**5. Risks factors of the UI in the frail elderly**

From the reports of the main epidemiological studies there have been identified several potential risk factors for UI depending of the characteristics of adult populations. However, the majority of studies have been cross-sectional in design which provides data only on risk factors for prevalent incontinence. Many of these studies are national population-based surveys on the general health of a particular population, and they are limited by the variables included in the study. Longitudinal studies incorporating multivariate analyses that provide data on the risk factors for incident incontinence are scarce. So, the data from studies which included frail population are very few.

In older women, modifiable risk factors included obesity, vaginal trauma, and vaginal prolapse. In general, the risk factors for the various types of UI (stress, urge, and mixed) also vary. Aging tends to be associated with changing risk profiles associated with UI and urge incontinence type. With limited evidence (level IIA from prospective cohort studies), appears that increased body mass index, diabetes mellitus, comorbidities, cognitive decline, and hormone therapy were associated with developing UI in community dwelling females. In men, consistent published evidence (level IIb-III) suggested that poor general health, limitation in daily activities, stroke, diabetes mellitus, and treatments for prostate cancer (mainly surgery) were associated with higher risk of UI in older men (Shamliyan et al, 2007).

Through the analysis of the studies performed in long term care (nursing homes), we know that the prevalence of UI increased with the length of stay, since 39 percent at 2 weeks to 44 percent at 1 year after admission. In that way, the majority of residents with cognitive

Geriatric Urinary Incontinence – Special Concerns on the Frail Elderly 121

**Urogenital Distress Inventory (UDI)**

**Incontinence Severity Index (women) International Continence Society (men) International Continence Society male –SF Bristol Female Lower Urinary Tract Symptoms** 

**Danish Prostatic Symptom Score (men)**

**International Consultation on Incontinence Questionnaire (ICIQ) (men and women)** 

**The Quality of Life of persons with Urinary Incontinence (I-QOL) (men and women)** 

Table 6. Main combined urinary questionnaires (incontinence and impact on QOL)

Table 7. The International Consultation on Incontinence Questionnaire Short Form

**King's Health Questionnaire** 

**UDI-SF Urge UDI** 

Table 5. Principal urinary questionnaires of incontinence

**Bristol Female Lower Urinary Tract Symptoms International Continence Society SF (men) The Sickness Impact Profile (women)** 

**The Incontinence Impact Questionnaire (women) The Urogenital Distress Inventory (women)**

impairment experienced UI (72 to 84 percent), and the proportion of incontinent patients increased significantly in relationship with the severity of impairment (from 60 percent in mild to 93 percent in severely demented). Physical dependency was associated with a higher prevalence of UI, from 26 percent in independent residents to 81 percent in disabled older patients (Shamliyan et al, 2007). However, few studies examined adjusted odds ratios of UI among residents in long term care independent of other confounding factors. Aging was associated with increased odds of UI by 3 percent per year to 24 percent per 5 years of age (Shamliyan et al, 2007; Offermans et al, 2009).

In addition of the medical conditions, it is very important to highlight the role of the drugs that frequently received the older patients, on the urinary continence, as previously exposed above.

In summary, a poor health status with medical problems especially in the neurological area, a high consumption of drugs (diuretics, psychotropics) and a limited functional status are main risks factors for loss of the continence in the frail elderly population.
