Byles Julie, Millar Cynthia J, Sibbritt David W, Chiarelli Pauline
Research Centre for Gender, Health and Ageing, School of Medicine and Public Health, The University of Newcastle, Callaghan NSW 2308, Australia.
Age Ageing. 2009 May;38(3):333-8; discussion 251. doi: 10.1093/ageing/afp013. Epub 2009 Mar 3.
urinary incontinence carries major social burden and considerable costs for health care systems.
the aim of this study was to investigate changes in continence status among a large cohort of older women, and to identify factors associated with incidence of incontinence in later life.
participants of the Australian Longitudinal Study of Women's Health (ALSWH), aged 70-75 years in 1996 and who have completed four health surveys over the past 10 years.
continence status across four survey periods, spanning 9 years, were defined according to women's reports of 'leaking urine' at each survey. Generalised estimating equation (GEE) models were used in longitudinal analyses of the factors associated with changing continence status over time.
this study presents longitudinal data on the prevalence and incidence of incontinence from a large cohort of older women, over 9 years of follow-up. Over this time, 14.6% (95% CI 13.9-15.3) of the women in the study who had previously reported leaking urine 'rarely' or 'never' developed incontinence, and 27.2% (95% CI 26.2%, 28.3%) of women participating in Survey 4 (S4) in 2005 reported leaking urine 'sometimes' or 'often' at that survey, with women being twice as likely to report incontinence at S4 as they were 6 years earlier. Longitudinal models demonstrated the association between incontinence and dementia (P < 0.001; OR = 2.34; 95% CI 1.64, 3.34), dissatisfaction with physical ability (P < 0.001; OR = 1.70; 95% CI 1.52, 1.89), falls to the ground (P <0.001; OR = 1.23; 95% CI 1.13, 1.33), BMI (P < 0.001; OR = 2.18; 95% CI 1.70, 2.80 for obese), constipation (P < 0.001; OR 1.46; 95% CI 1.34-1.58), urinary tract infection (P < 0.001; OR 2.07; 95% CI 1.89-2.28), history of prolapse (P </= 0.001; OR = 1.53; 95% CI 1.35, 1.74) and prolapse repair (P = 0.002; OR = 1.23; 95% CI 1.08, 1.40). Stroke (P = 0.01), parity (P = 0.017) and hysterectomy (P = 0.026) and number of visits to the general practitioner (P = 0.040) were less strongly associated with incontinence in the final longitudinal model. Incontinence was not significantly associated with area of residence (P = 0.344), education (P = 0.768), smoking (P = 0.055), diabetes (P = 0.072), attending support groups (P = 0.464) or attending social groups (P = 0.022).
strong associations between BMI, dysuria and constipation indicate key opportunities to prevent incontinence among older women.
尿失禁给社会带来了沉重负担，也给医疗保健系统造成了可观的成本。
本研究旨在调查一大群老年女性的尿失禁状况变化，并确定与晚年尿失禁发生率相关的因素。
澳大利亚女性健康纵向研究（ALSWH）的参与者，她们在1996年年龄为70 - 75岁，且在过去10年中完成了四项健康调查。
根据女性在每次调查中关于“漏尿”的报告，定义了跨越9年的四个调查期的尿失禁状况。广义估计方程（GEE）模型用于对随时间变化的尿失禁状况相关因素进行纵向分析。
本研究呈现了一大群老年女性在9年随访期间尿失禁患病率和发病率的纵向数据。在此期间，研究中先前报告“很少”或“从不”漏尿的女性中有14.6%（95%可信区间13.9 - 15.3）出现了尿失禁，2005年参与第四次调查（S4）的女性中有27.2%（95%可信区间26.2%，28.3%）在该次调查中报告“有时”或“经常”漏尿，女性在S4时报告尿失禁的可能性是6年前的两倍。纵向模型显示尿失禁与痴呆（P < 0.001；比值比 = 2.34；95%可信区间1.64，3.34）、对身体能力不满意（P < 0.001；比值比 = 1.70；95%可信区间1.52，1.89）、跌倒在地（P < 0.001；比值比 = 1.23；95%可信区间1.13，1.33）、体重指数（P < 0.001；肥胖者的比值比 = 2.18；95%可信区间1.70，2.80）、便秘（P < 0.001；比值比1.46；95%可信区间1.34 - 1.58）、尿路感染（P < 0.001；比值比2.07；95%可信区间1.89 - 2.28）、脱垂病史（P ≤ 0.001；比值比 = 1.53；95%可信区间1.35，1.74）和脱垂修复（P = 0.002；比值比 = 1.23；95%可信区间1.08，1.40）之间存在关联。在最终的纵向模型中，中风（P = 0.01）、产次（P = 0.017）、子宫切除术（P = 0.026）和看全科医生的次数（P = 0.040）与尿失禁的关联较弱。尿失禁与居住地区（P = 0.344）、教育程度（P = 0.768）、吸烟（P = 0.055）、糖尿病（P = 0.072）、参加支持小组（P = 0.464）或参加社交团体（P = 0.022）无显著关联。
体重指数、排尿困难和便秘之间的密切关联表明，这是预防老年女性尿失禁的关键机会。
