Relationship of urinary incontinence and late-life disability: Implications for clinical work and research in geriatrics

Der Zusammenhang von Harninkontinenz und Behinderung im Alter: Bedeutung für die klinische Arbeit und geriatrische Forschung

Abstract

The role of urinary incontinence (UI) in the disablement process model has been mainly defined according to its impact on quality of life, global wellbeing, life satisfaction, institutionalization and death, which are global outcomes of disability. Recent research focused on the “active” role of UI in the main pathway of the disablement process model, i.e. actively involved in the causes of disability. The aim of this paper is to review the complex current scientific evidence on this second active role and to define the implications for further research and for clinical work in geriatrics. The relationship between UI and disability can be classified in the following five pathways:

1) UI as risk factor for functional decline and reduced physical activity through the increased risk of falls and fractures.

2) Functional decline and reduced physical activity as risk factors for the onset of UI.

3) Shared risk factors for UI and functional decline: white matter changes, stroke and other neurological conditions.

4) UI in a unifying conceptual framework: the multifactorial etiology of geriatric syndromes.

5) UI as an indicator of frailty.

Understanding these pathways could improve insight into clinical, pharmacological, environmental, behavioral and rehabilitative mechanisms to define measures for the prevention and treatment of the geriatric syndromes cascade. However, research on effective interventions on these overlapping areas is still quite rare. Additionally there is an urgent need to use the standardized terminology of lower urinary tract symptoms (LUTS), established by the International Continence Society (ICS) to find a common language in disability research. To conclude, the relationship of UI and disability is evident in different pathways. Understanding these associations can have substantial implications for both clinical work and research in this area.

Zusammenfassung

Die Rolle der Harninkontinenz wurde im Modell des „Disablement Process“ bislang hauptsächlich anhand globaler Endpunkte von Behinderung, wie Lebensqualität, allgemeinem Wohlbefinden, Lebenszufriedenheit, Institutionalisierung und Tod untersucht. Aktuelle Forschungsprojekte behandeln stattdessen die aktive Rolle der Harninkontinenz im Hauptpfad des „Disablement Process-Modells“, womit ihr eine direkte Rolle bei der Entstehung von funktioneller Einschränkung und Behinderung zugesprochen wird. Das Ziel dieses Artikels ist es, einen Überblick über die komplexen Zusammenhänge dieser zweiten, „aktiven“ Rolle der Harninkontinenz zu geben und mögliche Auswirkungen für Forschung und klinisch geriatrische Arbeit aufzuzeigen. Der Zusammenhang zwischen Harninkontinenz und Beeinträchtigung kann anhand der folgenden 5 Pfade dargestellt werden:

1) Harninkontinenz als Risikofaktor für funktionellen Abbau und reduzierte körperliche Aktivität durch eine Erhöhung des Sturz- und Frakturrisikos.

2) Funktionsminderung im Alltag und reduzierte körperliche Aktivität als Risikofaktoren für den Beginn einer Harninkontinenz.

3) Gemeinsame Risikofaktoren für das Entstehen von Harninkontinenz und Funktionsminderung im Alltag: Marklagerveränderungen, Schlaganfall und andere neurologische Erkrankungen.

4) Harninkontinenz in einem vereinheitlichenden Rahmenkonzept: die multifaktorielle Ätiologie geriatrischer Syndrome.

5) Harninkontinenz als Gebrechlichkeits- Indikator.

Die Anwendung dieser Pfade könnte zu einem besseren Verständnis klinischer, pharmakologischer, rehabilitativer und verhaltenstherapeutischer Zusammenhänge führen, um Maßnahmen zur Prävention und Behandlung geriatrischer Syndrome zu definieren. Die Zahl von Forschungsprojekten zur weiteren Charakterisierung dieser sich überschneidenden Gebiete ist jedoch weiterhin sehr gering. Zudem besteht dringender Bedarf, die neue und standardisierte Terminologie von Symptomen des unteren Harntrakts (LUTS) der International Continence Society (ICS) zu verwenden, um in zukünftigen Forschungsprojekten mit dem Thema Behinderung im Alter eine gemeinsame Sprache zu finden.

Zusammenfassend kommt die Beziehung von Behinderung und Inkontinenz in verschiedenen Pfaden deutlich zum Ausdruck. Das Verständnis dieser Zusammenhänge kann bedeutende Auswirkungen für klinische Arbeit und geriatrische Forschung haben.

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Correspondence to Laura Coll-Planas.

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Coll-Planas, L., Denkinger, M.D. & Nikolaus, T. Relationship of urinary incontinence and late-life disability: Implications for clinical work and research in geriatrics. Z Gerontol Geriat 41, 283–290 (2008). https://doi.org/10.1007/s00391-008-0563-6

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Key words

  • urinary incontinence
  • late-life disability
  • functional decline
  • disablement process model

Schlüsselwörter

  • Harninkontinenz
  • Behinderung im Alter
  • funktioneller Abbau
  • Modell des „Disablement Process“