Elderly women with incontinence may be at a greater risk of falling

Elderly women who have urinary incontinence during the day may face another problem at night – if they also wet the bed, they are at increased risk of falls, a recent study suggests.

The reason may be that women who wet the bed are frailer or in poorer physical or mental health than their peers who don’t have a bedwetting problem, researchers note in the Journal of Urology.

“The study data suggested that poorer overall physical functioning was associated with falls and that incontinence was a marker for poor physical functioning,” said Glenn Brassington, a researcher at Sonoma State University who wasn’t involved in the study. While not surprising, the results add to a growing body of evidence supporting efforts to reduce nighttime awakening and improve patients’ ability to safely navigate from bed to bathroom and back, Brassington said by email.

“The take-home message for me is that a multi-pronged approach including medical management, strengthening, health behaviors, and creating a safe environment will reduce falls and promote independent living and quality of life of older adults – women and men,” Brassington added. The study by Dr. Avita Pahwa and colleagues at the University of Pennsylvania focused on 37 elderly women who all had urinary incontinence to see what factors might make them more or less likely to fall in the middle of the night. Pahwa didn’t respond to requests for comment.

The women were 74 years old, on average, and about half were at high risk for falls. Almost all of them reported waking up at least once during the night to go to the bathroom, and 68 percent said they woke at least twice nightly. Half of the women in the study reported wetting the bed.

Those who wet the bed had lower physical performance test scores than the women who didn’t.

Among women who wet the bed, 61 percent had a very high risk of falls.

When researchers adjusted for age, bed-wetting and physical function, however, only physical function was associated with an increased fall risk. This probably means that bed-wetting could be a marker for fall risk in women not seeking care for urinary incontinence, the researchers conclude.

These women may benefit from interventions designed to build both upper body and lower limb strength, which might reduce their risk of falls, the authors note.

In addition to the study’s small size, other limitations include the lack of data on other health conditions that can affect bed wetting, such as sleep apnea, the researchers concede.

Even so, the study still touches on one factor that is bound to influence whether women have an increased risk of falls, noted Dr. Jeanette Brown, director of the women’s health clinical research center at the University of California, San Francisco.

“We think it has to do with getting up at night,” Brown, who wasn’t involved in the study, said by email.

While the study didn’t address treatment strategies, it’s possible that women who get treatment for daytime urinary incontinence may be able to reduce their risk of falls and fractures, Brown said. Exercises to build muscle strength and improve balance may also help. In addition, Brown added, “we think night lights may help and removing obstacles.”