TY - JOUR
T1 - Longitudinal Associations between Concurrent Changes in Phenotypic Frailty and Lower Urinary Tract Symptoms among Older Men
AU - Osteoporotic Fractures in Men (MrOS) Research Group
AU - Bauer, Scott R.
AU - McCulloch, C. E.
AU - Cawthon, P. M.
AU - Ensrud, K. E.
AU - Suskind, A. M.
AU - Newman, J. C.
AU - Harrison, S. L.
AU - Senders, A.
AU - Covinsky, K.
AU - Marshall, L. M.
N1 - Publisher Copyright:
© 2022, The Author(s).
PY - 2023/2
Y1 - 2023/2
N2 - Background: Lower urinary tract symptoms (LUTS) are associated with prevalent frailty and functional impairment, but longitudinal associations remain unexplored. Objectives: To assess the association of change in phenotypic frailty with concurrent worsening LUTS severity among older men without clinically significant LUTS at baseline. Design: Multicenter, prospective cohort study. Setting: Population-based. Participants: Participants included community-dwelling men age ≥65 years at enrollment in the Osteoporotic Fractures in Men study. Measurements: Data were collected at 4 visits over 7 years. Phenotypic frailty score (range: 0–5) was defined at each visit using adapted Fried criterion and men were categorized at baseline as robust (0), pre-frail (1–2), or frail (3–5). Within-person change in frailty was calculated at each visit as the absolute difference in number of criteria met compared to baseline. LUTS severity was defined using the American Urologic Association Symptom Index (AUASI; range: 0–35) and men with AUASI ≥8 at baseline were excluded. Linear mixed effects models were adjusted for demographics, health-behaviors, and comorbidities to quantify the association between within-person change in frailty and AUASI. Results: Among 3235 men included in analysis, 48% were robust, 45% were pre-frail, and 7% were frail. Whereas baseline frailty status was not associated with change in LUTS severity, within-person increases in frailty were associated with greater LUTS severity (quadratic P<0.001). Among robust men at baseline, mean predicted AUASI during follow-up was 4.2 (95% CI 3.9, 4.5) among those meeting 0 frailty criteria, 4.6 (95% CI 4.3, 4.9) among those meeting 1 criterion increasing nonlinearly to 11.2 (95% CI 9.8, 12.6) among those meeting 5 criteria. Conclusions: Greater phenotypic frailty was associated with nonlinear increases in LUTS severity in older men over time, independent of age and comorbidities. Results suggest LUTS and frailty share an underlying mechanism that is not targeted by existing LUTS interventions.
AB - Background: Lower urinary tract symptoms (LUTS) are associated with prevalent frailty and functional impairment, but longitudinal associations remain unexplored. Objectives: To assess the association of change in phenotypic frailty with concurrent worsening LUTS severity among older men without clinically significant LUTS at baseline. Design: Multicenter, prospective cohort study. Setting: Population-based. Participants: Participants included community-dwelling men age ≥65 years at enrollment in the Osteoporotic Fractures in Men study. Measurements: Data were collected at 4 visits over 7 years. Phenotypic frailty score (range: 0–5) was defined at each visit using adapted Fried criterion and men were categorized at baseline as robust (0), pre-frail (1–2), or frail (3–5). Within-person change in frailty was calculated at each visit as the absolute difference in number of criteria met compared to baseline. LUTS severity was defined using the American Urologic Association Symptom Index (AUASI; range: 0–35) and men with AUASI ≥8 at baseline were excluded. Linear mixed effects models were adjusted for demographics, health-behaviors, and comorbidities to quantify the association between within-person change in frailty and AUASI. Results: Among 3235 men included in analysis, 48% were robust, 45% were pre-frail, and 7% were frail. Whereas baseline frailty status was not associated with change in LUTS severity, within-person increases in frailty were associated with greater LUTS severity (quadratic P<0.001). Among robust men at baseline, mean predicted AUASI during follow-up was 4.2 (95% CI 3.9, 4.5) among those meeting 0 frailty criteria, 4.6 (95% CI 4.3, 4.9) among those meeting 1 criterion increasing nonlinearly to 11.2 (95% CI 9.8, 12.6) among those meeting 5 criteria. Conclusions: Greater phenotypic frailty was associated with nonlinear increases in LUTS severity in older men over time, independent of age and comorbidities. Results suggest LUTS and frailty share an underlying mechanism that is not targeted by existing LUTS interventions.
KW - Aging
KW - benign prostatic hyperplasia
KW - epidemiology
KW - sarcopenia
UR - http://www.scopus.com/inward/record.url?scp=85131650391&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85131650391&partnerID=8YFLogxK
U2 - 10.14283/jfa.2022.33
DO - 10.14283/jfa.2022.33
M3 - Article
AN - SCOPUS:85131650391
SN - 2260-1341
VL - 12
SP - 117
EP - 125
JO - The Journal of frailty & aging
JF - The Journal of frailty & aging
IS - 2
ER -