Lower urinary tract symptoms and incident functional limitations among older community-dwelling men

Scott R Bauer; Peggy M Cawthon; Kristine E Ensrud; Anne M Suskind; John C Newman; Howard A Fink; Kaiwei Lu; Rebecca Scherzer; Andrew R Hoffman; Kenneth Covinsky; Lynn M Marshall; Osteoporotic Fractures in Men (MrOS) Research Group

doi:10.1111/jgs.17633

Lower urinary tract symptoms and incident functional limitations among older community-dwelling men

J Am Geriatr Soc. 2022 Apr;70(4):1082-1094. doi: 10.1111/jgs.17633. Epub 2021 Dec 24.

Authors

Scott R Bauer^{1

2

3}, Peggy M Cawthon^{4

5}, Kristine E Ensrud^{6

7}, Anne M Suskind², John C Newman^{8

9}, Howard A Fink^{6

7

10}, Kaiwei Lu³, Rebecca Scherzer^{1

3}, Andrew R Hoffman¹¹, Kenneth Covinsky^{3

9}, Lynn M Marshall¹²; Osteoporotic Fractures in Men (MrOS) Research Group

Affiliations

¹ Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, California, USA.
² Department of Urology, University of California, San Francisco, California, USA.
³ San Francisco VA Healthcare System, San Francisco, California, USA.
⁴ Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
⁵ Research Institute, California Pacific Medical Center, San Francisco, California, USA.
⁶ Department of Medicine and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA.
⁷ Center for Care Delivery and Outcomes Research, Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.
⁸ Buck Institute for Research on Aging, Novato, California, USA.
⁹ Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA.
¹⁰ Geriatric Research Education and Clinical Center, Veterans Affairs Health Care System, Minneapolis, Minnesota, USA.
¹¹ Department of Medicine, Stanford University School of Medicine.
¹² Oregon Health and Science University-Portland State University School of Public Health, Portland, Oregon, USA.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: aging; benign prostatic hyperplasia; disability; epidemiology; functional health status.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Activities of Daily Living*
Aged
Humans
Independent Living
Lower Urinary Tract Symptoms* / epidemiology
Mobility Limitation
Walking

Abstract

Publication types

MeSH terms

Grants and funding