Association between nocturia and frailty among elderly males in a veterans administration population

Monaghan, Thomas F.; Wagg, Adrian; Bliwise, Donald L.; Agudelo, Christina W.; Michelson, Kyle P.; Rahman, Syed N.; Epstein, Matthew; Haddad, Rebecca; Everaert, Karel; Lazar, Jason; Weiss, Jeffrey P.

doi:10.1007/s40520-019-01416-y

Cited by 12 publications

(17 citation statements)

References 32 publications

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“…14,38 Through unknown mechanisms, older men with LUTS and high frailty index scores are more likely to have excess nocturnal urine production compared with men with lower frailty index scores that can worsen nocturnal storage LUTS. 39 Lastly, the cumulative deficit model, a conceptual model of frailty that was not assessed in our study, defines frailty as the accumulation of health and functional problems including LUTS or lower urinary tract dysfunction that cumulatively (rather than individually) contribute to increased risk of morbidity and mortality. 25 It is also unknown if LUTS and frailty are a consequence of shared pathophysiology.…”

Section: Discussionmentioning

confidence: 99%

Co‐Occurrence of Lower Urinary Tract Symptoms and Frailty among Community‐Dwelling Older Men

Bauer

Scherzer

Suskind

et al. 2020

J American Geriatrics Society

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BACKGROUND/OBJECTIVES To estimate associations between lower urinary tract symptoms (LUTS) and phenotypic frailty in older men. DESIGN Cross‐sectional study. SETTING Community‐dwelling men recruited from 2000 to 2002 from six U.S. academic centers for the Osteoporotic Fractures in Men Study. PARTICIPANTS A total of 5,979 men aged 65 and older. MEASUREMENTS The independent variable was LUTS severity (none/mild, moderate, or severe) assessed with the American Urologic Association Symptom Index. Participants were categorized as frail, intermediate stage, or robust using an adapted Cardiovascular Health Study index (components: low lean mass, weakness, exhaustion, slowness, and low physical activity). Associations were estimated with odds ratios and 95% confidence intervals (CIs) from multivariable multinomial logistic regression models adjusted for potential confounders of age, other demographics, health‐related behaviors, and comorbidities. RESULTS The prevalence of frailty was 7%, 11%, and 18% among men with none/mild, moderate, and severe LUTS, respectively. Moderate and severe LUTS, overall and by storage and voiding subscores, were associated with higher odds of both intermediate stage and frailty in all models. After adjustment for confounders, the odds of frailty was 1.41 times higher among men with moderate LUTS (95% CI = 1.14–1.74) and 2.51 times higher among men with severe LUTS (95% CI = 1.76–3.55), compared with none/mild LUTS. Severe LUTS was associated with a greater odds of individual frailty components exhaustion and low physical activity. CONCLUSION The prevalence of phenotypic frailty is higher among older community‐dwelling men with moderate or severe LUTS compared with those with mild or no LUTS. The positive association between LUTS severity and frailty among older men appears independent of age and known frailty risk factors. Although the temporal direction of this association and the utility of LUTS or frailty interventions in this population remain unclear, the high co‐occurrence of these conditions could lead to earlier identification of frailty when clinically appropriate.

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Section: Discussionmentioning

confidence: 99%

Co‐Occurrence of Lower Urinary Tract Symptoms and Frailty among Community‐Dwelling Older Men

Bauer

Scherzer

Suskind

et al. 2020

J American Geriatrics Society

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“… 23 Positive associations have also been reported between measures of frailty and LUTS subtypes, such as overactive bladder, 35 as well as physiological abnormalities that can cause LUTS, such detrusor overactivity 36 and nocturnal polyuria. 24 We previously demonstrated that compared with older men seeking treatment for other urologic conditions, older men with overactive bladder, mixed overactive bladder and BPH, and BPH were 2.6, 1.8, and 1.7 times, respectively, more likely to have slow Timed-Up-And-Go-Test times, an easily measurable surrogate for frailty. 21 Our longitudinal analysis builds on this prior literature by reporting a positive association of deficit accumulation frailty index with a higher risk of clinical BPH progression and LUTS progression among men rigorously assessed for inclusion in a BPH trial and monitored carefully for progression events.…”

