Urinary Incontinence in Frail Older Adults

Sandra Engberg; Hongjin Li


Urol Nurs. 2017;37(3):119-125. 

In This Article

UI and Frailty

Frailty and UI often co-exist, and there is evidence to suggest the relationship between frailty and incontinence may not be unidirectional (i.e., frailty leading to incontinence) (Wagg et al., 2013). Miles et al. (2001) examined the association between markers of frailty and a new onset UI in a sample of 2,600 older adults. The subjects who developed a new onset of UI during the two years they were followed were significantly more likely to be impaired in the markers of frailty used in this study. Berardelli et al. (2013) also examined the association between UI and frailty in older adults (n = 570). Controlling for the effects of age and sex, subjects with UI were 6.5 times more likely to be frail than those who were continent of urine. The investigators in both of these studies concluded that UI might be a marker of frailty.

In older adults age 65 years and older, both UI and frailty are considered geriatric syndromes. Geriatric syndromes are multifactorial, consisting of multiple interacting risk factors contributing to their etiology (Inouye, Studenski, Tinetti, & Kuchel, 2007). Common risk factors are older age and functional decline, mobility, and cognitive impairment. In addition, cerebral white matter lesions are common MRI findings in a number of geriatric syndromes and could represent a key common risk factor in the development of these syndromes (Kuo & Lipsitz, 2000). A number of studies are beginning to identify central nervous system (CNS) abnormalities in older adults with UI, including white matter lesions and altered central and peripheral neurotransmitter concentrations and actions (Wagg et al., 2013).