Physical multimorbidity and incident urinary incontinence among community-dwelling adults aged ≥50 years: findings from a prospective analysis of the Irish Longitudinal Study on Ageing

Abstract

Background There are no prospective studies on the association between multimorbidity and urinary incontinence (UI), while mediators in this association are unknown. Thus, we aimed to (i) investigate the longitudinal association between multimorbidity and UI in a large sample of Irish adults aged ≥50 years and (ii) investigate to what extent physical activity, polypharmacy, cognitive function, sleep problems, handgrip strength and disability mediate the association. Methods Data on 5,946 adults aged ≥50 years old from the Irish Longitudinal Study on Aging were analysed. The baseline survey was conducted between 2009 and 2011 and follow-up after 2 years was conducted. Information on self-reported occurrence of UI in the past 12 months and lifetime diagnosis of 14 chronic conditions were obtained. Multivariable logistic regression and mediation analysis were conducted. Results After adjustment for potential confounders, compared to having no chronic conditions at baseline, having three (odds ratio [OR] = 1.79; 95% confidence interval [CI] = 1.30–2.48) and four or more (OR = 1.86; 95% CI = 1.32–2.60), chronic conditions were significantly associated with incident UI. Mediation analysis showed that polypharmacy, sleep problems and disability explained 22.7, 17.8 and 14.7% of the association between multimorbidity (i.e. two or more chronic conditions) and incident UI, respectively. Conclusion A greater number of chronic conditions at baseline were associated with a higher risk for incident UI at 2-year follow-up among adults aged ≥50 years in Ireland. Considering the effects of different medications on UI and improving sleep quality and disability among people aged ≥50 years with multimorbidity may reduce the incidence of UI.

Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis

“… 132 Tanzania Low- or LMIC 2021 2017–2018 Cross-sectional The Dar es Salaam Health and Demographic Surveillance System (HDSS) Self-reported 2299 ≥40 53.0 32.4 8 24.8 Smith et al. 133 Ireland HIC 2021 2009–2013 Cross-sectional Irish Longitudinal Study on Ageing (TILDA) Survey Self-reported 5946 ≥50 62.7 51.7 14 50.3 Delpino et al., 134 Brazil UMIC 2021 2019 Cross-sectional The Brazilian National Health Survey 2019 Self-reported 65,803 18–59 NA 47.8 14 22.3 Marthias et al., 135 Indonesia UMIC 2021 2014 Cross-sectional The Indonesian Family Life Survey 2014 (Wave – 5) Self-reported and Objective 3678 ≥50 65 (median) 46.1 10 22.0 Zhang et al. 136 China UMIC 2021 2019 Cross-sectional A cross-sectional study Self-reported and Objective 3250 ≥60 NA 46.6 26 30.3 Lin et al., 137 Taiwan HIC 2021 2017–2019 Cross-sectional A community-based survey Self-reported ...…”

Multimorbidity associated with urinary incontinence among older women and men with complex needs in Aotearoa | New Zealand

“…Based on the bladder incontinence question, UI was then dichotomised into continent (complete control; response "0") and incontinent (any episodes; responses "2," "3," "4," "5") groups, as has been employed elsewhere. 6,7,14,20 Previous research supports the validity and high accuracy of self-reported UI. 21 Motivated by Ho et al 12 multimorbidity was defined to capture (where possible) their core set of 20 chronic conditions.…”

“…With developments in statistical methods and computational power, this has led some to assert that “There is no longer any good justification for fitting logistic regression models and estimating odds ratios when the odds ratio is not a good approximation of the risk or prevalence ratio.” 16 Instead, a modified Poisson regression approach to the analysis of binary data has been advocated 16,17 . Finally, while it is widely recognized that UI and multimorbidity are both sex and age related, 2,7 sex‐specific analyses for females and males are rarely investigated.…”

Overactive Bladder and Cognitive Impairment: The American Urogynecologic Society and Pelvic Floor Disorders Research Foundation State-of-the-Science Conference Summary Report

“…In addition to prescription medications, patients may take over-the-counter medications and supplements, which they may not consider as part of their “med list.” The risk of UUI in older adults increases with the number of chronic conditions. In 1 study, the odds ratio for UI in persons with 4 or more conditions was 1.86 (95% CI, 1.32–2.60) 108 . Importantly, 22.7% of the association between multi-morbidity and UI was explained by polypharmacy (including medications not directly associated with the chronic conditions).…”

“…In 1 study, the odds ratio for UI in persons with 4 or more conditions was1.86 (95% CI, 1.32-2.60). 108 Importantly, 22.7% of the association between multi-morbidity and UI was explained by polypharmacy (including medications not directly associated with the chronic conditions).…”