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An Exploration of the Association Between Lower Urinary Tract Symptoms and Falls in Older People
- Author / Creator
- Gibson, William R
Falls and urinary incontinence are both highly prevalent in older people, and are both associated with significant impact on health, impairment of quality of life, increased healthcare resource use and costs. There is a well recognised but unexplained association between lower urinary tract symptoms (LUTS), including urgency, urgency incontinence, and nocturia, and falls in older people. Despite calls from the research community, the causes of this association are unknown and little attention has been paid to the potential underlying reasons for the association. There is evidence that the sensation of a strong desire to void (SDV) can influence cognitive function in younger people, and there is a strong association between the prevalence of LUTS in older adults and cognitive dysfunction. This thesis examines the hypothesis that urinary urgency acts as a source of diverted attention, the concept where performing two cognitively demanding tasks leads to impairment in one or both of those tasks. This concept is explored by using cognitive testing and gait analysis in people with and without overactive bladder (OAB) when they are experiencing an urgent need to void, when they are distracted by a validated source of diverted attention, the n back test, and when neither condition is the case. The underlying literature and theory is outlined in Chapters One and Two.
In Chapter Three, healthy volunteers without LUTS performed the Trail Making B (TMT-B) test and a test of simple reaction time (SRT) under the three conditions. The SRT increased significantly with both SDV and distraction, from 371ms to 421ms and 582ms respectively (p=0.018 and p<0.001), but performance on TMT-B was unaffected. In Chapter Four a similar experiment in adults over the age of 65 without LUTS demonstrated the same effect, with SRT increasing from 451ms to 515ms with SDV and 885ms with distraction (p<0.001 for both).
In Chapter Five the performance on cognitive testing when undistracted and with an empty bladder of older adults with and without OAB was undertaken. In this trial older adults with OAB took significantly longer to complete the TMT-B, (103s vs 77s, p=0.003), suggesting that those with OAB had demonstrable impairment of executive function.
Chapter Six describes a pilot study of a novel experimental approach to assessing gait in older women with LUTS, using 3 dimensional instrumented gait analysis in women aged over 65 with OAB when they were at baseline and when experiencing urinary urgency.
This study confirmed the feasibility and safety of the method, which was used in Chapter Seven to perform gait analysis in adults age over 65 with OAB walking with urgency, when distracted by the n back test, and with an empty bladder. This study demonstrated significant reduction in gait velocity (from 1.1ms-1 at baseline to 1.0 ms-1 with urgency and 0.8 ms-1 with distraction, p=0.008 and p<0.001 respectively), as well as a shortened stride length, suggesting that the sensation of urgency acts as a source of diverted attention to induce gait changes in older adults with OAB.
Taken together these results suggest that older adults with OAB may have impaired executive function compared to their continent peers, and that in adults of all ages with or without OAB, the sensation of SDV can act as a source of diverted attention. In older adults with OAB this effect is sufficiently powerful to induce gait changes which are associated with an increased falls risk. Future research should investigate the possibility and efficacy of dual-task training in older adults with OAB to control urgency and therefore reduce falls risk.
- Graduation date
- Fall 2019
- Type of Item
- Doctor of Philosophy
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