The population aged 85 and over is predicted to increase. Still, few studies have included very old adults (≥85 years) and especially frail elderly with dementia. The aim of this study was therefore to determine how common urinary incontinence (UI) is among 85-, 90-, and ≥ 95-year-old women and men and its impact on morale/quality of life.

This study used data from the Gerontological Regional Database (GERDA). Data was collected between 2000-2017 using structured interviews in the participants’ place of residence every five years, and if the participants consented, medical records were also reviewed. Every other 85-year-old, all those who were 90 years and all those 95 and older were invited to participate. No exclusion criteria were applied, so people with dementia were also included. An experienced specialist in geriatric medicine evaluated all available data and diagnosed dementia. 

Urinary incontinence was determined from the Barthel Index item about bladder control and was considered present if either the answer “incontinent, or catheterized and unable to manage alone” or “occasional accident” was given. This study analyses the prevalence of urinary incontinence using descriptive statistics.

Morale (quality of life) was measured using the Philadelphia Geriatric Center Morale Scale (PGCMS), a 17-item questionnaire assessing psychological well being among older adults. Only participants with complete data were included. The mean total PGCM score among those with urinary incontinence was compared to the mean in the group without urinary incontinence using Student’s t-test.

In total, 1,683 participants were included, corresponding to 63.0% of invited women (n = 1,119) and 70.8% of invited men (n = 564). The prevalence of any type of dementia was 35.7% among women and 30.9% among men. 

Among women the UI prevalence was 33.1 % and the mean PGCMS score was 11.66 (SD 3.21). Among the 85-year-olds, 18.9 % reported UI, among 90-year old 31.6 % and 95 years and older 49.0%.  

Among men the UI prevalence was 21.6 % and the mean PGCMS score was 12.47 (SD 2.94). The reported prevalence of UI was 17.7 %, 21.0% and 30.1% among 85-, 90- and 95-year-olds and older, respectively. 

Mean PGCMS scores differed significantly by UI status in both sexes. Among women, 773 had complete data on the PGCMS and mean scores were lower among those with UI compared with those without (11.25 [SD 3.27] vs 12.25 [SD 3.01], p < 0.001). A similar pattern was observed among men (n = 424), with mean scores of 11.59 (SD 3.27) and 12.93 (SD 2.70), respectively (p < 0.001).

This is a unique study including very old adults, both healthy and frail. Both prevalence rates and impact on quality of life are in line with previous research (1-3), but our results more clearly showed an increase with age. However, previous studies have not included participants with dementia/severe frailty, subgroups where UI is more common.

Strengths of this study included the sample size and the high response rate, given that it did not exclude the frailest older adults. Limitations included the use of the Barthel index, which had limited sensitivity, and the inability to determine the type and severity of incontinence.

Urinary incontinence increases with age, also among the very old, and it has a significant impact on quality of life. Further studies on preventable risk factors and possible treatments are needed.

Eredics K, Wehrberger C, Edlinger L, Müller U, Rauchenwald M, Wehrberger M, et al. Urinary Incontinence, Quality of Life, and Risk Factors in a Geriatric Cohort. Urol Int. 2023;107(9):866-71.
Pinkas J, Gujski M, Humeniuk E, Raczkiewicz D, Bejga P, Owoc A, et al. State of Health and Quality of Life of Women at Advanced Age. Med Sci Monit. 2016;22:3095-105.
Malmsten UG, Molander U, Peeker R, Irwin DE, Milsom I. Urinary incontinence, overactive bladder, and other lower urinary tract symptoms: a longitudinal population-based survey in men aged 45-103 years. Eur Urol. 2010;58(1):149-56.