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Characterizing the Functional Decline of Older Women With Incident Urinary Incontinence

Parker-Autry, Candace MD; Houston, Denise K. PhD; Rushing, Julia MS; Richter, Holly E. PhD, MD; Subak, Leslee MD; Kanaya, Alka M. MD; Kritchevsky, Stephen B. PhD

doi: 10.1097/AOG.0000000000002322
Contents: Original Research

OBJECTIVE: To characterize change in physical performance and differential prevalence of low skeletal muscle mass and strength (sarcopenia) and lower 25-hydroxyvitamin D concentrations among older women who developed urinary incontinence (UI) symptoms.

METHODS: This is a secondary analysis of the Health, Aging, and Body Composition Study. Urinary incontinence symptoms were assessed using validated questions. The Short Physical Performance Battery measured physical performance. Sarcopenia, defined by low muscle mass and strength, was determined using validated cutoffs for gait speed, grip strength, and appendicular skeletal muscle mass. All parameters were evaluated at baseline and year 4. Serum 25-hydroxyvitamin D concentrations were assessed at year 2. The primary outcome was change in Short Physical Performance Battery total scores. Sarcopenia and lower serum 25-hydroxyvitamin D concentrations have been independently associated with poor physical performance and UI and were therefore included as secondary outcomes. Univariate and multivariate analyses were used to characterize the associations of change in physical performance from baseline to year 4, incidence of sarcopenia, and lower serum 25-hydroxyvitamin D on the development of UI symptoms.

RESULTS: Of the 1,583 women enrolled, 910 were excluded (730 had baseline UI; 180 with missing data). Six hundred seventy-three women were continent at baseline; 223 (33%) developed UI symptoms at year 4. SPPB total scores significantly declined in women with UI versus continent women (mean difference continent−incident UI 0.32, 95% CI 0.04–0.60, P=.02). Of subscale measures, standing balance showed the greatest decline at 0.20 (0.05–0.36; continent−incident UI, respectively; P=.009). Sarcopenia developed at a higher rate with incident UI (adjusted odds ratio [OR] 1.7, 95% CI 1.0–2.9). Low 25-hydroxyvitamin D was not associated with incident UI (adjusted OR 1.1, 95% CI 0.7–1.6 and 1.1, 95% CI 0.7–1.6 for deficient or insufficient versus sufficient status, respectively).

CONCLUSION: We observed a significant decline in standing balance among older women who developed UI symptoms. This decline may be associated with coinciding development of sarcopenia.

A greater decline in physical performance and standing balance is associated with the development of urinary incontinence in older, previously continent women.

Departments of Obstetrics and Gynecology, Urology, Biostatistical Sciences, and Internal Medicine, Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina; the Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama; the Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California; and the Department of Medicine, Epidemiology & Biostatistics, University of California–San Francisco, San Francisco, California.

Corresponding author: Candace Parker-Autry, MD, Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157; email: cparkera@wakehealth.edu.

Supported by the National Institute on Aging (contracts N01-AG-6-2101, N01-AG-6-2103, and N01-AG-6-2106); National Institute on Aging grant R01 G028050; and the Wake Forest Older Americans Independence Center (P30 AG021332).

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at PFD Week 2016, the American Urogynecology Association's national meeting, September 27 to October 1, 2016, Denver, Colorado.

The authors thank Karen Klein, MA, for her editorial assistance, supported by the Wake Forest Clinical and Translational Science Institute (UL1 TR001420; Principal Investigator: McClain).

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.