Urinary Incontinence: Does it Increase Risk for Falls and Fractures?
Abstract
OBJECTIVE: To determine if urge urinary incontinence is associated with risk of falls and non‐spine fractures in older women. METHODS: Type and frequency of incontinent episodes were assessed by 6049 community‐dwelling women using a self‐completed questionnaire. Postcards were subsequently mailed every 4 months to inquire about falls and fractures. Incident fractures were confirmed by radiographic report. Logistic and proportional hazard models were used to assess the independent association of urge urinary incontinence and risk of falling or fracture. RESULTS: The mean age of the women was 78.5 (± 4.6) years. During an average follow‐up of 3 years, 55% of women reported falling, and 8.5% reported fractures. One‐quarter of the women (1493) reported weekly or more frequent urge incontinence, 19% (1137) reported weekly or more frequent stress incontinence, and 708 (12%) reported both types of incontinence. In multivariate models, weekly or more frequent urge incontinence was associated independently with risk of falling (odds ratio = 1.26; 95% confidence interval (CI), 1.14‐1.40) and with non‐spine nontraumatic fracture (relative hazard 1.34; 95% CI, 1.06‐1.69; P = .02). Stress incontinence was not associated independently with falls or fracture. CONCLUSIONS: Weekly or more frequent urge incontinence was associated independently with an increased risk of falls and non‐spine, nontraumatic fractures in older women. Urinary frequency, nocturia, and rushing to the bathroom to avoid urge incontinent episodes most likely increase the risk of falling, which then results in fractures. Early diagnosis and appropriate treatment of urge incontinence may decrease the risk of fracture. J Am Geriatr Soc 48:721–725, 2000 .
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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 [4]
In adults over 65, worsening urinary incontinence independently predicts falls, fractures, and functional dependence.
“Conversely, worsening urinary incontinence has been shown to be an independent predictor of falls, fractures and functional dependence in the elderly over age of 65 years.(4)”
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 [4]
Urgency to reach the toilet can lead to falls and fractures, followed by reduced physical activity, functional decline, and disability.
“Conversely, urgency to reach the toilet can result in increased falls and fractures with subsequent reduced physical activity, functional decline and disability.(4, 15)”
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 [4]
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 [4]
Cites
Longitudinal data analysis using generalized linear models
LIANG, K.-Y., & ZEGER, S. L. (1986) · Biometrika · doi:10.1093/biomet/73.1.13 · Cited by 18,550 · see citing works
Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living
Lawton, M. P., & Brody, E. M. (1969) · The Gerontologist · doi:10.1093/geront/9.3_part_1.179 · Cited by 18,540 · see citing works
Longitudinal Data Analysis for Discrete and Continuous Outcomes
Zeger, S. L., & Liang, K. (1986) · Biometrics · doi:10.2307/2531248 · Cited by 7,730 · see citing works
Risk Factors for Falls among Elderly Persons Living in the Community
Tinetti, M. E., Speechley, M. R., & Ginter, S. F. (1988) · New England Journal of Medicine · doi:10.1056/nejm198812293192604 · Cited by 6,507 · see citing works
The Mini‐Mental State Examination: A Comprehensive Review
Tombaugh, T. N., & McIntyre, N. J. (1992) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1992.tb01992.x · Cited by 5,152 · see citing works
Risk Factors for Recurrent Nonsyncopal Falls
Nevitt, M. C. (1989) · JAMA · doi:10.1001/jama.261.18.2663 · Cited by 1,876 · see citing works
Self-citationIncidence of and Risk Factors for Falls and Injurious Falls among the Community-dwelling Elderly
O’Loughlin, J. L., Robitaille, Y., Boivin, J.-F., & Suissa, S. (1993) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a116681 · Cited by 1,127 · see citing works
Cummings, S. R. (1990) · JAMA · doi:10.1001/jama.263.5.665 · Cited by 1,014 · see citing works
Standardizing Assessment of Elderly People in Acute Care: The interRAI Acute Care Instrument
Gray, L., Bernabei, R., Berg, K., Finne‐Soveri, H., Fries, B. E., Hirdes, J. P., Jónsson, P. V., Morris, J. N., Steel, K., & Ariño‐Blasco, S. (2008) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2007.01590.x · Cited by 967 · see citing works
Risk Factors for Injurious Falls: a Prospective Study
Nevitt, M. C., Cummings, S. R., & Hudes, E. S. (1991) · Journal of Gerontology · doi:10.1093/geronj/46.5.m164 · Cited by 942 · see citing works
Self-citationRisk Factors for Serious Injury During Falls by Older Persons in the Community
Tinetti, M. E., Doucette, J. T., Claus, E. B., & Marottoli, R. A. (1995) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1995.tb07396.x · Cited by 910 · see citing works
Cummings, S. R., Nevitt, M. C., & Kidd, S. A. (1988) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1988.tb06155.x · Cited by 782 · see citing works
Self-citationPrevalence of Urinary Incontinence and Other Urological Symptoms in the Noninstitutionalized Elderly
Diokno, A. C., Brock, B. M., Brown, M. B., & Herzog, A. R. (1986) · The Journal of Urology · doi:10.1016/s0022-5347(17)45194-9 · Cited by 735 · see citing works
Behavioral vs Drug Treatment for Urge Urinary Incontinence in Older Women
Burgio, K. L., Locher, J. L., Goode, P. S., Hardin, J. M., McDowell, B. J., Dombrowski, M., & Candib, D. (1998) · JAMA · doi:10.1001/jama.280.23.1995 · Cited by 625 · see citing works
Factors Associated with Appendicular Bone Mass in Older Women
Bauer, D. C., Browner, W. S., Cauley, J. A., ORWOLL, E. S., Scott, J. C., Black, D. M., Tao, J. L., & Cummings, S. R. (1993) · Annals of Internal Medicine · doi:10.7326/0003-4819-118-9-199305010-00001 · Cited by 563 · see citing works
Prevalence of urinary incontinence and associated risk factors in postmenopausal women
Js, B. (1999) · Obstetrics and Gynecology · doi:10.1016/s0029-7844(99)00263-x · Cited by 410 · see citing works
Efficacy of Bladder Training in Older Women With Urinary Incontinence
Fantl, J. A. (1991) · JAMA · doi:10.1001/jama.1991.03460050063021 · Cited by 389 · see citing works
Definition of overactive bladder and epidemiology of urinary incontinence
Hampel, C., Wienhold, D., Benken, N., et al. (1997) · Urology · doi:10.1016/s0090-4295(97)00578-5 · Cited by 378 · see citing works
Predictors for Falls and Fractures in the Longitudinal Aging Study Amsterdam
Tromp, A. M., Smit, J. H., Deeg, D. J. H., Bouter, L. M., & Lips, P. T. A. M. (1998) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.1998.13.12.1932 · Cited by 326 · see citing works
Appell, R. A. (1997) · Urology · doi:10.1016/s0090-4295(97)00599-2 · Cited by 311 · see citing works
ONCE DAILY CONTROLLED VERSUS IMMEDIATE RELEASE OXYBUTYNIN CHLORIDE FOR URGE URINARY INCONTINENCE
Anderson, R. U., Mobley, D., Blank, B. H., et al. (1999) · The Journal of Urology · doi:10.1016/s0022-5347(05)68810-6 · Cited by 294 · see citing works
The urinary diary in evaluation of incontinent women: a test-retest analysis.
