The association between lower urinary tract symptoms and falls: Forming a theoretical model for a research agenda

BackgroundThere is a well-recognised association between falls and lower urinary tract symptoms (LUTS) in older adults, with estimates of odd ratios for falls in the presence of LUTS ranging between 1.5 and 2.3. Falls and LUTS are both highly prevalent among older people and both are markers of frailty, with significant associated morbidity, mortality, and healthcare resource cost. This association is not well examined or explained in the literature. AimsWe aimed to outline current knowledge of the association between falls and lower urinary tract symptoms and suggest a research program to further investigate this. Materials and MethodsA consensus conference of experts in the field was convened to review the current literature and brainstorm potential future investigative avenues. Results and DiscussionDespite the recognition of this association, there has been little research to examine its potential causes, and no intervention trial has established if reducing LUTS or urinary incontinence can reduce the risk of falls. The commonly held assumption that urgency causes falls through rushing to the toilet is likely incorrect. Falls and LUTS are both symptoms of frailty and have many common causes. Gait, balance, and continence are all processes requiring cognitive input, and the concept of dual tasking may be a further link. ConclusionThe significant association between lower urinary tract symptoms and falls is currently unexplained, and further research into the potential causes of this association is needed.