Life Space Assessment in Older Women Undergoing Non-Surgical Treatment for Urinary Incontinence


Objective: Urinary incontinence (UI) impacts all aspects of life activities. This study aims to characterize change in mobility within the community utilizing the Life Space Assessment (LSA) questionnaire in women undergoing non-surgical UI treatment. Methods: This prospective cohort study, performed from July 2007 to March 2009, followed women seeking non-surgical UI treatment from an outpatient tertiary-care clinic and assessed their mobility and symptoms using LSA, Urogenital Distress Inventory (UDI-6), and Incontinence Impact Questionnaire (IIQ-7) at baseline and 2, 6, and 12 months post-treatment. Estimated Percent Improvement (EPI) and Patient Satisfaction Question (PSQ) were obtained post-treatment. The women were treated with multi-component behavioral and/or pharmacologic therapies, and we hypothesized that LSA would improve with treatment. Repeated measures analysis with Tukey’s HSD and backwards selection linear regression model were performed. Results: 70 ambulatory, community-dwelling women, aged 65 years or older, seeking non-surgical care for UI were recruited. LSA score decreased from baseline to 2 months (mean ± SD; 63 ± 29 to 56 ± 28, p < 0.001) and was sustained at 6 and 12 months (54 ± 28, 54 ± 28). UDI scores improved from 36 ± 23 to 25 ± 24, p < 0.001, at 2 months, and improvement persisted at 6 and 12 months (22 ± 22, 21 ± 24). Improvements in UDI and patient perceived improvement in UI were not associated with LSA change. Age, race, and depression impacted LSA, which decreased 1-point for each additional year of age (p = 0.004), 6-points for each point higher on the Geriatric Depression Scale (GDS) (p = 0.002), and 6-point for African American race (p = 0.048). Conclusion: Decreased mobility represented by LSA was related to age, depression, and race, but not UI symptom improvement.

Share and Cite:

