increased frequency of incontinence. In the adjusted model, FI remained significantly related to survival (P<0.001), whereas UI did not (P=0.31). Increased frequency of FI was associated with an increased likelihood of death (hazard ratio 1.28).

CONCLUSIONS

This large national study is the first study to prove a statistically significant relationship between FI and mortality in a large, old and functionally impaired community. These findings will help improve the management of increasingly complex older populations.

Urinary Incontinence as a Predictor of Death: A Systematic Review and Meta-Analysis

Background

The association between urinary incontinence (UI) and increased mortality remains controversial. The objective of our study was to evaluate if this association exists.

Methods

We performed a systematic review and meta-analysis of observational studies comparing death rates among patients suffering from UI to those without incontinence. We searched in Medline, Embase and the Cochrane library using specific keywords. Studies exploring the post-stroke period were excluded. Hazard ratios (HR) were pooled using models with random effects. We stratified UI by gender and by UI severity and pooled all models with adjustment for confounding variables.

Results

Thirty-eight studies were retrieved. When compared to non-urinary incontinent participants, UI was associated with an increase in mortality with pooled non adjusted HR of 2.22 (95%CI 1.77–2.78). The risk increased with UI severity: 1.24 (95%CI: 0.79–1.97) for light, 1.71 (95%CI: 1.26–2.31) for moderate, and 2.72 (95%CI: 1.90–3.87) for severe UI respectively. When pooling adjusted measures of association, the resulting HR was 1.27 (95%CI: 1.13–1.42) and increased progressively for light, moderate and severe UI: 1.07 (95%CI: 0.79–1.44), 1.25 (95%CI: 0.99–1.58), and 1.47 (95%CI: 1.03–2.10) respectively. There was no difference between genders.

Conclusion

UI is a predictor of higher mortality in the general and particularly in the geriatric population. The association increases with the severity of UI and persists when pooling models adjusted for confounders. It is unclear if this association is causative or just reflects an impaired general health condition. As in most meta-analyses of observational studies, methodological issues should be considered when interpreting results.

Multimorbidity and functional decline in community-dwelling adults: a systematic review

BACKGROUND

Multimorbidity affects up to one quarter of primary care populations. It is associated with reduced quality of life, an increased risk of mental health difficulties and increased healthcare utilisation. Functional decline is defined as developing difficulties with activities of daily living and is independently associated with poorer health outcomes. The aim of this systematic review was to examine the association between multimorbidity and functional decline and to what extent multimorbidity predicts future functional decline.

METHODS

A systematic literature search (1990-2014) and narrative analysis was conducted.

INCLUSION CRITERIA

Population; Community-dwelling adults (≥18 years), Risk; Multimorbidity defined as the presence of ≥2 chronic medical conditions in an individual, Primary outcome; Physical functional decline measured using a validated instrument, Study design; cross-sectional or cohort studies. The following databases were included: PubMed, EMBASE, CINAHL, the Cochrane Library and the International Research Community on Multimorbidity (IRCMo) publication list. Methodological quality assessment of included studies was conducted with a suitable risk of bias tool.

RESULTS

A total of 37 studies were eligible for inclusion (28 cross-sectional studies and 9 cohort studies). The majority of cross-sectional studies (n = 24/28) demonstrated a consistent association between multimorbidity and functional decline. Twelve of these studies reported that increasing numbers of chronic condition counts were associated with worsening functional decline. Nine cohort studies included 14,133 study participants with follow-up periods ranging from one to six years. The majority (n = 5) found that multimorbidity predicted functional decline. Of the five studies that reported the impact of increasing numbers of conditions, all reported greater functional decline with increasing numbers of conditions. One study examined disease severity and found that this also predicted greater functional decline. Overall, cohort studies were of good methodological quality but were mixed in terms of participants, multimorbidity definitions, follow-up duration, and outcome measures.

CONCLUSIONS

The available evidence indicates that multimorbidity predicts future functional decline, with greater decline in patients with higher numbers of conditions and greater disease severity. This review highlights the importance of considering physical functioning when designing interventions and systems of care for patients with multimorbidity, particularly for patients with higher numbers of conditions and greater disease severity.

