International Urogynecology Journal

, Volume 26, Issue 6, pp 823–830 | Cite as

Frailty, cognitive impairment, and functional disability in older women with female pelvic floor dysfunction

  • Elisabeth A. Erekson
  • Terri R. Fried
  • Deanna K. Martin
  • Thomas J. Rutherford
  • Kris Strohbehn
  • Julie P. W. Bynum
Original Article


Introduction and hypothesis

There is a growing body of evidence demonstrating frailty as an important predictor of surgical outcomes in older adults undergoing major surgeries. The age-related onset of many symptoms of female pelvic floor dysfunction (PFD) in women suggests that many women seeking treatment for PFD may also have a high prevalence of frailty, which could potentially impact the risks and benefits of surgical treatment options. Our primary objective was to determine the prevalence of frailty, cognitive impairment, and functional disability in older women seeking treatment for PFD.


We conducted a cross-sectional study with prospective recruitment between September 2011 and September 2012. Women, age 65 years and older, were recruited at the conclusion of their new patient consultation for PFD at a tertiary center. A comprehensive geriatric screening including frailty measurements (Fried Frailty Index), cognitive screening (Saint Louis University Mental Status score), and functional status evaluation for activities of daily living (Katz ADL score) was conducted.


Sixteen percent (n/N = 25/150) of women were categorized as frail according to the Fried Frailty Index score. After adjusting for education level, 21.3 % of women (n/N = 32/150) screened positive for dementia and 46 (30.7 %) reported functional difficulty or dependence in performing at least one Katz ADL. Sixty-nine women (46.0 %) chose surgical options for treatment of their PFD at the conclusion of their new patient visit with their physician.


Frailty, cognitive impairment, and functional disability are common in older women seeking treatment for PFD.


Female pelvic floor dysfunction Frailty Functional disability Pelvic organ prolapse Urinary incontinence 



This research was supported in part by a grant from the American Urogynecologic Society (AUGS) Foundation. Dr. Erekson was supported through a grant from the Claude D. Pepper Older Americans Independence Center at Yale University School of Medicine (#P30AG021342 NIH/NIA). The funding agreement ensured the authors independence in designing the study, interpreting the data, and writing and publishing the article.