Wheeler II, T. , Illston, J. , Markland, A. , Goode, P. and Richter, H. (2014) Life Space Assessment in Older Women Undergoing Non-Surgical Treatment for Urinary Incontinence. Open Journal of Obstetrics and Gynecology, 4, 809-816. doi: 10.4236/ojog.2014.414112.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Hunskaar, S., Arnold, E.P., Burgio, K.L., Diokno, A.C., Herzog, A.R. and Mallett, V.T. (2000) Epidemiology and Natural History of Urinary Incontinence. International Urogynecology Journal and Pelvic Floor Dysfunction, 11, 301-319.
[2] Diokno, A.C., Brock, B.M., Brown, D. and Herzog, A.R. (1986) Prevalence of Urinary Incontinence and Other Urologic Symptoms in the Noninstitutionalized Patient. Journal of Urology, 136, 1022-1025.
[3] Fantl, J.A., Wyman, J.F., McClish, D.K., Harkins, S.W., Elswick, R.K., Taylor, J.R., et al. (1991) Efficacy of Bladder Training in Older Women with Urinary Incontinence. JAMA, 265, 609-613.
[4] Burgio, K.L., Locher, J.L., Goode, P.S., Hardin, J.M., McDowell, B.J., Dombrowski, M., et al. (1998) Behavior vs Drug Treatment for Urge Urinary Incontinence in Older Women. JAMA, 280, 1995-2000.
[5] Goode, P.S., Burgio, K.L., Locher, J.L., Roth, D.L., Umlauf, M.G., Richter, H.E., et al. (2003) Effect of Behavioral Training with or without Pelvic Floor Electrical Stimulation on Stress Incontinence in Women: A Randomized Controlled Trial. JAMA, 290, 345-352.
[6] Dumoulin, C. and Hay-Smith, J. (2010) Pelvic Floor Muscle Training versus No Treatment, or Inactive Control Treatments, for Urinary Incontinence in Women. Cochrane Database of Systematic Reviews, 1, Article ID: CD005654.
[7] Jenkins, K.R. and Fultz, N.H. (2005) Functional Impairment as a Risk Factor for Urinary Incontinence among Older Americans. Neurology and Urodynamics, 24, 51-55.
[8] Matthews, C.A., Whitehead, W.E., Townsend, M.K. and Grodstein, F. (2013) Risk Factors for Urinary, Fecal, or Dual Incontinence in the Nurses’ Health Study. Obstetrics Gynecology, 122, 539-545.
[9] Melville, J.L., Fan, M.Y., Rau, H., Nygaard, I.E. and Katon, W.J. (2009) Major Depression and Urinary Incontinence in Women: Temporal Associations in an Epidemiologic Sample. American Journal of Obstetrics Gynecology, 201, 490.e1-e7.
[10] Bürge, E., Von Guten, A. and Berchtold, A. (2013) Factors Favoring a Degradation or an Improvement in Activities of Daily Living (ADL) Performance among Nursing Home (NH) Residents: A Survival Analysis. Archives of Gerontology and Geriatrics, 56, 250-257.
[11] Nuotio, M., Luukkaala, T., Tammela, T.L.J. and Jylh?, M. (2009) Six-Year Follow-Up and Predictors of Urgency Associated Urinary Incontinence and Bowel Symptoms among the Oldest Old: A Population-Based Study. Archives of Gerontology and Geriatrics, 49, e85-e90.
[12] Smith, A.L., Wang, P.C., Anger, J.T., Mangione, C.M., Trejo, L., Rodríguez, L.V. and Sarkisian, C.A. (2010) Correlates of Urinary Incontinence in Community Dwelling Older Latinos. Journal of the American Geriatrics Society, 58, 1170-1176.
[13] Verbrugge, L.M., Gruber, A.L. and Fozard, J.L. (1996) Age Differences and Age Changes in Activities: Baltimore Longitudinal Study of Aging. Journal of Gerontology Series B: Psychological Sciences and Social Sciences, 51B, S30- S41.
[14] Bluestein, D. and Rutledge, C.M. (2006) Perceived Health and Geriatric Risk Stratification. Canadian Family Physician, 52, 626-627.
[15] Baker, P.S., Bodner, E.V. and Allman, R.M. (2003) Measuring Life-Space Mobility in Community-Dwelling Older Adults. Journal of the American Geriatrics Society, 51, 1610-1614.
[16] Peel, C., Baker, P.S., Roth, D.L., Brown, C.J., Bodner, E.V. and Allman, R.M. (2005) Assessing Mobility in Older Adults: The UAB Study of Aging Life-Space Assessment (University of Alabama at Birmingham). Physical Therapy, 12, 1008-1019.
[17] Burgio, K.L., Goode, P.S., Richter, H.E., Locher, J.L. and Roth, D.L. (2006) Global Ratings of Patient Satisfaction and Perceptions of Improvement with Treatment for Urinary Incontinence: Validation of Three Global Patient Ratings. Neurourology and Urodynamics, 25, 411-417.
[18] Uebersax, J.E., Wyman, J.F., Shumaker, S.A. and McClish, D.K. (1995) Short Forms to Assess Life Quality and Symptom Distress for Urinary Incontinence in Women: The Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Neurourology and Urodynamics, 14, 131-139.
[19] Harada, N.D., Chiu, V. and Stewart, A.L. (1999) Mobility-Related Function in Older Adults: Assessment with a 6 Minute Walk Test. Archives of Physical Medicine and Rehabilitation, 80, 837-841.
[20] Charlson, M.E., Pompei, P., Ales, K.L. and MacKenzie, C.R. (1987) A New Method of Classifying Prognostic Comorbidity in Longitudinal Studies: Development and Validation. Journal of Chronic Diseases, 40, 373-383.
[21] Allman, R.M., Baker, P.S., Maisak, R.M., Sims, R.V. and Roseman, J.M. (2004) Racial Similarities and Differences of Mobility Change over Eighteen Months. Journal of General Internal Medicine, 19, 1118-1126.
[22] Dyer, K.Y., Xu, Y., Brubaker, L., Nygaard, I., Markland, A., Rahn, D., et al. (2011) Minimum Important Difference for Validated Instruments in Women with Urge Incontinence. Neurourology and Urodynamics, 30, 1319-1324.
[23] Sloan, J.A., Cella, D. and Hays, R.D. (2005) Clinical Significance of Patient-Reported Questionnaire Data: Another Step toward Consensus. Journal of Clinical Epidemiology, 58, 1217-1219.
[24] Nygaard, I., Turvey, C., Burns, T.L., Crischilles, E. and Wallace, R. (2003) Urinary Incontinence and Depression in Middle-Aged United States Women. Obstetrics & Gynecology, 101, 149-156.
[25] Engberg, S., Sereika, S., Weber, E., Engberg, R., McDowell, B.J. and Reynolds, C.F. (2001) Prevalence and Recognition of Depressive Symptoms among Homebound Older Adults with Urinary Incontinence. Journal of Geriatric Psychiatry and Neurology, 14, 130-139.
[26] Stach-Lempinen, B., Hakala, A.L., Laippala, P., Lehtinen, K., Mets?noja, R. and Kujansuu, E. (2003) Severe Depression Determines Quality of Life in Urinary Incontinent Women. Neurourology and Urodynamics, 22, 563-568.
[27] Avery, J.C., Stocks, N.P., Duggan, P., Braunack-Mayer, A.J., Taylor, A.W., Goldney, R.D. and MacLennan, A.H. (2013) Identifying the Quality of Life Effects of Urinary Incontinence with Depression in an Australian Population. BMC Urology, 13, 11.
[28] Vigod, S.N. and Stewart, D.E. (2006) Major Depression in Female Urinary Incontinence. Psychosomatics, 47, 147-151.
[29] Kafri, R., Kodesh, A., Shames, J., Golomb, J. and Melzer, I. (2013) Depressive Symptoms and Treatment of Women with Urgency Urinary Incontinence. International Urogynecology Journal, 24, 1953-1959.
[30] Knorst, M.R., Resende, T.L. and Goldim, J.R. (2011) Clinical Profile, Quality of Life and Depressive Symptoms of Women with Urinary Incontince Attending a University Hospital. Brazilian Journal of Physical Therapy, 15, 109-116.
[31] Dugan, E., Cohen, S.J., Bland, D.R., Preisser, J.S., Davis, C.C., Suggs, P.K. and McGann, P. (2000) The Association of Depressive Symptoms and Urinary Incontinence among Older Adults. Journal of the American Geriatrics Society, 48, 413-416.
[32] Sung, V.W., West, D.S., Hernandez, A.L., Wheeler, T.L., Myers, D.L., Subak, L.L., Program to Reduce Incontinence by Diet and Exercise (PRIDE) (2009) Association between Urinary Incontinence and Depressive Symptoms in Overweight and Obese Women. American Journal of Obstetrics and Gynecology, 200, 557.e1-e5.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.