Frailty is an important clinical syndrome whose impact on the health status of older adults may result in higher risk of falls, hospitalizations, and death. Pre-frail status has been associated with geriatric impairments in physical function and the geriatric incontinence syndrome. Thus, increasing our knowledge regarding the associations between frailty status and urinary incontinence (UI) in older women undergoing surgical interventions for pelvic floor disorders is needed. The primary aim of this study is to determine the association between frailty and moderate UI in women undergoing surgery for symptomatic pelvic organ prolapse (POP). We hypothesized that frailty status would be associated with moderate UI symptoms.

This was a secondary analysis of combined datasets of women aged ≥ 60 years who underwent POP surgery enrolled in studies primarily focused on perioperative neurocognitive disorders. Exclusion criteria include history of known cognitive impairment diagnosis, modified mini-mental status exam score <84, history of stroke or major neurologic disorder, and non-English speakers. Frailty was measured using Fried Frailty Index (FFI) prior to surgery. Frailty status was classified as follows: score of 0 non-frail, a score of 1-2 pre-frail, and score of ≥3 as frail. Urinary incontinence was characterized by the Urinary Distress Inventory short form (UDI-6) at baseline (score range 0-100). Moderate UI symptoms was defined by the previously validated cut-point score of >33.33. Chi-square (Fisher’s exact) tests for categorical variables and T-test (Mann-Whitney U) for continuous variables were applied to compare clinical and demographic characteristics based on presence of moderate UI symptoms. Univariable and multivariable logistic regression analyses were also performed to examine the independence of the relationship between frailty status and UI symptoms.

Two-hundred and fifty participants were included in this analysis: 47 non-frail (18.8%), 183 (73.2%) pre-frail, and 20 (8%) frail. There were 131 (52.4%) women with moderate UI symptoms. The mean (standard deviation (SD)) age and BMI were 72.9 (6.23) years and 27.56 (4.44) kg/m2 . mean (standard deviation (SD)) age and BMI were 72.9 (6.23) years and 27.56 (4.44) kg/m2. Moderate UI was significantly associated with frailty status (p=0.001), greater BMI (p=0.02), higher American Society of Anesthesiologist (ASA) class (p=0.001), and patient self-reported vision impairment (p=0.045) (Table 1). On logistic regression, frailty status was significantly associated with experiencing moderate UI symptoms (p<0.001). The association between frailty status and moderate UI symptoms remained significant when controlling for ASA classification and BMI (Table 2).

Frailty status is associated with the presence of moderate UI symptoms in independent community-dwelling women scheduled to undergo prolapse surgery.

The presence of frailty and moderate UI symptoms in symptomatic women undergoing surgery for pelvic organ prolapse should influence surgical counseling and decision-making to minimize the potential negative impact frailty may have on perioperative outcomes. It may be prudent to consider concomitant treatment of UI symptoms with prolapse repair to minimize risk of short interval return to the surgical suite as this may increase frailty associated risks. Further research on the perioperative impact of frailty status in women undergoing surgery for POP with concomitant treatment of moderate UI is needed.