Association of dual urinary and fecal incontinence with risk of fall in older women

Objectives: While there is a known association between urinary incontinence (UI) and risk of fall among older women, it is yet unclear if having both UI and fecal incontinence, or dual incontinence, increases this risk even further. Thus, the objective of our study was to elucidate a relationship between dual incontinence and fall among older women.

Methods: This was a retrospective cohort study using electronic medical records at a tertiary academic health system of female patients aged 65 years and older presenting for a new patient visit to a urogynecology provider for UI from 2019 to 2021. Demographic data (age, race, ethnicity, body mass index, and primary residential ZIP code) and responses to intake questionnaires on fall, markers of frailty (difficulty with activities with daily living [ADL], ambulation, unintentional weight loss) and abuse were extracted. Patients were categorized into those who experienced a fall and those who had not experienced a fall in the last year. Multivariate logistic regression adjusting for covariates identified upon univariable comparison was performed to identify factors associated with fall.

Results: A total of 2814 women were included in the analysis; 360 (12.79%) patients reported a fall and 2454 (87.21%) did not report a fall in the past year. Women who reported a fall were more likely to have dual incontinence than women who did not report a fall (35/360; 9.7% versus 157/2454; 6.39%, p< .001). Univariable comparison also showed that these two groups differed regarding: BMI, estimated median household income, and markers of frailty (Table 1). On multivariable logistic regression adjusted for these covariates, dual incontinence was significantly associated with falls: adjusted OR 2.56, 95% CI 1.02-5.46 (Table 2). Other factors independently associated with falls in older women with UI include (adjusted OR, 95% CI): lower income groups (2.35, 1.50-3.67 for $20,000-$40,000 income group and 1.78, 1.16-2.73 for $40,000-$60,000 income group, compared to $100,000 and higher income group), difficulty with ADL (1.60, 1.25-2.13), and unintentional weight loss (1.68, 1.05-2.68).

Conclusions: Our study shows that patients with dual incontinence have a two-fold higher risk of fall compared to patients with UI alone. We also show that patients in lower income groups have a higher risk of fall, pointing to a need for further exploration of potential disparity in this patient population.