As women age, their ability to get around affects their quality of life. A new study shows that older women’s physical functioning declines more rapidly if they develop urinary incontinence, according to public health researchers at the University of Hawaiʻi at Mānoa.

Catherine Pirkle and Yan Yan Wu, both assistant professors in the Office of Public Health Studies in the Myron B. Thompson School of Social Work, collaborated with researchers in Brazil, Colombia and Canada to recruit approximately 900 women in their sixties and seventies from those three countries plus Albania. About 25 percent of women over age 60 experience urinary incontinence.

Study participants completed a short test of physical functioning, which included measuring the speed of their usual walking pace, checking their balance and testing how fast they could stand up from a chair. The women also completed a questionnaire about their health, which included a query about whether they had experienced any leakage of urine in the past week. After two years, the women repeated the physical functioning test.

Pirkle said the researchers were surprised by how much physical function had decreased over a two-year period in women who had reported experiencing urine leakage at the study’s start.

“The loss of physical function in this group was quite large and happened very rapidly,” said Pirkle. “We know that, as women age, they tend to experience more functional limitations and disability than men do. But the reasons for this gender gap are not clear.”

Cycle of incontinence and decreasing physical activity

Wu said one supposition is that women who experience incontinence start to engage in less physical activity out of fear of losing urine. This could lead to a vicious cycle, as a reduction in physical activity leads to worsening incontinence and overall health.

But it’s possible that other factors, such as giving birth to many children, may contribute to both urinary incontinence and a physical performance decline. Pirkle and Wu said the next step for the research team is to look at whether women’s reproductive lives, such as the number of children they have and their history of gynecological or obstetric problems, influence their risk of incontinence, as well as other health outcomes of importance to older women.

The study was published in the September 2018 Journal of Aging and Health. Pirkle and Wu’s collaborators on the study include Luana Caroline de Assunção Cortez Corrêa and Saionara Maria Aires da Câmara of the Federal University of Rio Grande do Norte in Brazil; Afshin Vafaei of Lakehead University in Canada; and Carmen-Lucia Curcio of Universidad de Caldas in Colombia.

A dozen international gerontologists affiliated with the Active Aging Consortium in Asia Pacific (ACAP), including two public health professors from the University of Hawaiʻi at Mānoa, met in Hong Kong recently to sign a declaration urging countries to adopt social policies in support of active aging.

“Active aging calls for a partnership involving individuals, governments, nonprofits, researchers and businesses,” said ACAP President Kathryn L. Braun, chair of the Office of Public Health Studies within the Myron B. Thompson School of Social Work. “Individuals must prepare for a long life, taking care of their health and continuing to contribute to society. Policymakers must assure a basic level of support for all and institute policies that promote healthy choices. And science must find, and business must create, affordable solutions to counter and compensate for disabilities common in old age.”

Ways to support active aging include the creation of age-friendly programs, active collaboration across sectors, use of research to address challenges and establishing international networks for exchange of best practices.

Present at the declaration signing were gerontologists representing Australia, China, Hong Kong, Indonesia, Japan, Korea, Malaysia, the Philippines, Singapore, Thailand, the United Kingdom and U.S. Representing the latter was UH Center on Aging Professor Christy Nishita, who gave a presentation on the Hawaiʻi Alzheimer’s Disease Initiative and a talk titled “Age-Friendly Honolulu.”

The world’s elderly population is growing at an unprecedented rate. According to the National Institutes of Health, 8.5 percent of the planet’s population is age 65 and older. In Hawaiʻi, the percentage of the elderly population is more than twice as high, about 17 percent in 2016.

“As the aged population grows, Hawaiʻi needs to increase support and opportunities for our kūpuna,” commented Braun. “The longer we can keep our elders healthy and active, the more they can contribute to families and society.”

ACAP‘s Asian partners have even more cause for concern. By the year 2050, people ages 60 or older will represent 41 percent of Japan’s population, 39 percent in Korea, 38 percent in Singapore and 37 percent in Hong Kong. This compares to only 27 percent in the U.S.

“Populations are aging rapidly in these countries because birth rates are below replacement, and elders are living longer and longer,” said Braun. “Asian governments are exploring policies to increase the retirement age, expand work and volunteer opportunities for older adults, and support elders to live independently in the community or with families, rather than in institutions—resulting in the need to import foreign elder care workers.”