Urinary Incontinence in Frail Older Adults

Sandra Engberg; Hongjin Li


Urol Nurs. 2017;37(3):119-125. 

In This Article


Bandeen-Roche and colleagues (2015) assessed a nationally representative sample of adults 65 years of age and older for frailty using validated criteria. Fifteen percent of the subjects met the criteria for frailty, and 45.5% were prefrail. In this study, prefrail was defined as subjects who met some of their validated criteria for frailty. In the group 85 years of age and older, the percentage of those meeting the criteria for frailty increased to more than 30%. Frailty is widely recognized as an important geriatric syndrome. Frailty is a risk factor for a variety of negative health outcomes, including increased vulnerability to infections, falls, adverse drug reactions, and death. Despite a wide range of studies focused on frailty published each year, there is no clear consensus reporting the most effective method to assess for frailty (Butaet et al., 2015).

One general agreement unifying health professionals is that frailty is a multi-dimensional health problem and not synonymous with a disability. However, there is considerable variability in methods of frailty assessment. Two separate efforts attempted to achieve a consensus definition. Rodriguez-Manas and colleagues (2013) reported that the experts participating in their Delphi consensus project agreed on the multi-dimensional nature of frailty. The authors agreed it is distinct from disability, but there was no agreement on a specific set of clinical and biomarkers useful for diagnosis (Rodriquez-Manas et al., 2013). Morley et al. (2013) reported that a consensus meeting of experts from six international organizations defined frailty as "a medical syndrome with multiple causes and contributors characterized by diminished strength, endurance, and reduced physiologic function that increases an individual's vulnerability for developing in creased dependency and/or death" (p. 393).

In a systematic review of frailty assessment instruments, Buta and colleagues (2015) identified 67 frailty instruments. Of the nine most commonly cited instruments, all included a measure of physical functioning. However, physical functioning was the only domain common to all nine. The most widely used measures are approaches based on deficits and physical phenotype models (Buta et al., 2015; Morley et al., 2013). The physical phenotype is based on the idea that critical mass of impairments or geriatric conditions adds up to the phenotype of frailty (Fried, Ferrucci, Darer, Williamson & Anderson, 2004). Based on this phenotype, frailty is a clinical syndrome consisting of three of more of the following conditions: unintentional weight loss, selfreported exhaustion, and weakness (often measured by grip strength); slow walking speed; and reduced physical activity (Fried et al., 2001). In their systematic review of frailty instruments, Buta et al. (2015) reported that the frailty phenotype is the most commonly used approach for assessing frailty. In contrast to the frailty phenotype, Guaraldi et al. (2015) proposed a deficit model that consists of summing an individual number of impairments and conditions to create a frailty index. These authors consider the deficits to include health variables, such as diagnosed conditions, signs and symptoms of disease, laboratory parameters, and self-report data. The rationale for this approach is that while an individual impairment or condition may result in relatively small deficits, the cumulative effect can be large.