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Urinary Incontinences Are Related with Fall and Fragility Fractures in Elderly Population: Nationwide Cohort Study

  • Kim, Hye-Jin (Red Cross College of Nursing, Chung-Ang University) ;
  • Kim, Jin-Woo (Department of Orthopaedic Surgery, Eulji Medical Center, Eulji University College of Medicine) ;
  • Jang, Soong-Nang (Red Cross College of Nursing, Chung-Ang University) ;
  • Kim, Kyung Do (Departments of Urology, Chung-Ang University College of Medicine) ;
  • Yoo, Jun-Il (Department of Orthopaedic Surgery, Gyeongsang National University Hospital) ;
  • Ha, Yong-Chan (Department of Orthopaedic Surgery, Chung-Ang University College of Medicine)
  • Received : 2018.11.03
  • Accepted : 2018.11.22
  • Published : 2018.11.30

Abstract

Background: This prospective cohort study used nationwide claims data to investigate the incidence of fall and fragility fractures in association with urinary incontinence (UI) in the elderly, and to compare mortality after fragility fractures in elderly patients with or without incontinence. Methods: A total of 39,854 Korean adults (age, 66-80 years) who participated in health examinations between 2007 and 2012 and were followed up until 2015 were analyzed. Patient and comparison groups were classified according to the presence or absence of UI. The cumulative incidence of osteoporotic fragility fractures and falls in the 2 groups was assessed and compared. Hazard ratios for fragility fractures were calculated for the risk of UI in association with falls using a Cox proportional hazards model. Results: Of 39,854 elderly participants, 5,703 were classified in the UI group, while 34,151 were placed in the comparison group. Fall rates were significantly higher (20.8%) in the incontinence group than in the comparison group (4.7%) (P<0.001). Women in the incontinence group (13.9%) showed a significantly higher incidence of all types of fragility fractures than those in the comparison group (11.8%) (P=0.005). After adjustment for confounders, UI was not a significant risk factor for fragility fractures in men (P=0.878) or women (P=0.324). Conclusions: This study demonstrated that elderly women with UI have a significantly higher incidence of osteoporotic fragility fractures. In addition, elderly women are at higher risk for falls.

Keywords

Acknowledgement

Supported by : Chung-Ang University

References

  1. Chiarelli PE, Mackenzie LA, Osmotherly PG. Urinary incontinence is associated with an increase in falls: a systematic review. Aust J Physiother 2009;55:89-95. https://doi.org/10.1016/S0004-9514(09)70038-8
  2. Brown JS, Vittinghoff E, Wyman JF, et al. Urinary incontinence: does it increase risk for falls and fractures? Study of Osteoporotic Fractures Research Group. J Am Geriatr Soc 2000;48:721-5. https://doi.org/10.1111/j.1532-5415.2000.tb04744.x
  3. Schluter PJ, Arnold EP, Jamieson HA. Falls and hip fractures associated with urinary incontinence among older men and women with complex needs: a national population study. Neurourol Urodyn 2018;37:1336-43. https://doi.org/10.1002/nau.23442
  4. Hasegawa J, Kuzuya M, Iguchi A. Urinary incontinence and behavioral symptoms are independent risk factors for recurrent and injurious falls, respectively, among residents in long-term care facilities. Arch Gerontol Geriatr 2010;50: 77-81. https://doi.org/10.1016/j.archger.2009.02.001
  5. Frost M, Abrahamsen B, Masud T, et al. Risk factors for fracture in elderly men: a population-based prospective study. Osteoporos Int 2012;23:521-31.
  6. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988;319:1701-7. https://doi.org/10.1056/NEJM198812293192604
  7. Gosch M, Talasz H, Nicholas JA, et al. Urinary incontinence and poor functional status in fragility fracture patients: an underrecognized and underappreciated association. Arch Orthop Trauma Surg 2015;135:59-67. https://doi.org/10.1007/s00402-014-2113-6
  8. Kang HY, Yang KH, Kim YN, et al. Incidence and mortality of hip fracture among the elderly population in South Korea: a population-based study using the national health insurance claims data. BMC Public Health 2010;10:230. https://doi.org/10.1186/1471-2458-10-230
  9. Kim HY, Ha YC, Kim TY, et al. Healthcare costs of osteoporotic fracture in Korea: Information from the national health insurance claims database, 2008-2011. J Bone Metab 2017; 24:125-33. https://doi.org/10.11005/jbm.2017.24.2.125
  10. Leung F, Blauth M, Bavonratanavech S. Surgery for fragility hip fracture-streamlining the process. Osteoporos Int 2010;21:S519-21. https://doi.org/10.1007/s00198-010-1402-3
  11. Wagner TH, Hu TW, Bentkover J, et al. Health-related consequences of overactive bladder. Am J Manag Care 2002; 8:S598-607.
  12. Takazawa K, Arisawa K. Relationship between the type of urinary incontinence and falls among frail elderly women in Japan. J Med Invest 2005;52:165-71. https://doi.org/10.2152/jmi.52.165
  13. Park CH, Lee YK, Ha YC. Change of bone mineral density measurement among patients with osteoporotic fractures in Korean population using national claim database. J Bone Metab 2017;24:183-6. https://doi.org/10.11005/jbm.2017.24.3.183
  14. Kim HS, Shin DW, Lee WC, et al. National screening program for transitional ages in Korea: a new screening for strengthening primary prevention and follow-up care. J Korean Med Sci 2012;27 Suppl:S70-5. https://doi.org/10.3346/jkms.2012.27.S.S70
  15. Yang DW, Cho Bl, Chey JY, et al. The development and validation of Korean Dementia Screening Questionnaire (KDSQ). J Korean Neurol Assoc 2002;20:135-41.
  16. Korean Association of External Quality Assurance Service. New generation proficiency testing program. 2018 [cited by 2018 May 1]. Available from: http://eqas.keqas.org/
  17. Palmer MH, Baumgarten M, Langenberg P, et al. Risk factors for hospital-acquired incontinence in elderly female hip fracture patients. J Gerontol A Biol Sci Med Sci 2002; 57:M672-7. https://doi.org/10.1093/gerona/57.10.M672
  18. Teo JS, Briffa NK, Devine A, et al. Do sleep problems or urinary incontinence predict falls in elderly women? Aust J Physiother 2006;52:19-24. https://doi.org/10.1016/S0004-9514(06)70058-7
  19. O'Loughlin JL, Robitaille Y, Boivin JF, et al. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol 1993;137:342-54. https://doi.org/10.1093/oxfordjournals.aje.a116681
  20. Johansson C, Hellstrom L, Ekelund P, et al. Urinary incontinence: a minor risk factor for hip fractures in elderly women. Maturitas 1996;25:21-8. https://doi.org/10.1016/0378-5122(96)01117-6
  21. Kiely DK, Kiel DP, Burrows AB, et al. Identifying nursing home residents at risk for falling. J Am Geriatr Soc 1998;46:551-5. https://doi.org/10.1111/j.1532-5415.1998.tb01069.x
  22. Kron M, Loy S, Sturm E, et al. Risk indicators for falls in institutionalized frail elderly. Am J Epidemiol 2003;158:645-53. https://doi.org/10.1093/aje/kwg203

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