Abstract
The incidence of both frailty and lower urinary tract symptoms, including urinary incontinence, overactive bladder, underactive bladder, and benign prostatic hyperplasia, increases with age. However, our understanding of the relationship between frailty and lower urinary tract symptoms, both in terms of pathophysiology and in terms of the evaluation and management of such symptoms, is greatly lacking. This brief review will summarize definitions and measurement tools associated with frailty and will also review the existing state of the literature on frailty and lower urinary tract symptoms in older individuals.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Drach GW, Griebling TL. Geriatric urology. J Am Geriatr Soc. 2003;51(7 Suppl):S355–8.
Clayton JL. Special needs of older adults undergoing surgery. AORN J. 2008;87(3):557–70. quiz 571-554
van Iersel MB, Rikkert MG. Frailty criteria give heterogeneous results when applied in clinical practice. J Am Geriatr Soc. 2006;54(4):728–9.
Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.
Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal. 2001;1:323–36.
Sternberg SA, Wershof Schwartz A, Karunananthan S, Bergman H, Mark Clarfield A. The identification of frailty: a systematic literature review. J Am Geriatr Soc. 2011;59(11):2129–38.
Velanovich V, Antoine H, Swartz A, Peters D, Rubinfeld I. Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database. J Surg Res. 2013;183(1):104–10.
Robinson TN, Eiseman B, Wallace JI, et al. Redefining geriatric preoperative assessment using frailty, disability and co-morbidity. Ann Surg. 2009;250(3):449–55.
Robinson TN, Wu DS, Pointer L, Dunn CL, Cleveland JC Jr, Moss M. Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg. 2013;206(4):544–50.
Robinson TN, Wu DS, Sauaia A, et al. Slower walking speed forecasts increased postoperative morbidity and 1-year mortality across surgical specialties. Ann Surg. 2013;258(4):582–8. discussion 588-590
Rosier PF, Gajewski JB, Sand PK, Szabo L, Capewell A, Hosker GL. Executive summary: the International Consultation on Incontinence 2008—committee on: "dynamic testing"; for urinary incontinence and for fecal incontinence. Part 1: innovations in urodynamic techniques and urodynamic testing for signs and symptoms of urinary incontinence in female patients. Neurourol Urodyn. 2010;29(1):140–5.
Hannestad YS, Rortveit G, Sandvik H, Hunskaar S. A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of incontinence in the county of Nord-Trondelag. J Clin Epidemiol. 2000;53(11):1150–7.
Stenzelius K, Mattiasson A, Hallberg IR, Westergren A. Symptoms of urinary and faecal incontinence among men and women 75+ in relations to health complaints and quality of life. Neurourol Urodyn. 2004;23(3):211–22.
DuBeau CE. Urinary incontinence. In: Medina-Walpole A, Pacala JT, Potter JF, editors. Geriatrics review syllabus: a core curriculum in geriatric medicine. 9th ed. New York: American Geriatrics Society; 2016.
• Wagg A, Gibson W, Ostaszkiewicz J, et al. Urinary incontinence in frail elderly persons: report from the 5th International Consultation on Incontinence. Neurourology and urodynamics. 2015;34(5):398–406. Evidence based guidelines on the management of frail older individuals with urinary incontinence
Thom DH, Haan MN, Van Den Eeden SK. Medically recognized urinary incontinence and risks of hospitalization, nursing home admission and mortality. Age Ageing. 1997;26(5):367–74.
Gibson W, Wagg A. New horizons: urinary incontinence in older people. Age Ageing. 2014;43(2):157–63.
Stenzelius K, Molander U, Odeberg J, et al. The effect of conservative treatment of urinary incontinence among older and frail older people: a systematic review. Age Ageing. 2015;44(5):736–44.
Resnick NM, Yalla SV, Laurino E. The pathophysiology of urinary incontinence among institutionalized elderly persons. N Engl J Med. 1989;320(1):1–7.
Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37–49.
Suskind AM. The aging overactive bladder: a review of aging-related changes from the brain to the bladder. Current Bladder Dysfunction 2017.
Suskind AM, Quanstrom K, Zhao S, et al. Overactive bladder is strongly associated with frailty in older individuals. 2017.
