(Poster 08) Is There an Association Between Moderate Urinary Incontinence and Frailty?

Objectives: Frailty is an important clinical syndrome with significant impact on the health status of older adults, resulting in higher risk of falls, hospitalizations, and death. Given that frailty is a common and potentially dangerous phenomenon in older adults, understanding its associations with chronic conditions such as urinary incontinence (UI) is ideal. The primary aim of this study is to determine the association between frailty and moderate UI in women undergoing surgery for symptomatic pelvic organ prolapse (POP). We hypothesized that frail patients are more likely to experience moderate UI symptoms.

Methods: This was a secondary analysis of combined datasets of women aged ≥ 60 years who underwent POP surgery enrolled in studies primarily focused on perioperative neurocognitive disorders. Exclusion criteria include history of known cognitive impairment diagnosis, modified mini-mental status exam score < 84, history of stroke or major neurologic disorder, and non-English speakers. Frailty was measured using Fried Frailty Index (FFI) prior to surgery. Frailty status was classified as follows: score of 0 non-frail, a score of 1-2 pre-frail, and score of ≥3 as frail. Patients completed UDI-6 at baseline. Moderate UI symptoms was defined as a score of >33.33 points on UDI-6 (a cut-point that was previously validated). Chi-square (Fisher’s exact) tests for categorical variables and T-test (Mann-Whitney U) for continuous variables were used to compare characteristics across women with and without moderate UI symptoms. Univariable and multivariable logistic regression analyses were also performed.

Results: There were 250 patients included in this cohort. There were 47 non-frail patients (18.8%), 183 (73.2%) pre-frail patients, and 20 (8%) frail patients. There were 131 (52.4%) patients with moderate UI symptoms. Mean (standard deviation (SD)) age was 72.9 (6.23) years and mean (SD) body mass index (BMI) was 27.56 (4.44) kg/m2. Moderate UI was significantly associated with frailty status (p=0.001), greater BMI (p=0.02), higher American Society of Anesthesiologist (ASA) class (p=0.001), and patient self-reported vision impairment (p=0.045) (Table 1). On logistic regression, frailty status was significantly associated with experiencing moderate UI symptoms (p < 0.001). The association between frailty status and moderate UI symptoms remained significant when controlling for ASA classification and BMI (Table 2).

Conclusions: Frailty status is associated with the presence of moderate UI symptoms in independent community-dwelling women scheduled to undergo prolapse surgery. This association is relevant as the presence of frailty and moderate UI symptoms in symptomatic POP may influence surgical counseling and decision-making. Frailty status may impact on surgical planning for treatment of concomitant UI symptoms. Further research on the relationship between frailty and UI in older adults is needed to further characterize anticipated outcomes for this patient population.