Shared Risk Factors for Falls, Incontinence, and Functional Dependence: Unifying the Approach to Geriatric Syndromes
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Objective. —To determine whether a set of factors representing impairments in multiple areas could be identified that predisposes to falling, incontinence, and functional dependence.\n\nDesign. —Population-based cohort with a 1-year follow-up.\n\nSetting. —General community.\n\nParticipants. —A total of 927 New Haven, Conn, residents, aged 72 years and older who completed the baseline and 1-year interviews.\n\nMain Outcome Measures. —At least one episode of urinary incontinence per week, at least two falls during the follow-up year, and dependence on human help for one or more basic activities of daily living.\n\nResults. —At 1 year, urinary incontinence was reported by 16%, at least two falls by 10%, and functional dependence by 20% of participants. The four independent predisposing factors for the outcomes of incontinence, falling, and functional dependence included slow timed chair stands (lower extremity impairment), decreased arm strength (upper extremity impairment), decreased vision and hearing (sensory impairment), and either a high anxiety or depression score (affective impairment). There was a significant increase in each of incontinence, falling, and functional dependence as the number of these predisposing factors increased. For example, the proportion of participants experiencing functional dependence doubled (7% to 14% to 28% to 60%) (X2=119.8; P<.001) as the number of predisposing factors increased from zero to one to two to at least three.\n\nConclusions. —Our findings suggest that predisposition to geriatric syndromes and functional dependence may result when impairments in multiple domains compromise compensatory ability. It may be possible to restore compensatory ability and prevent or delay the onset of several geriatric syndromes and, perhaps, functional dependence by modifying a shared set of predisposing factors. Perhaps it is time to take a more unified approach to the geriatric syndromes and functional dependence.
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Most research on the UI-disability link has been conducted in adults over 65 within late-life geriatric syndromes.
“Most studies that have examined the relationship between urinary incontinence and disability have been performed in the elderly over age 65 years in the context of late life geriatric syndromes such as delirium, falls, and frailty.(3)”
From Urinary incontinence and disability in community-dwelling women: A cross-sectional study: Urinary Incontinence and Disability in Ambulatory Women (2015) · cites this paper as [3]
In a prospective study of older adults with mean age 79, worsening ADL, IADL, and physical performance were linked to higher risk of new urinary incontinence.
“Tinetti et al. showed that in elderly adults with a mean age of 79 years, functional decline and disability as measured by worsening ADL, IADL, and physical performance measures were prospectively associated with an increased risk of developing incident urinary incontinence.(3)”
From Urinary incontinence and disability in community-dwelling women: A cross-sectional study: Urinary Incontinence and Disability in Ambulatory Women (2015) · cites this paper as [3]
In older adults, urinary incontinence and disability are mutually causal.
“In the elderly, disabilities are both a cause and result of urinary incontinence.”
From Urinary incontinence and disability in community-dwelling women: A cross-sectional study: Urinary Incontinence and Disability in Ambulatory Women (2015) · cites this paper as [3]
There is relatively little evidence on disability prevalence or the UI-disability relationship in ambulatory community-dwelling women.
“relatively little data is available on the prevalence of disability in ambulatory community-dwelling women with urinary incontinence or on the relationship between urinary incontinence and disability in these women.”
From Urinary incontinence and disability in community-dwelling women: A cross-sectional study: Urinary Incontinence and Disability in Ambulatory Women (2015) · cites this paper as [3]
Low physical activity is an important risk factor for disability.
“low levels of physical activity are an important risk factor for disability (3)”
From Urinary incontinence and disability in community-dwelling women: A cross-sectional study: Urinary Incontinence and Disability in Ambulatory Women (2015) · cites this paper as [3]
In older adults, especially those over 70, a direct UI-disability relationship has been established.
“In the elderly, especially those over age 70, a direct relationship between urinary incontinence and disability has been elucidated.”
From Urinary incontinence and disability in community-dwelling women: A cross-sectional study: Urinary Incontinence and Disability in Ambulatory Women (2015) · cites this paper as [3]
Poor physical function, frailty, and disability have been prospectively shown to increase UI risk, likely through reduced ability to reach the toilet.
“Poor physical function, with increasing frailty and disability has been prospectively shown to be a risk factor for urinary incontinence, likely through decreased ability to reach the toilet.(3)”
From Urinary incontinence and disability in community-dwelling women: A cross-sectional study: Urinary Incontinence and Disability in Ambulatory Women (2015) · cites this paper as [3]
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Lenze, E. J., Rogers, J. C., Martire, L. M., Mulsant, B. H., Rollman, B. L., Dew, M. A., Schulz, R., & Reynolds, C. F. (2001) · The American Journal of Geriatric Psychiatry · doi:10.1097/00019442-200105000-00004 · Cited by 593 · see citing works
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- Authors
- Tinetti, M. E.
- Corresponding author
- Tinetti, Mary E.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 1995-05-03
- Volume
- 273
- Issue
- 17
- Pages
- 1348
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W7214227318
- Cited by
- 6
- References
- 0
- Citations by year
- 2022: 1 · 2015: 1 · 2014: 1
- FWCI
- 0.40
- Type
- journal article
- Language
- en
- Open access
- green
- nrs.harvard.edu
- Licence
- cc-by
- Locations
- JAMA (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Keywords
- falls, urinary incontinence, functional dependence, geriatric syndromes, shared risk factors, activities of daily living, lower extremity impairment, arm muscle strength, sensory impairment, anxiety, depression, older adults, compensatory abilities
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