Frailty, Cognitive Impairment, and Functional Disability in Older Women With Female Pelvic Floor Dysfunction

Abstract

Frailty is common in the elderly. It is characterized by increased vulnerability to stressors such as extreme heat or cold, falls, infection, and surgery. There are no consistent definitions of frailty, and different inclusion and exclusion criteria have been used. A large proportion of elderly develop the frailty syndrome, which is predictive for a constellation of adverse outcomes in community-dwelling individuals, including long-term nursing home stay, injurious falls, and death. It is becoming increasingly clear that frailty is also an important predictor of adverse surgical outcomes in elderly patients undergoing major procedures requiring admission to intensive care units. In addition to routine assessment prior to surgery, both the American College of Surgeons and the American Geriatrics Society have recommended that older patients be evaluated for frailty, cognitive ability, and functional status. Since the onset of female pelvic floor dysfunction (PFD) symptoms in women is age related, a high prevalence of frailty in elderly women seeking treatment for PFD could impact the risks and benefits of different treatment options. The primary aim of this prospective cross-sectional study was to determine the prevalence of frailty, cognitive impairment, and functional disability among older women seeking treatment for PFD. Community-dwelling older women, 65 years or older, were enrolled at the conclusion of their new patient consultation for PFD at a tertiary center between September 2011 and September 2012. Comprehensive geriatric screening was performed as follows: frailty was assessed using the Fried Frailty Index; cognitive screening was performed using the Saint Louis University Mental Status examination, and functional status for activities of daily living (ADLs) was evaluated according to Katz’s classification (Katz ADL score). The Fried Frailty Index score categorized 17% (n/N = 25/150) of women as frail. After adjusting the data for education level, 21.3% of women (n/N = 32/150) screened positive for dementia, and 30.7% (46/150) reported functional difficulty or dependence in performing at least 1 Katz ADL. At the conclusion of the new patient visit with a physician, 46% (64/150) of the women in the study chose surgical options for treatment of their PFD. These findings demonstrate that frailty, cognitive impairment, and functional disability are prevalent among older women seeking treatment for PFD.