Predictors of urinary incontinence in community-dwelling frail older adults with diabetes mellitus in a cross-sectional study

Abstract

BackgroundDiabetes mellitus is a potent risk factor for urinary incontinence. Previous studies of incontinence in patients with diabetes have focused on younger, healthier patients. Our objective was to characterize risk factors for urinary incontinence among frail older adults with diabetes mellitus in a real-world clinical setting.MethodsWe performed a cross-sectional analysis on enrollees at On Lok (the original Program for All-Inclusive Care of the Elderly) between October 2004 and December 2010. Enrollees were community-dwelling, nursing home-eligible older adults with diabetes mellitus (N = 447). Our outcome was urinary incontinence measures (n = 2602) assessed every 6 months as “never incontinent”, “seldom incontinent” (occurring less than once per week), or “often incontinent” (occurring more than once per week). Urinary incontinence was dichotomized (“never” versus “seldom” and “often” incontinent). We performed multivariate mixed effects logistic regression analysis with demographic (age, gender and ethnicity), geriatric (dependence on others for ambulation or transferring; cognitive impairment), diabetes-related factors (hemoglobin A1c level; use of insulin and other glucose-lowering medications; presence of renal, ophthalmologic, neurological and peripheral vascular complications), depressive symptoms and diuretic use.ResultsThe majority of participants were 75 years or older (72%), Asian (65%) and female (66%). Demographic factors independently associated with incontinence included older age (OR for age >85, 3.13, 95% CI: 2.15-4.56; Reference: Age <75) and African American or other race (OR 2.12, 95% CI: 1.14-3.93; Reference: Asian). Geriatric factors included: dependence on others for ambulation (OR 1.48, 95% CI: 1.19-1.84) and transferring (OR 2.02, 95% CI: 1.58-2.58) and being cognitively impaired (OR 1.41, 95% CI: 1.15-1.73). Diabetes-related factors associated included use of insulin (OR 2.62, 95% CI: 1.67-4.13) and oral glucose-lowering agents (OR 1.81, 95% CI: 1.33-2.45). Urinary incontinence was not associated with gender, hemoglobin A1c level or depressive symptoms.ConclusionsGeriatric factors such as the inability to ambulate or transfer independently are important predictors of urinary incontinence among frail older adults with diabetes mellitus. Clinicians should address mobility and cognitive impairment as much as diabetes-related factors in their assessment of urinary incontinence in this population.

Influence of secondary diagnoses in the development of urinary incontinence after radical prostatectomy

“…The absence of SDg or patients with better health condition was associated with not suffering any degree of UI after RP (23.64% in GA versus 8.72% in GB, p < 0.001). This finding is consistent with other published results (9,12). Erectile dysfunction prior to the surgery has been proposed as a risk factor for IU after RP (18).…”

“…DM has been proposed as an independent factor for the development of urinary incontinence. It is usually associated to age over 65 and to the use of insulin as markers of severity (11,12). In our series is noteworthy that the prevalence of DM in the group of incontinent patients (2.90%) is lower than in the group of continents (13.56%) (p < 0.0001).…”

Prevalência e fatores associados à incontinência urinária em idosos não institucionalizados

“…Sabe-se que as mulheres têm, em geral, doença mais severa que o homem 34 . A limitação na marcha e a dependência para deambular podem ser fatores implicados na associação de tais agravos com a IU, ao dificultar o acesso ao banheiro 35,36 . Diante dessa situação, revela-se a necessidade de uma assistência de melhor qualidade, que poderia levar a um aumento na expectativa de vida livre de incapacidade em idosos 37 .…”

Report and Research Agenda of the American Geriatrics Society and National Institute on Aging Bedside‐to‐Bench Conference on Urinary Incontinence in Older Adults: A Translational Research Agenda for a Complex Geriatric Syndrome

“…Metabolic syndrome is also an important precursor to diabetes mellitus and vascular diseases, but there is less evidence that it is a UI risk factor . Diabetes mellitus, which may result in neurological and vascular impairments, is associated with twice the risk of UI in population‐based studies . Obesity is also associated with UI, including stress and urgency UI subtypes, in epidemiological studies and clinical trials .…”