Incontinência urinária e mortalidade em nonagenários e centenários do Projeto AMPAL

Abstract

Introduction: Aging causes physiological changes that can facilitate the emergence of chronic, disabling and progressive diseases that compromise the independence and autonomy of people, especially nonagenarians and centenarians. Urinary incontinence (UI) is a frequent symptom in the elderly population, considered one of the great Giants of Geriatrics. Because it is disabling and costly, it can generate factors that increase long-term fragility, directly affecting their quality of life and perhaps their survival. Objective: To study the influence of UI on the mortality of nonagenarians and centenarians. Methods: Nonagenarians and centenarians participating in the Multiprofessional Long-term Care (AMPAL) project, identified as having or not UI in the initial assessment of 2016 and periodically monitored until August 30, 2019, were included in this research. At the end of the follow-up, participants who died by telephone contact or consultation were identified by the list of deaths provided by the Funeral Care Center of the Porto Alegre City Hall. Initially, a descriptive analysis of possible UI-related factors (sociodemographic, clinical, lifestyle and functional performance covariates) was performed. For survival analysis, we used the follow-up time, calculated by the number of months between the first assessment and the date of death for the deceased group, and the date of the last contact for the supposedly living participants. The analysis was performed by Cox Damage Regression in simple models, including significant covariates in the descriptive analysis. Subsequently, the adjusted UI analysis was performed, aiming to understand the possible influence of the condition on the covariates and their influence on the UI. Results: The prevalence of urinary incontinence was 56%, being 64% among women and 38% among men (p<0.01). The presence of UI was significantly related to marital status (p<0.01), more frequently among widowers. Incontinents left homeless (p=0.0207), participated less in social activities (p=0.0742), had more chronic diseases (p=0.0235) and depressive symptoms (p=0.0800). and worse score on cognitive assessment (p=0.0420). Participants with UI had a shorter survival, although the result was not significant (p=0.2292). On the other hand, being older (p = 0.0008), having multimorbidities (p = 0.0177), having depressive symptoms (p = 0.0025), leaving less than home (p = 0.0059), participating less social activities (p <0.001) and having worse lower limb functionality (MsIs) (p <0.001) were significant variables for lower survival. In the adjusted analysis, the presence of males in the model increased the prediction of urinary loss from 29% to 33% the chance of death, although not significant (p = 0.188). The variables most impacted by UI in the death prediction model were: presence ≥ 10 NCDs and> 3 depressive symptoms. The variables that most impacted the prediction of death by UI were: participation in social activities, leaving home, MMSE and lower limb performance. Conclusions: UI was not a significant predictor of mortality despite shorter survival. The presence of loss of urine will have less impact on mortality if the participant keeps leaving home, participating in social activities, with cognition and performance of preserved lower limb activities.