In Japan, the percentage of the elderly population, which is a super-aging society, is 27.7%. The mean life expectancy of women and men is 87.14 and 80.98 years, respectively, and is expected to reach 91.35 and 84.95 years, respectively in 2065 [1]. The required number of years (doubling time) from when the percentage of the elderly exceeds 7% and reaches 14% is 85 years in Sweden, 115 years in France, and 46 years in the United Kingdom, whereas in Japan, it is 24 years, showing that the percentage of the elderly is increasing rapidly [1].
In such a super-aging society as Japan, the increase in healthy life expectancy has become an urgent issue. For that purpose, Healthy Japan 21 is being promoted based on the Health Promotion Law. Moreover, measures such as integrated community support and service (integrated community care system) that enables elderly individuals to continue their accustomed way of living in the community up to their final stages of life are being promoted. Furthermore, due to the implementation of the Long-term Care Insurance Law (2000), the goal is to prevent decreased self-support and conditions that require long-term care of the elderly, establish home-care of the elderly as a mechanism of mutual support by society as a whole, and maintain a community-based symbiotic society [2]. The long-term care insurance system in Japan can be utilized for conditions that require constant, long-term care, such as being bedridden and having dementia, and conditions for which long-term care prevention service is effective (conditions requiring support) [2].　　
Urinary incontinence affects quality of life. It severely affects many individuals who attempt to deal with it secretly and independently because of a sense of shame associated with it. To date, the authors have elucidated the causal factors linked to the ratio of complaints of urinary incontinence in young-elderly and middle-aged women. As a result, the related factors were different between them. Furthermore, the level of care of urinary incontinence in old-elderly women in the northern Japan have to be considered with the level of the certification of long-term care needs. In this study, we aimed to investigate the relationship between urinary incontinence in community-dwelling old-elderly women in Northern Japan, which has a super-aging society, and a level of certification of long-term care needs.

The subjects consisted of 400 women aged ≥75 years and <90 years that were randomly selected from the Basic Resident Register of City A in Northern Japan. An anonymized self-administered questionnaire survey was performed. Four hundred individuals equivalates to 0.003% of the people of this age group in this region. “Urinary incontinence present” was defined as any response other than “Absent” for the frequency of urinary incontinence in the International Consultation on Incontinence – Questionnaire (ICIQ-SF) [3], which is a compilation of questions on symptoms and QOL.

The effective response rate was 21.0% (84 individuals). The mean age of the subjects was 81.8±3.9 years, and the ratio of those with complaints (the rate of self-reported prevalence of urinary incontinence (UI)) of urinary incontinence based on self-reporting was 54.8% (46 individuals). The mean age of the subjects with urinary incontinence was 82.3±4.0 years, and that of those without was 81.0 ±3.7 (years), showing no significant difference (p=0.144, Mann-Whitney U-test). Of the subjects, 26 (31.0%) were under certification of long-term care needs, among which 7 (8.3%) and 5 (6.0%) subjects required support 1 and 2, respectively; 4 (4.8%), 5 (6.0%), 1 (1.2%), 3 (3.6%), and 1 (1.2%) subjects required long-term care 1, 2, 3, 4, and 5, respectively.  The ICIQ-SF of the subjects with no certification of requiring support or requiring long-term care were 3.3±3.9. The respective values of those subjects requiring support 1 and 2 were 4.9±4.9 and 7.2±5.7. The respective values of those subjects requiring long-term care 1, 2, and 4 were 3.0±3.6, 6.4±5.9, and 12.3±10.8. As such, a significant difference was observed between the level of certification of long-term care needs and ICIQ-SF (p=0.017, Bonferroni) (Fig. 1). As the requiring long-term care 3 and 5 was one individual, these two excluded from the analysis.
Regarding the volume of urinary incontinence, a small, medium, and large amount was the case for 33 (39.3%), 11 (13.1%), and 2 (2.4%), respectively. Regarding the timing of urinary incontinence, just before arriving at the toilet was the case for 28 (33.3%), following a cough or sneeze was the case for 20 (23.8%), during sleep for 6 (7.1%), during bodily movements for 3 (3.6%), when dressing after voiding for 2 (2.4%), leakage for a known reason 4 (4.8%), and constant leakage for 1 (1.2%) subject. 
Regarding the presence of an illness, the ICIQ-SF for subjects with and without asthma was 7.29±4.5 and 3.95±4.7, respectively, showing a significantly higher value for those with asthma (p=0.044, Mann-Whitney U-test). However, for present illnesses such as diabetes, urological diseases, and gynecological diseases, there was no significant differences regarding the status of urinary incontinence (p=0.418, Mann-Whitney U test).

The ratio of those with complaints of urinary incontinence based on the self-reporting of the subjects was 54.8%, demonstrating that at least half of the community-dwelling latter-stage elderly women were likely aware of their urinary incontinence. Because there was a significant difference in the level of certification of long-term care needs and ICIQ-SF, it became evident that urinary incontinence is a symptom that has a notable effect on QOL. However, a high level of certification of long-term care needs does not necessarily mean that ICIQ-SF is high. The state corresponding to the physical condition of each individual subject needs to be identified. Urinary incontinence commonly occurred just before arriving at the toilet, and after a cough or sneeze, and the types are functional urinary incontinence, abdominal strain urinary incontinence, and mixed urinary incontinence. All are estimated to affect urinary function, motor function, cognitive function etc., which accompany aging. 
　Among patients with a present illness, those with asthma showed a significantly higher ICIQ-SF value compared to those without. We guess that the backgrounds are accidental cough , abdominal strain due to sputum, and damages accompanying modulation of chronic respiratory function triggered by asthma. In the latter-stage elderly, infection or aspiration etc., readily triggers modulation of respiratory functions. Therefore, appropriate voiding care is important in the field of view because of the possibility of concurrent urinary incontinence.
　The limitations of this study include its low number of respondents and the possibility that there may have been individuals with serious bodily conditions, which was not considered in the study and may have affected the results.

1．The ratio of women who complained of urinary incontinence based on the self-reporting of latter-stage elderly women living in Northern Japan, which is a super-aging society, was 54.8%.
2．A significant difference was observed between the level of certification of long-term care needs and ICIQ-SF.
3．ICIQ-SF was significantly higher in individuals with asthma compared to those without.

The Cabinet Office. 2018 version of the Annual Report on the Aging Society. https://www8.cao.go.jp/kourei/whitepaper/w-2018/html/zenbun/index.html. Accessed on 2019.2.26
Ministry of Health, Labour and Welfare. Outline of the long-term care insurance system. https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/hukushi_kaigo/kaigo_koureisha/gaiyo/index.html.Accessed on 2019.2.26
Gotoh M, Donovan J, Corcos J, et al. Scored ICIQ-SF (International consultation on Incontinence Questionnaire Short-Form) for symptoms and QOL assessment in patients with urinary incontinence. J Neurogenic Bladder Soc 2003; 14: 248-55 (Japanese text with English abstract).