title: Noctural Enuresis as a Risk Factor for Falls in Older Community Dwelling Women with Urinary Incontinence.
abstract: OBJECTIVE
  We determined the association of urinary symptoms with fall risk and physical limitations in older community dwelling women with urinary incontinence.
  
  
  METHODS
  We performed an in-depth assessment of daytime and nighttime urinary symptoms, fall risk, physical function, physical performance tests and mental function in older community dwelling women with urinary incontinence who had not sought care for urinary symptoms. All assessments were performed in participant homes. We used univariable and multivariable linear regression to examine the relationship of urinary symptoms to fall risk, physical function and physical performance.
  
  
  RESULTS
  Of 37 women with a mean ± SD age of 74 ± 8.4 years who had urinary incontinence 48% were at high risk for falls. Nocturnal enuresis was reported by 50% of the women. Increased fall risk was associated with increasing frequency of nocturnal enuresis (p = 0.04), worse lower limb function (p <0.001), worse upper limb function (p <0.0001) and worse performance on a composite physical performance test of strength, gait and balance (p = 0.02). Women with nocturnal enuresis had significantly lower physical performance test scores than women without nocturnal enuresis (median 7, range 0 to 11 vs 9, range 1 to 12, p = 0.04). In a multivariable regression model including age, nocturnal enuresis episodes and physical function only physical function was associated with an increased fall risk (p <0.0001).
  
  
  CONCLUSIONS
  Nocturnal enuresis is common in older community dwelling women with urinary incontinence. It may serve as a marker of fall risk even in women who do not seek care for urinary symptoms. Interventions targeting upper and lower body physical function could potentially decrease the risk of falls in older women with urinary incontinence.
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Urology, Department of Surgery, Women's Health Clinical Research Center, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Epidemiology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: avita.pahwa@uphs.upenn.edu.
authors.forename: Avita K
authors.initials: AK
authors.lastname: Pahwa
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Urology, Department of Surgery, Women's Health Clinical Research Center, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Epidemiology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Uduak U
authors.initials: UU
authors.lastname: Andy
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Urology, Department of Surgery, Women's Health Clinical Research Center, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Epidemiology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Diane K
authors.initials: DK
authors.lastname: Newman
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Urology, Department of Surgery, Women's Health Clinical Research Center, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Epidemiology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Hanna
authors.initials: H
authors.lastname: Stambakio
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Urology, Department of Surgery, Women's Health Clinical Research Center, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Epidemiology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Schmitz
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Urology, Department of Surgery, Women's Health Clinical Research Center, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Epidemiology, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Lily A
authors.initials: LA
authors.lastname: Arya
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D057187:Independent Living; D053206:Nocturnal Enuresis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D010414:Pennsylvania / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014549:Urinary Incontinence / Q000150:complications / Q000503:physiopathology*; D014554:Urination / Q000502:physiology*
keywords: accidental falls; aged; female; nocturnal enuresis; urinary bladder