Multimorbidity and functional decline in community-dwelling adults: a systematic review

BACKGROUND

Multimorbidity affects up to one quarter of primary care populations. It is associated with reduced quality of life, an increased risk of mental health difficulties and increased healthcare utilisation. Functional decline is defined as developing difficulties with activities of daily living and is independently associated with poorer health outcomes. The aim of this systematic review was to examine the association between multimorbidity and functional decline and to what extent multimorbidity predicts future functional decline.

METHODS

A systematic literature search (1990-2014) and narrative analysis was conducted.

INCLUSION CRITERIA

Population; Community-dwelling adults (≥18 years), Risk; Multimorbidity defined as the presence of ≥2 chronic medical conditions in an individual, Primary outcome; Physical functional decline measured using a validated instrument, Study design; cross-sectional or cohort studies. The following databases were included: PubMed, EMBASE, CINAHL, the Cochrane Library and the International Research Community on Multimorbidity (IRCMo) publication list. Methodological quality assessment of included studies was conducted with a suitable risk of bias tool.

RESULTS

A total of 37 studies were eligible for inclusion (28 cross-sectional studies and 9 cohort studies). The majority of cross-sectional studies (n = 24/28) demonstrated a consistent association between multimorbidity and functional decline. Twelve of these studies reported that increasing numbers of chronic condition counts were associated with worsening functional decline. Nine cohort studies included 14,133 study participants with follow-up periods ranging from one to six years. The majority (n = 5) found that multimorbidity predicted functional decline. Of the five studies that reported the impact of increasing numbers of conditions, all reported greater functional decline with increasing numbers of conditions. One study examined disease severity and found that this also predicted greater functional decline. Overall, cohort studies were of good methodological quality but were mixed in terms of participants, multimorbidity definitions, follow-up duration, and outcome measures.

CONCLUSIONS

The available evidence indicates that multimorbidity predicts future functional decline, with greater decline in patients with higher numbers of conditions and greater disease severity. This review highlights the importance of considering physical functioning when designing interventions and systems of care for patients with multimorbidity, particularly for patients with higher numbers of conditions and greater disease severity.

Association between activities of daily living and mortality among institutionalized elderly adults in Japan

Background

We assessed the association between activities of daily living (ADL) and mortality among nursing home residents in Japan.

Methods

This 1-year prospective cohort study investigated 8902 elderly adults in 140 nursing homes. Baseline measurements included age, sex, height, weight, body mass index (BMI), ADL, and dementia level. ADL levels were obtained by caregivers, using the Barthel Index (BI), after which total BI scores were calculated (higher scores indicate less dependence). Information on dates of discharge and mortality was also obtained to calculate person-years. The Cox proportional hazards model was used to estimate hazard ratios (HRs).

Results

Mean age was 84.3 years, and mean total BI score was 38.5. The HRs of mortality adjusted for sex, age, BMI, and type of nursing home were 7.6 (95% CI: 3.3–17.8) for those with a BI score of 0 (totally dependent), 3.9 (1.7–9.0) for those with a score of 1 to 10, 3.5 (1.4–8.7) for those with a score of 11 to 40, 2.7 (1.4–5.1) for those with a score of 41 to 70, and 1.3 (0.7–2.4) for those with a score of 71 to 99 (P for trend <0.001), as compared with those with a score of 100. Multivariate analysis revealed that BI, sex, age, and BMI were significantly associated with mortality rate.

Conclusions

There was a clear inverse association between ADL level and mortality. In conjunction with other risk factors, ADL level might effectively predict short-term mortality in institutionalized elderly adults.

Prevalence and causes of functional disability in an elderly general population of Japanese: the Hisayama study

BACKGROUND

There are limited data on the prevalence and causes of disability in the elderly general population in Japan.

METHODS

In a population-based cross-sectional study of 1550 Japanese aged 65 years or older, we examined the prevalence of functional disability (defined as a Barthel Index score of ≤95) and its causes.

RESULTS

A total of 311 of the participants had a disability (prevalence 20.1%). The prevalence of disability increased with age and doubled with every 5-year increment in age. Prevalence was higher in women than in men, especially among those aged 85 years or older. With respect to the cause of functional disability, dementia accounted for 23.5%, stroke for 24.7%, orthopedic disease for 12.9%, and other disease for 38.9% of cases in men; in women, the respective values were 35.8%, 9.3%, 31.0%, and 23.9%. Regarding age, dementia was the most frequent cause of disability in subjects aged 75 years or older, whereas stroke was most common in subjects aged 65 to 74 years. Approximately two-thirds of cases of total dependence were attributed to dementia in both sexes, whereas the main cause of slight or moderate/severe dependence was stroke in men and orthopedic disease in women. Among participants with total dependence, 94.8% resided in a hospital or health care facility.