Section: Discussionmentioning

confidence: 99%

“… 14 , 15 Although associations between chronological age and male LUTS or BPH are well established, 8 , 16 , 17 , 18 including data from the MTOPs trial, 19 frailty and other markers of biological age may represent more important risk factors than chronological age alone. 20 , 21 , 22 , 23 , 24 , 25 However, prior studies are limited by cross-sectional design, lack of a clinical diagnosis or objective measures of benign prostatic obstruction and frailty, BPH interventions that were neither randomized nor placebo controlled, and no formal interaction testing.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Frailty and Association With Progression of Benign Prostatic Hyperplasia Symptoms and Serious Adverse Events Among Men Using Drug Therapy

et al. 2021

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Key Points Question Is frailty associated with increased risk of progression of benign prostatic hyperplasia (BPH) symptoms and serious adverse events among men receiving drug therapy? Findings In a cohort study of 3047 men with moderate-to-severe lower urinary tract symptoms due to suspected BPH, higher deficit accumulation frailty index was associated with a higher risk of clinical BPH progression, particularly among men receiving doxazosin with finasteride, and serious adverse events. Meaning These findings suggest that frail men with lower urinary tract symptoms due to suspected BPH are more likely to have progression of symptoms, despite drug therapy, as well as serious adverse events.

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“…Although the role of skeletal muscle in LUTS has been minimally explored, the external urethral sphincter (40), pelvic floor (41), and abdominal musculature (39) are all skeletal muscles suspected to play a role in both micturition control and regulation of bladder sensations. Frail older men produce excess urine at night (42), potentially due to changes in the circadian rhythm of water excretion (43,44). Lastly, changes within the lower urinary tract that occur with increasing age, such as decreased functional bladder capacity and increased detrusor instability, may be more exaggerated among frail older men (44).…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Associations between Concurrent Changes in Phenotypic Frailty and Lower Urinary Tract Symptoms among Older Men

et al. 2022

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BACKGROUND: Lower urinary tract symptoms (LUTS) are associated with prevalent frailty and functional impairment, but longitudinal associations remain unexplored. OBJECTIVES: To assess the association of change in phenotypic frailty with concurrent worsening LUTS severity among older men without clinically significant LUTS at baseline. DESIGN: Multicenter, prospective cohort study. SETTING: Population-based. PARTICIPANTS: Participants included community-dwelling men age ≥65 years at enrollment in the Osteoporotic Fractures in Men study. MEASUREMENTS: Data were collected at 4 visits over 7 years. Phenotypic frailty score (range: 0-5) was defined at each visit using adapted Fried criterion and men were categorized at baseline as robust (0), pre-frail (1-2), or frail (3-5). Within-person change in frailty was calculated at each visit as the absolute difference in number of criteria met compared to baseline. LUTS severity was defined using the American Urologic Association Symptom Index (AUASI; range: 0-35) and men with AUASI ≥8 at baseline were excluded. Linear mixed effects models were adjusted for demographics, health-behaviors, and comorbidities to quantify the association between within-person change in frailty and AUASI. RESULTS: Among 3235 men included in analysis, 48% were robust, 45% were pre-frail, and 7% were frail. Whereas baseline frailty status was not associated with change in LUTS severity, within-person increases in frailty were associated with greater LUTS severity (quadratic P<0.001). Among robust men at baseline, mean predicted AUASI during followup was 4.2 (95% CI 3.9, 4.5) among those meeting 0 frailty criteria, 4.6 (95% CI 4.3, 4.9) among those meeting 1 criterion increasing nonlinearly to 11.2 (95% CI 9.8, 12.6) among those meeting 5 criteria. CONCLUSIONS: Greater phenotypic frailty was associated with nonlinear increases in LUTS severity in older men over time, independent of age and comorbidities. Results suggest LUTS and frailty share an underlying mechanism that is not targeted by existing LUTS interventions.

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Association between nocturia and frailty among elderly males in a veterans administration population

Cited by 12 publications

References 32 publications

Co‐Occurrence of Lower Urinary Tract Symptoms and Frailty among Community‐Dwelling Older Men

Co‐Occurrence of Lower Urinary Tract Symptoms and Frailty among Community‐Dwelling Older Men

Assessment of Frailty and Association With Progression of Benign Prostatic Hyperplasia Symptoms and Serious Adverse Events Among Men Using Drug Therapy

Longitudinal Associations between Concurrent Changes in Phenotypic Frailty and Lower Urinary Tract Symptoms among Older Men

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