• Samuelsson E, Odeberg J, Stenzelius K, et al. Effect of pharmacological treatment for urinary incontinence in the elderly and frail elderly: a systematic review. Geriatrics & gerontology international. 2015;15(5):521–34. Systematic review of 1038 abstracts and 309 texts looking at the efficacy of pharmacological treatment for urinary incontinence in the elderly and frail elderly.
Ouslander JG, Schnelle JF, Uman G, et al. Does oxybutynin add to the effectiveness of prompted voiding for urinary incontinence among nursing home residents? A placebo-controlled trial. J Am Geriatr Soc. 1995;43(6):610–7.
Lackner TE, Wyman JF, McCarthy TC, Monigold M, Davey C. Randomized, placebo-controlled trial of the cognitive effect, safety, and tolerability of oral extended-release oxybutynin in cognitively impaired nursing home residents with urge urinary incontinence. J Am Geriatr Soc. 2008;56(5):862–70.
Lackner TE, Wyman JF, McCarthy TC, Monigold M, Davey C. Efficacy of oral extended-release oxybutynin in cognitively impaired older nursing home residents with urge urinary incontinence: a randomized placebo-controlled trial. J Am Med Dir Assoc. 2011;12(9):639–47.
• Dubeau CE, Kraus SR, Griebling TL, et al. Effect of fesoterodine in vulnerable elderly subjects with urgency incontinence: a double-blind, placebo controlled trial. The Journal of Urology. 2014;191(2):395–404. Randomized, double-blind placebo controlled trial of fesoterodine in medically complex older individuals with urgency incontinence. This study is among the first to evalute the use of medical therapy in frail individuals and found that it was generally well tolerated.
Liao CH, Wang CC, Jiang YH. Intravesical onabotulinumtoxinA injection for overactive bladder patients with frailty, medical comorbidities or prior lower urinary tract surgery. Toxins (Basel). 2016;8(4):91.
Liao CH, Kuo HC. Increased risk of large post-void residual urine and decreased long-term success rate after intravesical onabotulinumtoxinA injection for refractory idiopathic detrusor overactivity. J Urol. 2013;189(5):1804–10.
Smith PP, Birder LA, Abrams P, Wein AJ, Chapple CR. Detrusor underactivity and the underactive bladder: symptoms, function, cause—what do we mean? ICI-RS think tank 2014. Neurourol Urodyn. 2016;35(2):312–7.
• Chancellor MB. The overactive bladder progression to underactive bladder hypothesis. International Urology and Nephrology. 2014;46(Suppl 1):S23–7. An interesting article discussing a theory on the progression of overactive to underactive bladder.
Platz EA, Smit E, Curhan GC, Nyberg LM, Giovannucci E. Prevalence of and racial/ethnic variation in lower urinary tract symptoms and noncancer prostate surgery in U.S. men. Urology. 2002;59(6):877–83.
Suskind AM, Walter LC, Jin C, et al. Impact of frailty on complications in patients undergoing common urological procedures: a study from the American College of Surgeons National Surgical Quality Improvement database. BJU Int. 2016;117(5):836–42.
Suskind AM, Jin C, Cooperberg MR, et al. Preoperative frailty is associated with discharge to skilled or assisted living facilities after urologic procedures of varying complexity. Urology. 2016;97:25–32.
Suskind AM, Walter LC, Zhao S, Finlayson E. Functional outcomes after transurethral resection of the prostate in nursing home residents. J Am Geriatr Soc 2016.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Anne Suskind declares no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Funding
NIDDK K12 DK83021-07; K12 Urologic Research (KURe) Career Development Program, Pepper Center Research Career Development Core (RCDC) Advanced Scholar Award.
Additional information
This article is part of the Topical Collection on Lower Urinary Tract Symptoms & Voiding Dysfunction
Rights and permissions
About this article
Cite this article
Suskind, A.M. Frailty and Lower Urinary Tract Symptoms. Curr Urol Rep 18, 67 (2017). https://doi.org/10.1007/s11934-017-0720-9
Published:
DOI: https://doi.org/10.1007/s11934-017-0720-9