LUTS a risk factor for falls in older men
Moderate and severe lower urinary tract symptoms (LUTS) independently increase the risk of falls, particularly recurrent falls, in elderly men.
This study from the US was performed as part of a large prospective cohort study of risk factors for falls and osteoporotic fractures in community-dwelling men 65 years of age and older.
A total of 5,872 men were evaluated for LUTS at baseline using the AUA-SI questionnaire (essentially the same as the IPSS) and were followed up for a year. At the start of the study, 3,188 men (54%) reported mild, 2,301 (39%) moderate, and 383 (7%) severe LUTS.
The mean age of the participants was 74. Men with severe LUTS tended to be older, had lower physical activity scores, were more likely to report arthritis, recent episodes of dizziness, a fall in the previous 12 months, heart attack, stroke, hypertension and use of urological medications.
During the one-year follow-up, 1,489 men (25%) reported at least one fall and 694 (12%) two or more falls.
Compared with men who had mild LUTS, the adjusted one-year cumulative incidence of falls was significantly higher in men with moderate or severe LUTS.
The risk of at least one fall was increased by 11% in moderate LUTS (relative risk 1.11, 95% CI, 1.01-1.22, p=0.02) and 33% in severe LUTS (RR 1.33, 95% CI, 1.15-1.53, p<0.001). The risk of two or more falls was increased by 21% (RR 1.21, 95% CI 1.05-1.40, p=0.01) and 63% in those with severe LUTS (RR 1.63, 95% CI, 1.31-2.02, p<0.001).
The LUTS that were most strongly associated with falling were, not surprisingly, urgency, nocturia and difficulty initiating micturition (probably due to precipitation of micturition syncope).
This study emphasises both the prevalence of LUTS in the community, and the significant health implications of severe LUTS.
LUTS are highly prevalent in older men, with approximately 70% of men in their sixties and approximately 80% of men in their eighties reporting significant symptoms. Likewise, falls are common in the elderly, with studies suggesting up to a quarter of men over 65 have one or more falls each year, often with serious implications such as fractured neck of femur.
As a prospective study, this does not tell us that treating LUTS prevents falls, and given that many urological medications (e.g. alpha blockers and anticholinergics) can cause postural symptoms and dizziness, this cannot be assumed.
However, the risk of falls should be considered when deciding whether to treat LUTS in men, and conversely, patients should be routinely asked about LUTS if they are having recurrent falls, given that this may be a modifiable risk factor.
Kellogg Parsons J, Mougey J, Lambert L et al. Lower urinary tract symptoms increase the risk of falls in older men. BJU Int 2009; 104: 63-68Reviewer
Dr Jonathan Rees
GPwSI Urology, Bristol