Perspectives of older women with coexisting urinary incontinence and high fall risk

Abstract

Background: Overactive bladder and urinary incontinence are strongly associated with falling in older adults. Despite this established link, research on how women experience these coexisting conditions is lacking.

Objective: This study aimed to better understand how older women with both urgency urinary incontinence and an increased risk of falls perceive their urinary symptoms in relation to fall risk.

Design: Mixed-methods study using concurrent triangulation design with qualitative interviews and quantitative patient-reported outcome measures.

Methods: English-speaking women aged 60 and older with urgency or mixed urinary incontinence who screened positive for fall risk were recruited through online advertising. Fall risk was assessed using the Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths, and Injuries "3 Key Questions." Semistructured interviews explored participants' perspectives on urinary symptoms, fall risk, and quality of life. Standardized measures included the Falls Efficacy Scale International, PROMIS Physical Function, The International Consultation on Incontinence Modular Questionnaire - Overactive Bladder symptom severity scale, The International Consultation on Incontinence Modular Questionnaire Lower Urinary Tract Symptoms Quality of Life Module, and Functional Comorbidity Index. Thematic analysis of interview transcripts was conducted using constant comparison. Multiple regression models examined associations between fear of falling, symptom severity, physical function, and urinary incontinence-related quality of life.

Results: Sixty women responded to the online advertising for the study and completed the initial screening questionnaire. Twenty-five were enrolled and interviewed. Mean age was 68 ± 4.7. None were aware of linkages between urinary incontinence and falls. Their concerns about falling were unique to the experience of living with a urinary condition and often interacted with social stigma such as embarrassment from incontinence after a fall. Fear of falling was more strongly associated with urinary incontinence-related quality of life than symptom severity, physical functioning, or comorbid burden after adjusting for age (p < 0.01). Fear of falling and symptom severity were the only factors significantly associated with urinary incontinence-related quality of life in regression models.

Conclusion: There is a need to better communicate to older women with urinary incontinence the known risk of falling associated with their urinary condition.

Keywords: falls; fear of falling; urinary incontinence.

Figure 1.

Frequency of responses to the 3 Key Questions by UI type. A “yes” response to any of the Three Key Questions indicates increased risk of falling: (1) Have you fallen in the past year? (2) Do you feel unsteady when standing or walking? and (3) Do you worry about falling? Some participants selected more than one response. UUI: urgency urinary incontinence; mixed UI: both urgency and stress incontinence.