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

项目摘要/摘要 急迫性尿失禁(UUI)是跌倒风险的生物标志物，对老年少数民族的影响不成比例 生活在城市社区的妇女。据估计，在1000万患有尿路感染的70岁及以上女性中，超过50%的人 体验一次跌倒。跌倒加剧了老年女性对尿失禁的功能依赖 他们的生活质量比中风还差。这项建议解决了一个关键的研究缺口：现有秋季 不能对患有尿路感染的妇女进行预防干预，有效的干预措施可以减少跌倒 居住在社区的患有尿失禁的老年妇女很少。我们的目标是确定一部小说的有效性 多维干预以减少UUI老年女性的跌倒。这种干预是基于 认为老年女性尿失禁是尿急相关的结果的假说 焦虑的环境下，腿部肌肉力量下降，平衡不良，并对环境造成危害。我们的审判 将展示一种量身定制的干预措施，通过集成解决这些相互依赖的因素 行为性膀胱训练和冲动抑制、力量和平衡练习以及家庭危险 评估将减少UUI老年社区女性的跌倒和改善尿失禁。 这项提案的调查人员已经在试点研究中开发并验证了干预措施，现在 建议对314名妇女进行随机对照试验，以严格确定其有效性。我们的具体目标 1)确定量身定制的综合运动和膀胱训练干预对老年人跌倒的影响 2)确定量身定制的综合运动和膀胱训练干预对 老年女性的急迫性尿失禁。试验将使用社区参与的方法来招募 生活在少数族裔比例较高的城市核心社区的妇女。这将是第一次正式的审判 一项旨在测试减少社区老年女性尿急患者跌倒的干预措施的动力研究 大小便失禁，也是第一个测试体育锻炼干预效果的充足动力研究 用于治疗尿失禁。这项研究将对公共卫生产生重大影响，因为它将 确定针对两种常见的高度病态疾病的可扩展干预的临床有效性： 老年女性的跌倒和大小便失禁。

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.