Combination of OAB, older age, and comorbid conditions increase fall risk in women with pelvic floor disorders

In this interview, Steve R. Fisher, PhD, PT, GCS, highlights key findings from the Urogynecology study, “Cumulative Effects of Comorbid Burden and Overactive Bladder Symptoms on Fall Risk Among Older Women Seeking Treatment for Urogynecologic Conditions,” for which he served as the lead author. Fisher is a professor in the department of physical therapy at the University of Texas Medical Branch (UTMB) in Galveston.

Steve R. Fisher, PhD, PT, GCS

Could you describe the background of this study?

There's a large body of evidence linking urinary incontinence, and specifically urgency urinary incontinence, and [overactive bladder] OAB symptoms with falls in older adults. In studies that use multivariate models to identify predictors of falling in older people, urinary incontinence is always right there in the top of the field. What was less known was the actual prevalence of high fall risk among treatment-seeking women with pelvic floor disorders. So, our objectives with this study, broadly, were 1, to estimate the prevalence of high fall risk among this specific patient population, and 2, because fall risk factors are cumulative—in other words, because the more risk factors that a person has the higher her risk of falls—we wanted to also investigate the cumulative effects of other known risk factors on fall risk in this patient population.

For this study, we looked at easily derivable in the busy clinic factors, so that was OAB symptom burden, other comorbid health condition burden, and age. To do that, the [Centers for Disease Control and Prevention’s] 3 key questions fall risk screening tool was included within the intake forms that all patients fill out when they're waiting to see their doctor at one of our outpatient pelvic health centers here at UTMB. We were able to have this relatively large cohort of patients with a valid fall screen and then go into the electronic medical record and extract other sociodemographic and clinical characteristics and look at these different patient profiles in terms of fall risk or likelihood of screening positive on the 3 key questions screening tool.

What were some of the notable findings? Were any of those surprising to you and your coauthors?

One of the surprising findings was the actual prevalence across age groups; about 30% of women screened positive, but when we looked at [the data] stratified by age, about 50% of women 65 years and older had a positive screen. Then, when we looked at those cumulative effects of these 3 characteristics: 65 years and older, 3 or more OAB symptoms, 4 or more comorbid conditions, the odds of screening positive were about 6-fold higher in women with that particular profile compared with women who didn't have that combination of factors. So, about 3 in 4 actually screened positive if they had those characteristics.

Is any further research on this topic planned? If so, what might that focus on?

We are planning additional research. The association between OAB symptoms, urinary incontinence, and falls is very well established in the literature. What is not known is if currently available treatments, including both pharmacologic and non-pharmacologic treatments, either reduce or increase falling in these patients. Our team is soon to move forward with a randomized clinical trial where we ultimately hope to determine among women that are identified as being at high risk for falls, [whether a] reduction in OAB symptoms through treatment also lead to a reduction in falling, risk of falling, concerns about falling, and if treatment approach matters.

What is the take-home message for urologists?

injurious falls, at minimum, can complicate the treatment of all other existing health conditions and can be life changing for older adults. So, raising this topic with a patient whose profile suggests it may be a concern could be important and in the context of this study, that profile would be an older woman with multiple OAB symptoms [and] multiple comorbid conditions. Some treatment approaches that might take fall risk into consideration would be things like, if feasible, using medications that have an [adverse event] profile that has less association with falling than some of the traditionally used anticholinergics, or, again, when feasible, emphasizing non-drug approaches like pelvic floor physical therapy. Then also possibly even referring these patients to a traditional course of physical therapy for more in-depth fall screen and possible exercise intervention.

Reference

1. Fisher SR, Halder GE, Lee MJ, Allen L, Kilic GS. Cumulative Effects of Comorbid Burden and Overactive Bladder Symptoms on Fall Risk Among Older Women Seeking Treatment for Urogynecologic Conditions. Urogynecology (Phila). [published online ahead of print March 8, 2023.] Accessed April 19, 2023. doi: 10.1097/SPV.0000000000001343.