Urinary urgency acts as a source of divided attention leading to changes in gait in older adults with overactive bladder

Abstract

Aims There is a well-recognised but unexplained association between lower urinary tract symptoms including urgency and urgency incontinence and falls in older people. It has been hypothesised that urinary urgency acts as a source of divided attention, leading to gait changes which increase falls risk. This study aimed to assess whether urinary urgency acts as a source of divided attention in older adults with overactive bladder (OAB). Methods 27 community-dwelling adults aged 65 years and over with a clinical diagnosis of OAB underwent 3-Dimensional Instrumented Gait Analysis under three conditions; bladder empty, when experiencing urgency, and when being distracted by the n-back test. Temporal-spatial gait and kinematic gait data were compared between each condition using repeated measures ANOVA. Results Gait velocity decreased from 1.1ms-1 in the bladder empty condition to 1.0ms-1 with urgency and 0.9ms-1 with distraction (p = 0.008 and p<0.001 respectively). Stride length also decreased, from 1.2m to 1.1m with urgency and 1.0m with distraction (p<0.001 for both). The presence of detrusor overactivity did not influence these results (p = 0.77). Conclusions In older adults with OAB, urinary urgency induced similar changes in gait to those caused by a distracting task. These gait changes are associated with increased fall risk. This may be part of the explanation for the association between falls and lower urinary tract symptoms in older people. Future research should examine the effect of pharmacological treatment of OAB on gait and on the effect of dual-task training on gait when experiencing urgency.

Efficacy and Safety of Vibegron for the Treatment of Overactive Bladder in Women: A Subgroup Analysis From the Double-Blind, Randomized, Controlled EMPOWUR Trial

“…Furthermore, a previous report showed falls to be more frequent in adults ≥65 years old (39.4%) with UUI compared with those without UUI 25 . Higher fall rates in this population may be partly due to a slower gait speed and increased variability in gait among older women (≥65 years) with severe UI experiencing urinary urgency 26,27 . As such, the significant improvements observed in this analysis with vibegron in both UUI episodes and urgency episodes suggest that vibegron may be a beneficial and safe treatment option among older women with OAB.…”

“…25 Higher fall rates in this population may be partly due to a slower gait speed and increased variability in gait among older women (65 years) with severe UI experiencing urinary urgency. 26,27 As such, the significant improvements observed in this analysis with vibegron in both UUI episodes and urgency episodes suggest that vibegron may be a beneficial and safe treatment option among older women with OAB. Given the symptoms associated with OAB can be burdensome and significantly affect patient QoL, the International Continence Society recommends evaluating QoL measures in addition to symptom measures.…”

Associated factors of stress, urgency, and mixed urinary incontinence in a geriatric outpatient assessment of older women with hip fracture

“…However, the underlying cause for this connection has been under some debate. Previously suggested simple rationale such as rushing to the toilet caused by the sense of urgency has been questioned [13,40], and the current evidence suggests that likely both UI and falls are markers of underlying vulnerability and disability [14,41,42]. Our results concur with these findings, given that our analysis was adjusted with considerable number of factors (many of which represent disability and vulnerability) and our selected study population consisted of participants with high level of disability as already demonstrated in our previous works [17,19].…”

Reducing Falls in Older Women with Urinary Incontinence

“…There is emerging evidence that urinary urgency affects gait in older adults by diverting attention from the task of walking. A small study of older adults with overactive bladder ( n = 25) found that urinary urgency resulted in gait changes similar to those induced by a distracting task, and such changes increase risk for fall [ 39 ]. Additionally, anxiety and depression are also worse in women with UUI who have already suffered a fall.…”