Examining the role of frailty on treatment patterns and complications among older women undergoing procedure-based treatment for urinary incontinence
Open accessAbstract
Background: Aging beyond 65 years is associated with increased prevalence of urinary incontinence (UI), frailty, and increased complication rate with UI treatments. To investigate this relationship, we examined frailty as a predictor of procedure-based UI treatment patterns and urologic complications in Medicare-eligible women. Methods: We identified women undergoing procedures for UI between 2011 and 2018 in the 5% limited Medicare data set. A claims-based frailty index (CFI) using data from the 12 months prior to the index procedure defined frailty (CFI ≥0.25). Urologic complications were assessed during the 12 months following the index procedure. We used unadjusted logistic regression models to calculate odds of having a specific type of UI procedure based on frailty status. Odds of postprocedure urologic complications were examined with logistic regression adjusted for age and race. Results: We identified 21 783 women who underwent a procedure-based intervention for UI, of whom 3 826 (17.5%) were frail. Frail women with stress UI were 2.6 times more likely to receive periurethral bulking (95% confidence interval [CI] 2.26–2.95), compared to nonfrail. Conversely, frailty was associated with lower odds of receiving a Sling or Burch colposuspension. Among women with urgency UI or overactive bladder, compared to nonfrail, frailty was associated with higher odds of both sacral neuromodulation (odds ratio [OR] = 1.21, 95% CI: 1.11–1.33) and intravesical Botox (OR = 1.16, 95% CI: 1.06–1.28), but lower odds of receiving posterior tibial nerve stimulation. Frailty was associated with higher odds of postprocedure urologic complications (OR = 1.64, 95% CI: 1.47–1.81). Conclusions: Frailty status may influence treatment choice for treatment of stress or urgency UI symptoms and increase the odds of postprocedural complications in older women.
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The study population had a lower percentage of overall frailty and fewer composite frailty measures than previously published prospectively studied surgical populations with frailty and a larger dataset of claims-based frailty indexes.
“The current study population had both a lower percentage of overall frailty and fewer composite frailty measures than previously published prospectively studied surgical populations with frailty and a larger dataset of claims-based frailty indexes.”
From Outcomes by frailty and mobility in older patients undergoing major urogynecologic surgery: a planned supplementary study of the apical suspension repair for vault prolapse in a three-arm randomized (ASPIRe) trial (2026) · cites this paper as [18]
The Results report a cohort of 21,783 women, 17.5% of whom were classified as frail; the Estimating Frailty in Medicare Data section describes the claims-based index. The paper does not provide the citing study’s frailty percentage or number of composite frailty measures, so it cannot establish that those were lower or fewer. Its Discussion also reports 9%–10% frailty in a previously studied surgical population, rather than establishing the claimed comparison. (LLM, conf=0.76)
Experimental — accuracy not yet measuredExamination of claims data has elucidated that frailty status influences treatment selection for urinary incontinence in female Medicare beneficiaries.
“However, examination of claims data has elucidated that frailty status influences treatment selection for urinary incontinence in female Medicare beneficiaries.18”
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- Authors
- Parker-Autry, C. Y., Bauer, S., Ford, C., Gregory, W. T., Badlani, G., & Scales, C. D.
- Affiliations
- Section on Female Pelvic Health, Department of Urology, Atrium Health Wake Forest Baptist , Winston-Salem, North Carolina , USA
- San Francisco VA Medical Center (US)
- Duke University (US)
- Oregon Health & Science University (US)
- Atrium Health Wake Forest Baptist (US)
- ORCID
- Venue
- The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences
- Publisher
- Oxford University Press (OUP)
- Published
- 2024-01-27
- Volume
- 79
- Issue
- 6
- ISSN
- 1079-5006 (ISSN-L)
- 1758-535X
- PMC
- PMC11079949
- OpenAlex
- W4391282714
- Cited by
- 7
- References
- 28
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 1
- FWCI
- 2.25
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journals of Gerontology Series A (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute on Aging (R03 AG056460, 1R03AG067937, 1K76AG074903, R25-HD094667)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- frailty, urinary incontinence, older women, urological procedures, midurethral sling, Burch colposuspension, sacral neuromodulation, posterior tibial nerve stimulation, urological complications, stress urinary incontinence, urge urinary incontinence, overactive bladder, treatment patterns, Medicare beneficiaries
- MeSH terms
- Frailty, Aged, Aged, 80 and over, Female, Medicare, Humans, Postoperative Complications, United States, Urinary Incontinence, Urinary Incontinence, Stress, Frail Elderly
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