Wyman, J. F., Choi, S.-W., Harkins, S. W., et al. (1988) · PubMed · Cited by 253 · see citing works
Self-citationIncidence rate of falls in an aged population in Northern Finland
Luukinen, H., Koski, K., Hiltunen, L. A., & Kivelä, S. (1994) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(94)90187-2 · Cited by 219 · see citing works
Smoking, Alcohol, and Neuromuscular and Physical Function of Older Women
Nelson, H. D. (1994) · JAMA · doi:10.1001/jama.1994.03520230035035 · Cited by 187 · see citing works
Clinical Practice Guideline #5
Pies, R. W. (1995) · Journal of Clinical Psychopharmacology · doi:10.1097/00004714-199502000-00018 · Cited by 159 · see citing works
Luukinen, H., Koski, K., Kivela, S.-L., et al. (1996) · Public Health · doi:10.1016/s0033-3506(96)80057-6 · Cited by 130 · see citing works
Factors Predicting Fractures During Falling Impacts Among Home‐Dwelling Older Adults
Luukinen, H., Koski, K., Laippala, P. J., & Kivelä, S. (1997) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1997.tb02928.x · Cited by 109 · see citing works
Urinary incontinence: a minor risk factor for hip fractures in elderly women
Johnasson, C., Hellström, L., Ekelund, P., et al. (1996) · Maturitas · doi:10.1016/0378-5122(96)01117-6 · Cited by 28 · see citing works
Johansson, C., Molander, U., Milsom, I., et al. (1996) · Maturitas · doi:10.1016/0378-5122(95)00982-5 · Cited by 25 · see citing works
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Guidelines for improving the care of the older person with diabetes mellitus
California Healthcare Foundation/American Geriatrics Society, C. (2003) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.51.5s.1.x · Cited by 651 · see citing works
Fritel, X., Lachal, L., Cassou, B., Fauconnier, A., & Dargent‐Molina, P. (2013) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.12316 · Cited by 80 · see citing works
Does Urinary Incontinence Affect Middle-Aged and Older Womenʼs Time Use and Activity Patterns?
Fultz, N. H., Fisher, G. G., & Jenkins, K. R. (2004) · Obstetrics & Gynecology · doi:10.1097/01.aog.0000143829.21758.3c · Cited by 65 · see citing works
Greer, J. A., Xu, R., Propert, K. J., & Arya, L. A. (2015) · Neurourology and Urodynamics · doi:10.1002/nau.22615 · Cited by 24 · see citing works
“Conversely, worsening urinary incontinence has been shown to be an independent predictor of falls, fractures, and functional dependence in the elderly over age of 65 years.(4) Most studies that have examined the relationship between urinary incontinence and disability have been performed in the elderly over age 65 yea…”
Background
- Authors
- Brown, J. S., Vittinghoff, E., Wyman, J. F., Stone, K. L., Nevitt, M. C., Ensrud, K. E., & Grady, D.
- Affiliations
- San Francisco VA Medical Center (US)
- University of Minnesota (US)
- Corresponding author
- Brown, Jeanette S.
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2000-07
- Volume
- 48
- Issue
- 7
- Pages
- 721-725
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- OpenAlex
- W1993384839
- Cited by
- 557
- References
- 29
- Citations by year
- 2026: 12 · 2025: 11 · 2024: 10 · 2023: 19 · 2022: 14 · 2021: 18 · 2020: 19 · 2019: 13 · 2018: 12 · 2017: 29 · 2016: 25 · 2015: 23 · 2014: 33 · 2013: 27 · 2012: 26
- FWCI
- 74.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (K08 AG0070-01A1)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Keywords
- urge urinary incontinence, stress urinary incontinence, falls, fracture, older women, community-dwelling women, fall risk, urinary frequency, nocturia, incontinence treatment
- MeSH terms
- Accidental Falls, Aged, Aged, 80 and over, Female, Fractures, Spontaneous, Humans, Prospective Studies, Risk Factors, United States, Urinary Incontinence, Osteoporosis, Postmenopausal, Causality, Proportional Hazards Models
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