CONCLUSIONS

Our findings indicate that functional disability is common among Japanese elderly adults and that its major cause is stroke in men and dementia in women.

Genetic contribution to the relationship between social role function and depressive symptoms in Japanese elderly twins: a twin study

BACKGROUND

Social role function is the capacity to maintain interpersonal relationships and is essential for being independent in the community. Limitations in social role function often coexist with depressive symptoms, suggesting a possible common mechanistic basis. We investigated whether the observed association between these traits is mainly a result of genetic or environmental influences.

METHODS

In 2008, a questionnaire was sent to 745 male twins aged 65 years and older. Our sample included 397 male twins. The number of monozygotic twins was 302, and dizygotic was 95. Among the twin pairs for whom data were available for both twins, 75 twin pairs (150 individuals) were monozygotic and 28 pairs (56 individuals) were dizygotic. Social role function was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Depressive symptoms were measured by the 15-item version of the Geriatric Depression Scale. Relative importance of genes and environments for the phenotypes was calculated using structural equation analyses.

RESULTS

Our results show that genetic influence was the major contributor to the relationship between social role function and depressive symptoms, and non-shared environmental influence was important for overall variation in each trait.

CONCLUSIONS

We concluded that focusing on a non-shared environment is an essential approach for maintaining social role function and psychological well-being. It is suggested that treatments specific to depressive symptoms are more effective than indirect intervention targeting social role function.

Gender differences in health among the Japanese elderly

Evidence has emerged recently to challenge the widely held notion that women experience more physical health problems than men. The purpose of this study is to re-evaluate this issue with a broad range of health measures gathered in a culturally diverse population--older adults in Japan. Taken as a whole, the findings suggest that there are gender differences in health. However, patterns of female excess in morbidity depend upon the type of health status measure that is examined. In particular, the data reveal that elderly women experience more functional disability and rate their overall health less favorably than older men. In contrast, a consistent pattern of gender differences in health fail to emerge when specific acute and chronic health problems are evaluated.

Six-year follow-up and predictors of urgency-associated urinary incontinence and bowel symptoms among the oldest old: a population-based study

Urinary urgency with incontinence, and fecal incontinence and constipation were followed up over a 6-year period in 398 subjects aged 70 years and over at baseline. Age- and gender-adjusted and multivariate Cox proportional hazard models were used to examine the associations of urinary urgency and fecal incontinence and constipation with mortality, and logistic regression models to determine predictors of incident symptoms among the survivors. The proportion of incident cases of urinary urgency with incontinence, fecal incontinence and constipation in the 252 survivors were 17% (n=46), 9% (n=34) and 13% (n=36), respectively. Frequently reported urinary urgency (hazard ratio, HR=2.23; 95% confidence interval, CI=1.37-3.61) and frequently reported fecal incontinence (HR=4.99; CI=2.11-11.79) were associated with mortality when adjusted for age and gender only. In the multivariate analyses, comorbidity (odds ratio, OR=5.54; CI=2.03-15.14), depressive mood (OR=5.78; CI=1.35-24.79) and instrumental activities of daily living (IADL) disability (OR=4.18, CI=1.52-11.50) predicted incident urgency urinary incontinence. Comorbidity (OR=2.91; CI=1.09-7.77) predicted incident fecal incontinence, while no significant predictors were identified for the incident symptom of constipation. Comorbidities and disabilities explain the association of severe urinary and fecal incontinence with mortality.

[Five-year follow-up of urinary incontinence in older people in a Spanish rural population]

OBJECTIVE

To determine prevalence, incidence and remission rates and change patterns of urinary incontinence (UI) over a 5-year time span.

DESIGN

Longitudinal study.

LOCATION

Basic Health Zone of Cabra (Cordoba).

PATIENTS

A random age-stratified sample of 827 subjects selected from a total of 5139 persons > or = 65 years of age and followed up between 1996 and 2001.

