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Obstetrics & Gynecology 2007;109:909-916
© 2007 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Urinary Incontinence in Older Community-Dwelling Women

The Role of Cognitive and Physical Function Decline

Alison J. Huang, MD, MPhil1,2, Jeanette S. Brown, MD1,2, David H. Thom, MD, PhD2, Howard A. Fink, MD3, Kristine Yaffe, MD1,2 for the Study of Osteoporotic Fractures Research Group

From the 1Veterans Affairs Medical Center, San Francisco, California; 2University of California San Francisco, San Francisco, California; and 3Veterans Affairs Medical Center, Minneapolis, Minnesota.

OBJECTIVES: To examine the association between cognitive decline, physical function decline, and urinary incontinence in older community-dwelling women.

METHODS: This was an observational study of 6,361 community-dwelling women aged 65 years and older participating in the Study of Osteoporotic Fractures. Clinical frequency and functional disruptiveness of incontinence were assessed by self-report questionnaires. Cognitive function was assessed at visits using the modified Mini-Mental State Examination, Trails B test, and Digit Symbol Substitution Test. Physical function was assessed by measuring walking speed over a 6-meter course and time needed to complete five chair stands. Women were considered to have recent, significant decline in cognitive or physical function if their cognitive or physical performance declined by greater than 1 standard deviation beyond the mean decline in the 6 years preceding assessment of incontinence.

RESULTS: Women with recent physical function decline were more likely to report weekly incontinence (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.09–1.56 for walking speed decline; OR 1.40, 95% CI 1.19–1.64 for chair stand decline), after adjusting for multiple characteristics. Women with recent cognitive decline were more likely to report incontinence that interfered with activities (OR 1.55, 95% CI 1.10–2.17 for modified Mini-Mental State Examination decline; OR 1.53, 95% CI 1.01–2.31 for Digit Symbol Substitution Test decline), after adjusting for multiple characteristics.

CONCLUSION: Both cognitive and physical function decline are likely important contributors to incontinence in community-dwelling women aged 65 years and older. Although cognitive decline may not be associated with greater frequency of incontinence, women with cognitive decline may have more difficulty coping with incontinence symptoms.

LEVEL OF EVIDENCE: II






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