Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, California, USA.
Department of Urology, University of California, San Francisco, California, USA.
J Am Geriatr Soc. 2022 Apr;70(4):1082-1094. doi: 10.1111/jgs.17633. Epub 2021 Dec 24.
Lower urinary tract symptoms (LUTS) are associated with frailty phenotype, a risk factor for functional decline. Our objective was to determine the association between baseline LUTS and 2-year risk of new functional limitation among older men.
We analyzed data from the Osteoporotic Fractures in Men (MrOS) study with baseline at Year 7 and follow-up through Year 9. Participants included 2716 community-dwelling men age ≥ 71 years without any baseline self-reported functional limitation. LUTS severity (American Urologic Association Symptom Index) was classified as none/mild (score 0-7), moderate (8-19), and severe (20-35). At baseline and follow-up, men reported their ability to complete several mobility, activities of daily living (ADLs), and cognition-dependent tasks. Risk was estimated for 3 incident functional limitation outcomes: (1) mobility (any difficulty walking 2-3 blocks or climbing 10 steps), (2) ADL (any difficulty bathing, showering, or transferring), and (3) cognition-dependent (any difficulty managing money or medications). We used Poisson regression with a robust variance estimator to model adjusted risk ratios (ARR) and 95% CIs controlling for age, site, and comorbidities; other demographic/lifestyle factors did not meet criteria for inclusion.
Overall, the 2-year risk was 15% for mobility, 10% for ADLs, and 4% for cognition-dependent task limitations. Compared to none/mild LUTS, risk of incident mobility limitations was increased for moderate (ARR = 1.35, 95% CI: 1.12, 1.63) and severe LUTS (ARR = 1.98, 95% CI: 1.48, 2.64). Men were also at higher risk for incident ADL limitations if they reported moderate (ARR = 1.32, 95% CI: 1.05, 1.67) and severe LUTS (ARR = 1.62, 95% CI: 1.07,2.43). Results were somewhat attenuated after adjusting for the frailty phenotype but remained statistically significant. LUTS were not associated with incident cognition-dependent task limitations.
LUTS severity is associated with incident mobility and ADL limitations among older men. Increased clinical attention to risk of functional limitations among older men with LUTS is likely warranted.
下尿路症状（LUTS）与虚弱表型有关，后者是功能下降的一个危险因素。我们的目的是确定基线 LUTS 与老年男性 2 年内新发生功能障碍的风险之间的关系。
我们分析了来自男性骨质疏松性骨折（MrOS）研究的数据，基线时间为第 7 年，随访时间为第 9 年。研究对象包括 2716 名年龄≥71 岁、无任何基线自我报告功能障碍的社区居住男性。LUTS 严重程度（美国泌尿科协会症状指数）分为无/轻度（评分 0-7）、中度（8-19）和重度（20-35）。在基线和随访时，男性报告了他们完成几项移动、日常生活活动（ADL）和认知相关任务的能力。风险估计了 3 个新发功能障碍的结果：（1）移动（步行 2-3 个街区或爬 10 级台阶有任何困难）；（2）ADL（洗澡、淋浴或转移有任何困难）；（3）认知相关（管理金钱或药物有任何困难）。我们使用泊松回归和稳健方差估计来模型调整后的风险比（ARR）和 95%CI，控制年龄、地点和合并症；其他人口统计学/生活方式因素不符合纳入标准。
总体而言，2 年内移动障碍的风险为 15%，ADL 障碍的风险为 10%，认知相关任务障碍的风险为 4%。与无/轻度 LUTS 相比，中度（ARR=1.35，95%CI：1.12，1.63）和重度（ARR=1.98，95%CI：1.48，2.64）LUTS 发生移动障碍的风险增加。如果男性报告中度（ARR=1.32，95%CI：1.05，1.67）和重度 LUTS（ARR=1.62，95%CI：1.07，2.43），他们也有更高的发生 ADL 障碍的风险。在调整虚弱表型后，结果有所减弱，但仍具有统计学意义。LUTS 与认知相关任务障碍的发生无关。
LUTS 严重程度与老年男性移动和 ADL 障碍的发生有关。对于患有 LUTS 的老年男性，可能需要更加关注功能障碍的风险。
