An integrated exercise and bladder training intervention to reduce falls in older women with urinary incontinence

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Project Summary/Abstract Urgency urinary incontinence (UUI) is a biomarker of falls risk and disproportionately affects older minority women living in urban communities. Over 50% of an estimated 10 million women age 70 and older with UUI will experience a fall. A fall compounds the functional dependency already present in older women with UUI making their quality of life worse than that following a stroke. This proposal addresses a key research gap: existing fall prevention interventions cannot be applied to women with UUI and effective interventions that reduce falls in older community-dwelling women with UUI are lacking. Our objective is to establish the effectiveness of a novel multidimensional intervention to reduce falls in older women with UUI. This intervention is based on the hypothesis that falls in older adult women with urinary incontinence are the result of urinary urgency related anxiety in the setting of reduced lower limb muscle strength, poor balance, and environmental hazards. Our trial will show that a tailored intervention that addresses each of these interdependent factors through integrated behavioral bladder training and urge suppression, strength and balance exercises, and home hazard assessment will reduce falls and improve urinary incontinence in older community-dwelling women with UUI. The investigators of this proposal have already developed and validated the intervention in pilot studies and now propose a randomized controlled trial of 314 women to rigorously establish its effectiveness. Our specific aims are: 1) To determine the effect of a tailored integrated exercise and bladder training intervention on falls in older women and 2) To determine the effect of a tailored integrated exercise and bladder training intervention on urgency urinary incontinence in older women. The trial will use a community-engagement approach to recruit women living in an urban core community with high proportion of minorities. This trial will be the first adequately powered study to test an intervention for reducing falls in older community-dwelling women with urgency urinary incontinence and also the first adequately powered study to test the efficacy of a physical exercise intervention for the treatment of urinary incontinence. This study will have significant public health impact because it will establish the clinical effectiveness of a scalable intervention that targets two common highly morbid conditions: falls and incontinence in older women.