INTERVENTIONS

Home interview.

MEASUREMENTS

Questions about detection and level of severity of UI, sociodemographic data, and level of functioning. Two logistic regression models were created to identify risk factors for the probability to be alive and to develop UI, respectively.

RESULTS

UI prevalence reached 36% at baseline and 46% five years later. Mortality rates were similar in continent and incontinent subjects. 54.5% of continent subjects in 1996 remained so in 2001. Five-year incidence and remission rates were 29% and 15%, respectively. In both sexes, slight and moderate incontinence mainly progressed to moderate and severe degrees, whereas severe UI remained unchanged in 40.1%. The main risk factors for increased survival and for UI incidence were self-rated health and level of functioning.

CONCLUSIONS

Prevalence of UI is high, incidence is moderate and remission is low. Urinary incontinence is a dynamic problem and does not affect mortality. Impaired mobility has a strong influence on UI incidence.

Predictors of mortality for the oldest old. A 4-year follow-up of community-based elderly in Sweden

The aim of this study is to investigate predictors for mortality in two age groups, 75-84 years old and 85 years and older. Interviews were carried out on 161 community-based persons aged 75-84 and 260 persons aged 85 and over. Predictors for mortality 4 years later were analyzed using logistic regression. Different models to predict mortality were found for the two age groups. Gender and IADL (Instrumental Activities of Daily Living) were found to be significant for the older group while ADL (Primary Activities of Daily Living), mobility and life satisfaction were significant for the younger group. Eliminating variables based on the nurse's evaluations did not change the model for the 85+ age group; in the 75-84 age group the nurse's assessment of ADL was replaced by a self-reported IADL index. Results confirm the heterogeneity of the elderly population and the importance of ADL and subjective measures for predicting mortality.

Disability predicted mortality in men but not women with coronary heart disease

OBJECTIVE

Disability increases mortality in patients with myocardial infarction in acute clinical settings, but the impact of disability on mortality in persons with coronary heart disease (CHD) at the population level is largely unknown.

STUDY DESIGN AND SETTING

We assessed disability as a predictor of mortality among 4,501 men and women aged 45 and over in a national sample of the Finnish population, examined in 1978-1980.

RESULTS

During follow-up until the end of 1994, 897 men and 846 women died. Disability was related to increased all-cause and CHD mortality after adjustment for cardiovascular risk factors in men regardless of baseline CHD status. In women with CHD at baseline, disability was not related to excess mortality, although disability predicted mortality in women without baseline CHD.

CONCLUSION

Disability predicts mortality in men with CHD, but not in women. This may reflect a gender difference in the nature of CHD, but these findings need to be verified in other large-scale population studies.

Urgency and urge incontinence in an older population: ten-year changes and their association with mortality

BACKGROUND AND AIMS

Urgency and urge incontinence are common urinary symptoms among older people, both men and women. The aim of this population-based prospective cohort study was to examine the independent association of urgency and urge incontinence with 10-year mortality in older men and women, and to describe the changes in these symptoms during those 10 years.

METHODS

At baseline, 1052 persons (524 men and 528 women) aged 60-89, selected by random sampling and stratified by 5-year age group and sex, were interviewed for the Tampere Longitudinal Study on Ageing. In 10 years, 541 persons had died, and 435 persons (175 men and 260 women) were re-interviewed. Cox proportional hazards models were used to examine the independent association of urgency and urge incontinence in each gender with 10-year mortality, adjusted for age, chronic diseases, activities of daily living (ADL) disability, socioeconomic status, smoking and alcohol use.

RESULTS

In 10 years, 86% of men and 54% of women who reported at least urgency at baseline had died. The respective figures for men and women without urgency were 57 and 38%. Adjusted for age, both urgency without incontinence (Risk Ratio 1.87; 95% Confidence Interval 1.28-2.74) and urge incontinence (RR 3.13; 95% CI 2.054.77) significantly predicted mortality in men, while only urge incontinence was a statistically significant predictor in women (RR 1.63; 95% CI 1.03-2.57). After further adjusting for chronic diseases and ADL disability, urge incontinence lost its predictive power (RR 1.44; 95% CI 0.88-2.23) in women, while the significant predictive power of urgency alone and urge incontinence in men persisted even after additional adjustment for socioeconomic status, smoking and alcohol use (RR 1.80; 95% CI 1.20-2.71, and RR 1.97; 95% CI 1.25-3.10, respectively).

