January 12, 2001
Volume XXXIV, No. 2

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Study searches for clues to sudden incontinence

Some degree of urinary incontinence - the inability to control urination - is a common malady, especially among older women. It can be brought on by menopause, surgery, childbirth, stroke, excess weight or other causes.

But the sudden onset of urinary incontinence in women or men over age 65, when they have never had the problem before, may signal a decline in general health that can be stopped or slowed if treated immediately. "This type of incontinence may be a precursor to frailty and should offer clues to caregivers about how and when to treat their elderly patients," said Dr. Toni Miles, family and community medicine. Dr. Miles is the lead author on a paper in the Jan. 2 Journal of Gerontology titled "New-Onset Incontinence and Markers of Frailty: Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly."

With financial support from the National Institute on Aging, researchers at the Health Science Center studied 2,660 men and women age 65 and older who were already enrolled in the ongoing, five-state Hispanic Established Population study. The researchers are now continuing to study similar populations among other ethnic groups.

Frailty is a definite phenomenon, but there is no exact definition of the condition, according to Dr. Miles. "Caregivers can agree that it includes weakness, slowness and shrinkage, but we are trying to further define the condition and develop ways to prevent or forestall the problem. People who reach old age without incontinence or frailty and suddenly develop incontinence may be experiencing something specific, perhaps neurological, and may need to be treated differently from people who develop incontinence at an earlier age."

To test this hypothesis, the researchers asked subjects to perform activities including a timed eight-foot walk, standing up from a seated position several times, and several balancing postures. In addition, subjects were asked about their ability to perform certain activities of daily living including bathing, walking, using the telephone, driving, shopping for groceries, preparing meals and so forth.

Findings indicated that newly incontinent subjects were significantly heavier, had greater difficulty with activities of daily living and performed more poorly on the physical and balancing tests than similar continent subjects. "This suggests there may be a common process linking difficulty in lower body mobility with the development of incontinence," the report concludes. "The emergence of difficulties with certain daily activities such as walking and balancing suggests that the common process may have its origin in neural control mechanisms," Dr. Miles said.

"Incontinence is the hallmark of bad things to come," she said. "Often, people with various problems, including frailty, can be treated at home, but once incontinence occurs, it breaks the back of the caregivers and often marks the point at which the patient must enter a care facility. We hope that this research will lead to better prevention strategies and treatment for individuals over the age of 65."

The research team included Drs. Raymond F. Palmer, David V. Espino and Charles P. Mouton, family and community medicine, and Dr. Michael J. Lichtenstein, internal medicine. They collaborated with Dr. Kyriakos Markides and colleagues in the preventive medicine and community health department at The U. T. Medical Branch at Galveston.