Urinary Symptoms, Mobility Limitation, and Subsequent Falls in Older Adults Across Two Longitudinal Cohorts

To examine whether urinary symptoms were associated with subsequent falls according to reported mobility limitation and whether they added meaningful information.

We analysed the first eligible window for adults aged ≥ 60 years in the English Longitudinal Study of Ageing (ELSA; N = 11,676) and Mexican Health and Aging Study (MHAS; N = 11,071). ELSA assessed generic urinary incontinence over 12 months; MHAS assessed urgency urinary incontinence over 2 years. Mobility was a cohort-specific high-demand walking limitation, and the outcome was any next-wave fall. Modified Poisson RRs, multiple imputation, marginal standardized risks, interaction, and effect modification were used.

With neither urinary symptoms nor mobility limitation as the reference, urinary-only RRs were 1.29 (95% confidence interval [CI] 1.19-1.39) in ELSA and 1.14 (95% CI 1.07-1.22) in MHAS; risk differences were +7.6 and +5.9 percentage points. ELSA showed sub-multiplicative interaction with mobility limitation (ratio 0.80, 95% CI 0.70-0.92) and age attenuation; at ≥ 75 years, the urinary-only RR was 1.03 (95% CI 0.88-1.21). Optimism-corrected ΔAUC was 0.0044 in ELSA and 0.0015 in MHAS.

Urinary symptoms were associated with subsequent falls without reported mobility limitation, but the association was context-dependent. ELSA showed mobility-context and age heterogeneity, and incremental discrimination was small. Urinary symptoms were not supported as a stand-alone or universal fall-screening marker.