Lower-Urinary-Tract Symptoms Place Older Men at Risk for Falls

Stephanie Doyle

May 21, 2008

May 21, 2008 (Orlando, Florida) — A greater likelihood of falling might be linked to lower-urinary-tract symptoms in men aged 65 years and older, and the risk dramatically increases as the symptoms worsen, according to new findings presented here at the American Urological Association 2008 Annual Meeting.

The study showed that older men with moderate symptoms had a 21% increased risk of falling at least twice within 1 year, and those with severe symptoms had a 63% increased risk, compared with older men without symptoms.

"The recommendation we're making to primary care physicians is that they consider assessing men 65 years and older for urinary symptoms, using the same questions we used in our study," lead researcher J. Kellogg Parsons, MD, from Moores Cancer Center at the University of California, San Diego, told Medscape Urology.

Falls are a common source of preventable morbidity in the elderly population. Injuries that result from falls often lead to temporary or permanent nursing care. The awareness that lower-urinary-tract symptoms are a risk factor for falls should encourage caregivers and patients take the necessary preventive precautions. Wearing a protective pad and ensuring a clear path to the restroom could help prevent falls.

Participants in the study were community-dwelling men 65 years or older who were evaluated every 6 months for urinary symptoms using the American Urological Association Symptom Index (AUA-SI). Symptoms included urgency, nocturia, urinary frequency, and the need to push or strain to initiate urination.

The 5872 eligible participants also were evaluated for falls between 2001 and 2005. To associate baseline urinary symptoms and 1-year cumulative incidence of falls, researchers used Poisson regression models with robust variance estimators. Age, history of falls, history of dizziness, and physical performance measures were included in the multivariable model.

At the beginning of the study, 3188 (54.3%) participants reported mild urinary symptoms, 2301 (39.2%) reported moderate urinary symptoms, and 383 (6.5%) reported severe urinary symptoms.

Those reporting moderate symptoms had an 11% increased risk of falling 1 or more times within 1 year, compared with men without symptoms (relative risk [RR], 1.11; 95% confidence interval [CI], 1.01–1.22; P =.02). Those reporting severe symptoms had a 33% increased risk (RR, 1.33; 95% CI, 1.15–1.53; P < .001).

Participants who reported moderate symptoms had a 21% increased risk of falling 2 or more times, compared with men without symptoms (RR, 1.21; 95% CI, 1.05–1.40; P = .01). Those with severe symptoms had a 63% increased risk (RR, 1.63; 95% CI, 1.31–2.02; P < .001).

Individual symptoms most strongly associated with falling were urinary urgency (RR, 1.31; 95% CI, 1.17–1.47), the need to push or strain to initiate urination (RR, 1.24; 95% CI, 1.06–1.46), nocturia (RR, 1.23; 95% CI, 1.08–1.41), and urinary frequency (RR, 1.17; 95% CI, 1.04–1.33).

The likelihood of falling was not significantly influenced by the use of alpha blockers, 5-alpha reductase inhibitors, or anticholinergics.

"I think this is a very important study because this is a public-health issue," said Tomas L. Griebling, MD, associate professor of urology at the University of Kansas, in Lawrence, and immediate past president of the Geriatric Urological Society.

Dr. Griebling, who was not involved in the study, said that 90% of hip fractures and about 70% of all accidental deaths are associated with falls.

"Trying to find a way to prevent an elderly [person from falling] can have a significant impact on public health," he said.

Funding was provided by the National Institutes Health. The authors have disclosed no relevant financial relationships..

American Urological Association 2008 Annual Meeting: Abstract 394. Presented May 18, 2008.

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