CONCLUSIONS

Urgency and urge incontinence are significant prognostic indicators of mortality especially in older men. This emphasizes the importance of evaluation and treatment of urinary symptoms as a part of comprehensive geriatric assessment and management.

Five-year incidence and remission rates of female urinary incontinence in a Swedish population less than 65 years old

OBJECTIVE

We sought to determine the incidence and remission rates of urinary incontinence in a population-based sample of women.

STUDY DESIGN

A total of 382 (87.6%) of 436 eligible women aged 20 to 59 years answered a questionnaire and underwent a gynecologic examination at baseline and were followed up approximately 5 years later.

RESULTS

Urinary incontinence was present in 23.6% of women at baseline and in 27.5% at follow-up. The mean annual incidence rate of incontinence was 2.9%, and the mean annual incidence rate of incontinence weekly or more often was 0.5%. Women that were receiving estrogen at baseline were more likely than other women to have incontinence during follow-up. The mean annual remission rate among the 90 women who were incontinent at baseline was 5.9%. The annual net increase of incontinence in the study population was 0. 82%.

CONCLUSION

Female urinary incontinence seems to be a dynamic condition with a relatively high rate of spontaneous remission, a fact of which physicians should be aware when assessing and planning prevention and treatment strategies.

Urinary incontinence and risk of death among community-living elderly people: results from the National Survey on Self-Care and Aging

OBJECTIVES

The authors explored whether urinary incontinence (UI) is associated with higher mortality and, if so, whether adjustment for demographics, health, and functional status diminishes the association.

METHODS

The Cox proportional hazards model was used with a nationally representative sample of community-living elderly people (N = 3,485).

RESULTS

In an analysis adjusted for age, gender, education, and probability sampling design, participants with mild to moderate UI (hazard ratio [HR] = 1.51; 95% confidence interval [CI] = 1.09-2.08) and severe UI (HR = 1.54; 95% CI = 1.03-2.29) experienced a higher risk of death. Adjustment for health and functional status diminished the association of UI and risk of death (mild to moderate UI, HR = 1.20, 95% CI = 0.85-1.68; severe UI, HR = 0.91, 95% CI = 0.59-1.39).

DISCUSSION

The relationship between UI and mortality in older adults can largely be understood on the basis of increased frailty in incontinent individuals.

Epidemiology and natural history of pelvic floor dysfunction

Pelvic floor dysfunction, including urinary incontinence, anal incontinence, and pelvic organ prolapse, is extremely common, affecting at least one-third of adult women. A minority of patients sustaining these conditions volunteer their symptoms. Risk factor identification and the development of tactics for prevention are significant priorities for future research. Understanding both the specific predisposing factors that place an individual woman at risk and the precise events of the labor and delivery process that initiate injury and dysfunction is important for primary prevention. Defining the relative importance of various promoting and decompensating factors is essential for secondary prevention.

The association of urinary incontinence with poor self-rated health

OBJECTIVES

To assess whether urinary incontinence (UI) and its severity are associated with poor self-rated health in a national sample of community-living older adults and whether this relationship persists after controlling for confounding attributable to functional status, comorbidity, and demographic factors.

DESIGN

A cross-sectional analysis using multivariate logistic regression.

SETTING

Subjects were from the 1990-1991 National Survey of Self-Care and Aging (N = 3485), a random sampling in geographic clusters of community-dwelling Medicare beneficiaries 65 years of age or older in the contiguous United States.

MEASURES

The responses to an interviewer-administered questionnaire regarding urinary incontinence, Basic Activities of Daily Living (BADL), Instrumental Activities of Daily Living (IADL), Mobility Activities of Daily Living (MADL), age, gender, place of residence, race, education, need for proxy response to the survey, and number of medical conditions.

RESULTS

Unadjusted analysis showed the presence of urinary incontinence to be associated with poor self-rated health (OR 2.7, 2.1-3.3). With gender, number of comorbid conditions, race, IADL impairment, and interaction terms of incontinence/race and incontinence/IADL in the final model, UI was associated with poor self-rated health in certain subgroups. White subjects with no IADL impairment and mild-moderate incontinence had an OR of 2.0 (95% CI 1.5-2.9) and those with severe incontinence had an OR of 4.5 (95% CI 2.4-8.4) of rating their health as poor, whereas those with no IADL impairment and no incontinence were the referent group. For those with a lot of difficulty performing one or more IADL activity, the association of UI and poor self-rated health was weak. For non-white subjects, there was no association, or a very weak association, of UI and poor self-rated health.