Conflicts of interest



  1. 1.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56(3):M146–M156CrossRefPubMedGoogle Scholar
  2. 2.
    Dasgupta M, Rolfson DB, Stolee P, Borrie MJ, Speechley M (2009) Frailty is associated with postoperative complications in older adults with medical problems. Arch Gerontol Geriatr 48(1):78–83Google Scholar
  3. 3.
    Robinson TN, Wu DS, Stiegmann GV, Moss M (2011) Frailty predicts increased hospital and six-month healthcare cost following colorectal surgery in older adults. Am J Surg 202(5):511–514CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Robinson TN, Wallace JI, Wu DS, Wiktor A, Pointer LF, Pfister SM et al (2011) Accumulated frailty characteristics predict postoperative discharge institutionalization in the geriatric patient. J Am Coll Surg 213(1):37–42, discussion 42–44CrossRefPubMedCentralPubMedGoogle Scholar
  5. 5.
    Hamel MB, Henderson WG, Khuri SF, Daley J (2005) Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc 53(3):424–429CrossRefPubMedGoogle Scholar
  6. 6.
    Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P et al (2010) Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 210(6):901–908CrossRefPubMedGoogle Scholar
  7. 7.
    Chow WB, Merkow RP, Cohen ME, Bilimoria KY, Ko CY (2012) Association between postoperative complications and reoperation for patients undergoing geriatric surgery and the effect of reoperation on mortality. Am Surg 78(10):1137–1142PubMedGoogle Scholar
  8. 8.
    Robinson TN, Raeburn CD, Tran ZV, Angles EM, Brenner LA, Moss M (2009) Postoperative delirium in the elderly: risk factors and outcomes. Ann Surg 249(1):173–178CrossRefPubMedGoogle Scholar
  9. 9.
    Rothman MD, Leo-Summers L, Gill TM (2008) Prognostic significance of potential frailty criteria. J Am Geriatr Soc 56(12):2211–2216CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J et al (2008) Prevalence of symptomatic pelvic floor disorders in US women. JAMA 300(11):1311–1316CrossRefPubMedCentralPubMedGoogle Scholar
  11. 11.
    Rortveit G, Hannestad YS, Daltveit AK, Hunskaar S (2001) Age- and type-dependent effects of parity on urinary incontinence: the Norwegian EPINCONT study. Obstet Gynecol 98(6):1004–1010CrossRefPubMedGoogle Scholar
  12. 12.
    Yip SO, Dick MA, McPencow AM, Martin DK, Ciarleglio MM, Erekson EA (2013) The association between urinary and fecal incontinence and social isolation in older women. Am J Obstet Gynecol 208(2):146.e1–146.e7Google Scholar
  13. 13.
    Melville JL, Fan MY, Newton K, Fenner D (2005) Fecal incontinence in US women: a population-based study. Am J Obstet Gynecol 193(6):2071–2076CrossRefPubMedGoogle Scholar
  14. 14.
    Washburn RA, Smith KW, Jette AM, Janney CA (1993) The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol 46(2):153–162CrossRefPubMedGoogle Scholar
  15. 15.
    Tariq SH, Tumosa N, Chibnall JT, Perry MH 3rd, Morley JE (2006) Comparison of the Saint Louis University mental status examination and the mini-mental state examination for detecting dementia and mild neurocognitive disorder—a pilot study. Am J Geriatr Psychiatry 14(11):900–910CrossRefPubMedGoogle Scholar
  16. 16.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383CrossRefPubMedGoogle Scholar
  17. 17.
    Spitzer WO (1987) State of science 1986: quality of life and functional status as target variables for research. J Chronic Dis 40(6):465–471CrossRefPubMedGoogle Scholar
  18. 18.
    Gill TM (2010) Assessment of function and disability in longitudinal studies. J Am Geriatr Soc 58(Suppl 2):S308–S312CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Gill TM, Robison JT, Tinetti ME (1998) Difficulty and dependence: two components of the disability continuum among community-living older persons. Ann Intern Med 128(2):96–101CrossRefPubMedGoogle Scholar
  20. 20.
    Irwin M, Artin KH, Oxman MN (1999) Screening for depression in the older adult: criterion validity of the 10-item Center for Epidemiological Studies Depression Scale (CES-D). Arch Intern Med 159(15):1701–1704Google Scholar
  21. 21.
    Lyness JM, Noel TK, Cox C, King DA, Conwell Y, Caine ED (1997) Screening for depression in elderly primary care patients. A comparison of the Center for Epidemiologic Studies-Depression Scale and the Geriatric Depression Scale. Arch Intern Med 157(4):449–454CrossRefPubMedGoogle Scholar
  22. 22.
    Barber MD, Walters MD, Bump RC (2005) Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol 193(1):103–113CrossRefPubMedGoogle Scholar
  23. 23.
    Barber MD, Chen Z, Lukacz E, Markland A, Wai C, Brubaker L et al (2011) Further validation of the short form versions of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ). Neurourol Urodyn 30(4):541–546CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Gill TM, Gahbauer EA, Allore HG, Han L (2006) Transitions between frailty states among community-living older persons. Arch Intern Med 166(4):418–423CrossRefPubMedGoogle Scholar
  25. 25.
    O’Doherty AF, West M, Jack S, Grocott MP (2013) Preoperative aerobic exercise training in elective intra-cavity surgery: a systematic review. Br J Anaesth 110(5):679–689CrossRefPubMedGoogle Scholar
  26. 26.
    Jack S, West M, Grocott MP (2011) Perioperative exercise training in elderly subjects. Best Pract Res Clin Anaesthesiol 25(3):461–472CrossRefPubMedGoogle Scholar
  27. 27.
    Robinson TN, Finlayson E (2014) How to best forecast adverse outcomes following geriatric trauma: an ageless question? JAMA Surg 149(8):773Google Scholar
  28. 28.
    Robinson TN, Eiseman B, Wallace JI, Church SD, McFann KK, Pfister SM et al (2009) Redefining geriatric preoperative assessment using frailty, disability and co-morbidity. Ann Surg 250(3):449–455PubMedGoogle Scholar
  29. 29.
    Fitzgerald MP, Richter HE, Bradley CS, Ye W, Visco AC, Cundiff GW et al (2008) Pelvic support, pelvic symptoms, and patient satisfaction after colpocleisis. Int Urogynecol J Pelvic Floor Dysfunct 19(12):1603–1609CrossRefPubMedCentralPubMedGoogle Scholar
  30. 30.
    Parker DY, Burke JJ 2nd, Gallup DG (2004) Gynecological surgery in octogenarians and nonagenarians. Am J Obstet Gynecol 190(5):1401–1403CrossRefPubMedGoogle Scholar
  31. 31.
    Stepp KJ, Barber MD, Yoo EH, Whiteside JL, Paraiso MF, Walters MD (2005) Incidence of perioperative complications of urogynecologic surgery in elderly women. Am J Obstet Gynecol 192(5):1630–1636CrossRefPubMedGoogle Scholar
  32. 32.
    Toglia MR, Nolan TE (2003) Morbidity and mortality rates of elective gynecologic surgery in the elderly woman. Am J Obstet Gynecol 189(6):1584–1587, discussion 1587–1589CrossRefPubMedGoogle Scholar

Copyright information

© The International Urogynecological Association 2014

Authors and Affiliations

  • Elisabeth A. Erekson
    • 1
    • 2
    • 6
  • Terri R. Fried
    • 3
    • 4
  • Deanna K. Martin
    • 3
  • Thomas J. Rutherford
    • 5
  • Kris Strohbehn
    • 1
  • Julie P. W. Bynum
    • 2
  1. 1.Department of Obstetrics and GynecologyGeisel School of Medicine at DartmouthHanoverUSA
  2. 2.The Dartmouth Institute for Health Policy and Clinical PracticeGeisel School of Medicine at DartmouthHanoverUSA
  3. 3.Department of MedicineYale University School of MedicineNew HavenUSA
  4. 4.Clinical Epidemiology Research CenterVA Connecticut Healthcare SystemWest HavenUSA
  5. 5.Department of Obstetrics, Gynecology, and Reproductive SciencesYale University School of MedicineNew HavenUSA
  6. 6.Division of UrogynecologyGeisel School of Medicine at DartmouthLebanonUSA

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