Associação entre incontinência urinária e instabilidade postural na mulher idosa frágil

Abstract

OBJECTIVES: The purpose of the present study is to evaluate the association between urinary incontinence (UI) and postural instability in frail elderly women attended the Geriatrics Service at HC-UFMG, in 2011. MATERIAL AND METHODS: A total of six hundred and forty-seven elderly women treated at the Institute of Jenny Andrade Faria, at Hospital das Clinicas of Universidade Federal de Minas Gerais, between January 2nd to December 31st, 2011. The variables analyzed were: age, education, dependence on basic activity of daily living (BADL) and instrumental activity of daily living (IADL), postural instability, cognitive disability, polypharmacy, depressive symptoms and other common chronic conditions in this population. A descriptive analysis of the variables using measures of central tendency and variability. In addition, analyzes were stratified according to the presence of urinary incontinence (UI). The differences between elderly with and without UI were tested by Student's t test for independent samples without variances equality assumption (continuous variables) and the chi-square test or Fisher's exact test when n <5 in a stratum. In the case of comparing medians the Mann-Whitney Utest was done. Variability measures used, when appropriate, were the standard deviation and the interquartile range. The multivariate logistic regression analysis was used to determine odds ratios. The Stata version 12 for Macintosh was used to analyze the data. RESULTS: The mean age was 76.9 years (SD 8.2). There was a predominance of low education, with illiteracy observed in 29.5% (182 elderly), elementary school 64.5% (399 elderly) and high school / higher by 6% (37 elderly). The prevalence of dependence on instrumental and basic LDA were, respectively, 54.3% (352 elderly) and 22.7% (147 elderly). The prevalence of cognitive impairment was 49.9% (323 elderly), postural instability 53.8% (348 elderly) and polypharmacy 46.9% (257 elderly). Presence of depressive symptoms was observed in 54.6% (353 elderly), sleep disorders in 44.1% (285 elderly), malnutrition in 38% (246 elderly). The most common chronic conditions were hypertension (74.8%), major depression (40.7%), dementia (26%), diabetes mellitus (25.2%), osteoporosis (22.7%), constipation (19%), obesity (17.6%), osteoarthritis (15.6%), orthostatic hypotension (11.3%) and recurrent falls (2.8%). The prevalence of UI was 33.7% (218 patients). The main variables associated with UI were age (p <0.001), dependence on basic activities (p <0.001), dependence on instrumental activities (p = 0.001), postural instability (p <0.001), presence of constipation (p = 0.004), depression (p = 0.023) and recurrent falls (p = 0.003). In the multivariate analysis, the variables in the final model (p <0.05) were recurrent falls (OR 3.51, CI 1.26 to 9.75; p = 0.016), postural instability (OR 1.97; CI 1.37 to 2.83; p <0.001) and dependence in BADL (OR 1.73, CI 1.07 to 2.41; p = 0.023). DISCUSSION: Urinary incontinence in frail elderly is strongly associated with postural instability and recurrent falls. The frail elderly approach with UI should be fully and routinely include an assessment of gait and the risk of falls, in addition to the diagnosis and treatment of osteoporosis in order to avoid brittle fracture. CONCLUSION: Urinary incontinence is strongly related to the dependence in BADL, postural instability and recurrent falls in frail elderly women.