Urgency and urge incontinence in an older population: ten-year changes and their association with mortality

Urgency and urge incontinence are common urinary symptoms among older people, both men and women. The aim of this population-based prospective cohort study was to examine the independent association of urgency and urge incontinence with 10-year mortality in older men and women, and to describe the changes in these symptoms during those 10 years.

At baseline, 1052 persons (524 men and 528 women) aged 60-89, selected by random sampling and stratified by 5-year age group and sex, were interviewed for the Tampere Longitudinal Study on Ageing. In 10 years, 541 persons had died, and 435 persons (175 men and 260 women) were re-interviewed. Cox proportional hazards models were used to examine the independent association of urgency and urge incontinence in each gender with 10-year mortality, adjusted for age, chronic diseases, activities of daily living (ADL) disability, socioeconomic status, smoking and alcohol use.

In 10 years, 86% of men and 54% of women who reported at least urgency at baseline had died. The respective figures for men and women without urgency were 57 and 38%. Adjusted for age, both urgency without incontinence (Risk Ratio 1.87; 95% Confidence Interval 1.28-2.74) and urge incontinence (RR 3.13; 95% CI 2.054.77) significantly predicted mortality in men, while only urge incontinence was a statistically significant predictor in women (RR 1.63; 95% CI 1.03-2.57). After further adjusting for chronic diseases and ADL disability, urge incontinence lost its predictive power (RR 1.44; 95% CI 0.88-2.23) in women, while the significant predictive power of urgency alone and urge incontinence in men persisted even after additional adjustment for socioeconomic status, smoking and alcohol use (RR 1.80; 95% CI 1.20-2.71, and RR 1.97; 95% CI 1.25-3.10, respectively).

Urgency and urge incontinence are significant prognostic indicators of mortality especially in older men. This emphasizes the importance of evaluation and treatment of urinary symptoms as a part of comprehensive geriatric assessment and management.