Quality of life and mortality of Brazilian nonagenarians and centenarians with urinary incontinence

Received on: Aug. 02nd, 2020 Accepted on: Nov. 16th, 2020 ABSTRACT OBJECTIVES: Urinary incontinence (UI) commonly occur in elderly people and it is associated with reduced functionality, quality of life and survival in older adults (65-80 years). Little is known about its impact in nonagenarians and centenarians. Thus, this study aimed to evaluate the health and mortality of nonagenarians and centenarians with UI. METHODS: Nonagenarians and centenarians residents of Porto Alegre, Brazil, participated in this cohort study and were followed between 2016 to 2019. Survival analysis were performed using Cox Proportional Hazards Regression methods in the simple and adjusted models. RESULTS: The overall prevalence of UI was 56%, 64% among women and 38% among men (p<0.01). UI was more frequent in widowers (p <0.01), those who left home (p=0.02) and participated in social activities less frequently (p=0.07). Also they had a higher frequency of chronic diseases (p = 0.02), more symptoms of depression (p=0.08) and reduced cognitive performance (p=0.04). Participants with UI had reduced survival in the simple (HR 0.29, p=0.23) and adjusted analysis (HR 0.33%, p=0.19). The variables that influenced the most, UI and mortality, were participation in social activities, ability to leave the home, cognitive performance and lower-limb function/mobility. CONCLUSIONS: Although UI was not a direct predictor, it was associated with reduced survival. Nonagenarians and centenarians with UI will likely experience a lower risk of mortality if they continue to participate in social activities, preserve their cognitive performance and practice physical activities.


Introduction
The aging process involves physiological changes  Our study sought to provide evidence on the relationships between UI and mortality in oldest-old and to serve as a basis for discussion of appropriate prevention strategies and treatment that promotes

Results
We excluded 11 participants due to the loss of contact. Therefore, our sample totalized 234 nonagenarians and centenarians, with a mean age of 92.3±3.62 years. The majority of the participants were female (73%), widow (67%), lived with family (76%) and were functionally literate (92%). with and without UI. The overall prevalence of UI was 56%, 64% in women and 38% in men (p<0.001).
The relationship between UI and marital status was more significant among widowers (p=0.005).
Participants' age were similar between groups, although UI was more frequent among centenarians (71%). UI was frequently reported by caucasian participants (p=0.812). In addition, the average years of schooling were lower in individuals with UI, they had a higher percentage of functional illiteracy (p=0.390). Participants that lived alone had a higher frequency of UI, however this data was not statistically significant (58.33%, p=0.820).   These results suggests that a relationship between UI and mortality would be reduced in participants who continued to leave home, participate in social activities, improve cognition and engage in physical activities involving the lower limbs.

Discussion
Despite of the literature demonstrates that the prevalence of UI varies, our sample consisted in a great number of individuals with UI. In a population-based survey, the Profile of the Elderly in Rio Grande do Sul, 3.9% of the interviewed reported urinary loss, while in the study of Marques, the prevalence was 29.4% 7,8 .
Although the prevalence was generally higher in women, the percentage of men with UI in our analysis exceeded the reported in other studies 2,8 .
Which might be explained by the inclusion of younger participants when compared to those in our sample. In addition, fewer studies describe
Regarding the marital status, 75% of the participants with UI were widowers. These results are higher than the ones found by Tavares