Abstract

Importance: Urinary Incontinence (UI) in older women is heterogeneous. Distinction between pelvic-floor cantered UI and Geriatric Incontinence Syndrome (GIS) is clinically important because GIS is a risk factor for frailty.
Objectives: To generate clinical criteria for the identification of the GIS in the clinical setting.
Study design: We present a cross-sectional analysis of a cohort of 61 community-dwelling women age ≥70 years with moderate-to-severe UI. UI severity is a key clinical feature of GIS. Severe UI is defined as ≥2 UI episodes/day and moderate UI is defined as <2 UI episodes/day. Nine geriatric impairments in physical performance, cognition, activities of daily living, mobility disability, sarcopenia, and frailty were identified based on feasibility of clinical assessment and prior reports of independent associations of each impairment with UI in older adults. Based on the geriatric premise of deficit accumulation, we hypothesized that the concomitant presence of multiple geriatric impairments associated with UI severity would be important criteria for the GIS. Accordingly, an exploratory model was created to test the association between the count of geriatric impairments and UI severity and to explore a ratio threshold for clinical criteria of the GIS.
Result: The count of geriatric impairments was significantly higher among women with severe UI compared to those with moderate UI (mean±SD= 4.4±1.8 vs. 3.4±2.0, p=0.04). Out of 9 geriatric impairments, 62% of participants had 4 or more present.
Conclusion: The deficit accumulation model applied to a 9-item scale of geriatric impairments is associated with GIS severity and may aid in clinical identification.

Keywords:Urinary incontinence; Geriatric syndrome; Older women