Fecal and urinary incontinence in older men with hip fracture: a geriatric syndrome with prognostic significance

PURPOSE: Hip fracture in older men is associated with disproportionately poor outcomes compared to women, yet the prevalence and prognostic significance of incontinence in this population remain understudied. This study aimed to determine the prevalence of urinary (UI) and fecal incontinence (FI) in older men with hip fracture, evaluate their association with 1-year mortality, and identify factors linked to UI at post-fracture out-patient comprehensive geriatric assessment (CGA). METHODS: This retrospective study analyzed data from 644 men aged ≥65 with first hip fracture (2007-2019) at Seinäjoki Central Hospital, Finland. Cox proportional hazards regression assessed associations of baseline UI (yes/no) and FI (yes/no) with 1-year mortality (n=549). Binary logistic regression identified baseline and CGA-derived factors associated with UI at 6-month post-fracture (n=331). RESULTS: Mean age was 81,4±7,8. Pre-fracture, 45% of men had UI and 12% had FI. One-year mortality was 34%. In multivariable-adjusted Cox regression, FI independently predicted mortality (HR 1.72, 95% CI 1.15-2.58), while UI did not. Other independent predictors included age, polypharmacy, non-independent mobility, poor nutritional status, and delayed urinary catheter removal. At CGA, 47% had UI. Cognitive disorder (OR 3.22, 95% CI 1.63-6.35) and non-independent mobility (OR 3.07, 95% CI 1.58-5.97) were independently associated with UI, as were CGA deficits in cognition, function, and physical ability. CONCLUSION: Pre-fracture FI is independently associated with increased 1-year mortality in older men with hip fracture, while UI is closely linked to cognitive and functional decline, emphasizing the syndromic nature of incontinence in these patients. Incontinence assessment including both UI and FI may help identify patients at highest risk of adverse outcomes.