CONCLUSION

In this national sample, urinary incontinence was independently and positively associated with poor self-rated health after adjustment for age, comorbidity, and frailty for most community-dwelling older adults. This association between UI and poor self-rated health was weaker and statistically insignificant when IADL impairment was present or in non-white subjects. Further research is indicated to better understand the impact of urinary incontinence in specific cultural settings.

Definition of overactive bladder and epidemiology of urinary incontinence

OBJECTIVES

To review the definition of the overactive bladder and to summarize the results of epidemiologic studies on this specific disorder as well as urinary incontinence (UI) in general.

METHODS

From a literature search covering the time period from 1954 through 1995, 48 epidemiologic studies and several other publications dealing with the prevalence and natural history of UI were reviewed. A meta-analysis of reported data was performed with respect to incontinence definitions, investigation methods, home country of survey, sex, and age groups.

RESULTS

Differences in definitions of incontinence, target populations, and study design in different investigations resulted in inhomogeneity and difficulties of comparing the available data. By grouping the studies with respect to similarities in the above-mentioned criteria and analyzing the results for each group of studies, an attempt was made to understand the great variation of reported results. Differences in prevalence of incontinence were identified for all examined groups of studies and for distinct ethnic populations. Scarce information about incidence, spontaneous remission rates, and risk factors was used to elucidate the natural history of UI in women and men.

CONCLUSIONS

Although generally accepted definitions of the overactive bladder specifically and UI in general are highly desirable, they have not yet been established. Such definitions should comprise aspects of severity and demonstrability of the condition, bother factor, and impact on quality of life. Moreover, basic requirements for epidemiologic surveys of incontinence, such as validation of questionnaire results, need to be defined and standardized to create a sensible basis for useful epidemiologic studies in the future.

Predictors of physical function among the oldest old: a comparison of three outcome variables in a 24-year follow-up

This study has measured physical function in a nationally representative sample of persons aged 77 to 98 (N = 508) in 1992. Three measures of function are used: activities of daily living (ADL), an index of mobility, and performance tests. These are used as outcomes and analyzed in relation to variables gathered in a survey in 1968. Variables from 1968 include education, mobility, smoking, and an index of circulation problems. All four variables predict some limitations in physical function in old age. However, there are different patterns of predictors found for the three outcome measures. All three outcomes are associated with age, education, and previous circulation problems. ADL limitations are also associated with poor previous mobility and smoking; mobility limitations are also associated with sex and smoking; performance limitations are also associated with sex.

Predictors of all-cause mortality between ages 70 and 80: the Koganei study

The present paper explores predictors of all-cause mortality based on a longitudinal multidisciplinary study of 422 community residents (197 men, 225 women) aged 69-71 years at baseline examination. The 422 subjects were followed up for 10 years (1976-1986), during which time 102 (59 men, 43 women) died. The Cox proportional hazards model was used to examine the effects of baseline variables on a time-dependent 10-year mortality. Body mass showed a U-shaped relationship to mortality in both sexes. Ex-drinking, current-smoking, history of stroke, history of diabetes mellitus, low ADL and ST and/or T changes in ECG had significant and direct effects on mortality in both sexes or either sex. Whereas, level of education, current-drinking, grip strength, visual retention, and serum albumin revealed significantly inverse relationships to mortality.

Measurement of competence: reliability and validity of the TMIG Index of Competence

The reliability and validity of a multidimensional 13-item index of competence, called the TMIG Index of Competence, were tested with data of 6776 elderly community residents. The index was designed to measure the higher-level competence which could not be adequately assessed by existing scales. A well-fitted second-order factor model was established. Three first-order factors in the model were named Instrumental Self-Maintenance, Intellectual Activity, and Social Role, and the second-order factor was Competence. The results confirmed high reliability of the index with reliability coefficients of Alpha, test-retest, and correlation between the second-order factor score and the total score, and high validity in terms of construct, discriminant, and predictive validity.