Abstract and Introduction
Abstract
Background: Life-space mobility represents the distance, frequency, and independence of mobility, ranging from one's bedroom to beyond their town. Older men with lower urinary tract symptoms (LUTS) may limit their life-space to stay close to a bathroom. However, it's unknown whether LUTS severity or urinary bother are associated with risk of life-space mobility restriction.
Methods: We analyzed data from 3025 community-dwelling men age ≥71 years without life-space mobility restriction at analytic baseline (Year 7) of the Osteoporotic Fractures in Men (MrOS) study. The American Urologic Association Symptom Index (AUASI) was assessed at baseline and includes one question assessing urinary bother ("If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?"; score 0–1,2,3,4–6) and seven items to classify LUTS severity as none/mild (score 0–7), moderate (8–19), or severe (20–35). The University of Alabama Life-space Assessment was used to define life-space mobility restriction (≤60) at baseline and follow-up (Year 9). We used log-binomial regression with robust variance estimators to model adjusted risk ratios (ARR) for LUTS severity and urinary bother with incident life-space mobility restriction, controlling for age, site, health-related factors, and comorbidities. We then mutually adjusted for urinary bother and LUTS severity.
Results: Overall, the 2-year risk of life-space mobility restrictions was 9.9%. Compared to men without urinary bother (scores 0–1), the risk of life-space mobility restriction was significantly higher among men with bother scores of 4–6 (ARR = 2.20, 95% CI: 1.52, 3.19), independent of LUTS severity and confounders. Conversely, LUTS severity was not independently associated with the risk of life-space mobility restriction.
Conclusions: Urinary bother, but not LUTS severity, is independently associated with incident life-space mobility restriction among older men. To maintain life-space mobility in older men with LUTS, future studies should identify shared mechanisms and interventions that minimize urinary bother.
Introduction
Lower urinary tract symptoms (LUTS) affect almost half of men after age 70 years[1,2] and are associated with increased risk of falls, mobility and functional limitations, and mortality.[3–9] LUTS is a complex syndrome of overlapping and chronic symptoms that occur during urine storage (urgency, frequency, nocturia, and incontinence), urine voiding (slow/weak or intermittent stream, hesitancy, and straining), or immediately after voiding (sensation of incomplete bladder emptying).[10] Older men with greater LUTS severity are also more likely to be depressed and phenotypically frail.[2,11] The combination of these physical and psychological comorbidities plus the need to remain in close proximity to a bathroom to avoid episodes of urgency urinary incontinence may cause older men with LUTS to avoid leaving their home. Life-space mobility, defined as the "movement extending from within one's home to movement beyond one's town or geographic region," attempts to capture the type of enacted mobility within an individual's own environment that could be compromised by the presence and impact of LUTS.[12,13] However, the relationship between LUTS and life-space mobility restrictions among older community-dwelling men remains unknown.
Maintaining mobility is critical to the well-being and independence of older adults, including older men with LUTS. Older men who are able to avoid life-space mobility restrictions have a lower risk of functional decline, institutionalization, and mortality, as well as lower health care utilization.[14–17] Importantly, life-space mobility measures account for the various demographic, biological, medical, psychological, sociological, and environmental factors that influence how frequently and how far someone travels beyond their bedroom. Therefore, life-space mobility is a more comprehensive and integrated measure of both intrinsic and extrinsic causes of mobility limitations among older men with LUTS compared to performance-based (e.g., gait speed) or self-reported (e.g., ability to walk 2–3 blocks) measures.
LUTS severity (frequency of urinary symptoms) and urinary bother (degree of bother due to urinary symptoms) are overlapping, but distinct measures of urologic health. Although they are correlated,[18–22] some men with moderate-to-severe LUTS report little or no urinary bother and some men with mild LUTS report significant urinary bother.[18,20,22] Thus, coping skills, personality traits, or greater physical functioning may be protective against changes in life-space mobility by minimizing urinary bother despite more severe LUTS. Alternatively, older men could be more affected by the frequency of LUTS when deciding whether or not to leave their home, independent of urinary bother.
In order to address this gap in knowledge, we evaluated the association of baseline LUTS severity and urinary bother with incident life-space mobility restriction in a large cohort of older, community-dwelling men. We hypothesized that men with more severe LUTS and greater urinary bother at baseline would have a higher risk of developing new life-space mobility restrictions within 2 years, and that these associations would be independent of each other.
J Am Geriatr Soc. 2023;71(4):1093-1104. © 2023 Blackwell Publishing
