The Association Between Overactive Bladder and Falls and Fractures: A Systematic Review

Abstract

IntroductionUrinary symptoms are associated with an increased risk of falls, but few studies have focused on patients with overactive bladder (OAB). This study aimed to synthesize estimates of the risk of falls and fractures in patients with OAB.MethodsMedline, EMBASE, the Cumulative Index to Nursing and Allied Health Literature, and Scopus were systematically searched for observational studies that focused on patients with OAB. When available, data from a non-OAB comparison sample were included. Double independent review and data extraction were performed. Falls and fractures data were summarized by unadjusted and adjusted risks, and percent attributable risk (PAR) of falls and fractures associated with OAB.ResultsFifteen studies were included in the analyses. The proportion of patients with OAB experiencing at least one fall over a year ranged from 18.9% to 50.0%, and the proportion of patients with OAB experiencing recurrent or serious falls ranged from 10.2% to 56.0%. In studies that included a non-OAB comparison sample, a higher risk of falls was observed in patients with OAB compared to those without. A significantly increased (1.3- to 2.3-fold) adjusted OAB-associated risk of falls was reported, while unadjusted PARs for OAB associated falls ranged from 3.7% to 15.5%. Risk was higher among women and those 65 years of age or older. While analysis of fractures showed elevated point estimates, most studies were underpowered to detect a statistically significant difference between groups.ConclusionsEvidence from the published literature clearly demonstrates the importance of OAB and its symptoms as risk factors for falls and fractures.FundingAstellas.Electronic supplementary materialThe online version of this article (10.1007/s12325-018-0796-8) contains supplementary material, which is available to authorized users.

Urinary and fecal incontinence are independently associated with falls risk among older women and men with complex needs: A national population study

“…Care must also be used in interpreting the findings, as the study involved community‐dwelling older women and men with complex needs which may limit generalizability to their healthier counterparts. Lastly, continence management strategies, including pharmacotherapy for OAB, have yielded little evidence for falls reduction to date 13,28 . Indeed, the increased falls risk associated with anticholinergic medications may offset the benefits of these continence management strategies in decreasing falls in this population 13,28 .…”

“…Lastly, continence management strategies, including pharmacotherapy for OAB, have yielded little evidence for falls reduction to date 13,28 . Indeed, the increased falls risk associated with anticholinergic medications may offset the benefits of these continence management strategies in decreasing falls in this population 13,28 . Although a large recent US population‐based retrospective study demonstrated that falls risk was lower for older adults who had received treatment (pharmacological, surgical, or both) for OAB compared with OAB patients who did not receive such treatment 29 …”

“…9,11 Yet, both UI and FI can be successfully managed in independent older adults with home-based integrated geriatric care strategies and aids. 11,12 The relationship between UI and falls in older adults has received considerable attention, 10,13,14 although men are commonly underrepresented or ignored in these studies, 14 and many studies suffer from methodological limitations such as incomplete control for confounding. [13][14][15] As such, there has been a call for more methodologically robust sex-specific research 16 ; which has garnered at least one response.…”

New participant stratification and combination of urinary biomarkers and confounders could improve diagnostic accuracy for overactive bladder

“…OAB is a symptom complex that may significantly impact sufferers' quality of life including their physical and mental health, social, sexual, economical and professional lives 17,18 . Idiopathic OAB is a symptom-based diagnosis, however, a consensus regarding the symptom severity or combination necessary for accurate OAB diagnosis is lacking.…”

Interaction between locomotion and three subcategories for patients with stroke demonstrating fewer than 37 points on the total functional independence measure upon admission to the recovery ward

“…The sphincter muscle is also important for bladder and bowel management. The pelvic floor muscle (PFM) is associated with sphincter and supports the abdominal viscera from the pelvic floor 32,36) . The passenger unit during post-stroke gait consists of the PFM, TrA, multifidus muscle, and the diaphragm.…”