Urgency urinary incontinence, loss of independence, and increased mortality in older adults: A cohort study

Takashi Yoshioka; Tsukasa Kamitani; Kenji Omae; Sayaka Shimizu; Shunichi Fukuhara; Yosuke Yamamoto

doi:10.1371/journal.pone.0245724

Peer Review History

Original SubmissionOctober 30, 2020
8 Dec 2020 Decision Letter - Pasquale Abete, Editor PONE-D-20-34134 Urgency urinary incontinence, loss of independence, and increased mortality in older adults: A cohort study PLOS ONE Dear Dr. YAMAMOTO, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jan 22 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: To the author: I delighted in reading the paper and I found the subject very interesting. It is well structured and written, however some aspects could be more extensively argued in a minor revision. Minor revision Method: Some medications, such as diuretics, could worsen urinary urge and incontinence effect in older adults. In this manuscript ten confounding covariates were considered with the exception of drugs. Therefore a difference between the two groups of subjects with and without urgency urinary incontinence in terms of medications is not explored. This could fade the relevance of some questionnaire items (How often do you urinate because you cannot defer the sudden desire to urinate? “never, less than once a week, once a week or more, about once a day, 2–4 times a day, and 5 times a day or more”). If data on medications lacking, the authors could debate the subject in the discussion and in the limitation of the study. Discussion: The majority of older adults with urinary incontinence present nocturnal lower urinary tract symptoms. Nocturia as well as urinary icontinence in older people is associated with high morbidity and mortality. This aspect could be mentioned in the discussion session. Please see references Denys MA et al. Int J Urol. 2017 and Galizia et al. J Am Med Dir Assoc. 2012. Reviewer #2: The Authors investigated the longitudinal association of urgency urinary incontinence with loss of independence (LOI) or death among independent community dwelling older adults. Data derived from a population-based cohort study in Japan in which 1,580 participants aged ≥65 years were enrolled in 2010. Urgency urinary incontinence (UUI) was measured by a questionnaire based on the definition of UUI from the International Continence Society. The primary outcome was defined as incidence of LOI or death. After the check-up in 2010, the outcome was monitored until March 2014. A multivariable Cox proportional hazard analysis was performed to estimate the hazard ratio for the outcome and for LOI and death separately. Ten potential confounders were adjusted in the analysis. Among all participants, 328 reported UUI. The incidence rates of the outcome were 20.4 and 11.4 (per 1,000 person–years) among participants with and without UUI, respectively. After multivariable adjustment, those who experienced UUI showed a substantial association with LOI or death (HR, 1.65; 95% CI, 1.01–2.68). However, they did not show such an association with LOI alone (HR, 1.07; 95% CI, 0.49–2.33). On the other hand, those with UUI exhibited a substantial association with death (HR, 2.23; 95% CI, 1.22–4.31). I found this study of interest, well designed, and conducted. Only one point of criticism is the lack of cognitive status evaluation and incident disability. Please, consider to cite this reference: Solfrizzi V, Scafato E, Lozupone M, Seripa D, Giannini M, Sardone R,Bonfiglio C, Abbrescia DI, Galluzzo L, Gandin C, Baldereschi M, Di Carlo A, Inzitari D, Daniele A, Sabbà C, Logroscino G, Panza F; Italian Longitudinal Study on Aging Working Group. Additive Role of a Potentially Reversible Cognitive Frailty Model and Inflammatory State on the Risk of Disability: The Italian Longitudinal Study on Aging. Am J Geriatr Psychiatry. 2017 Nov;25(11):1236-1248. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0245724.r001
Revision 1
18 Dec 2020 Author Response Comments from Reviewer #1 Comment: To the author: I delighted in reading the paper and I found the subject very interesting. It is well structured and written, however some aspects could be more extensively argued in a minor revision. Response: Thank you very much. We carefully designed and conducted this research. We have changed the manuscript to reflect the suggestions provided by the reviewers. Comment 1: Method: Some medications, such as diuretics, could worsen urinary urge and incontinence effect in older adults. In this manuscript ten confounding covariates were considered with the exception of drugs. Therefore a difference between the two groups of subjects with and without urgency urinary incontinence in terms of medications is not explored. This could fade the relevance of some questionnaire items (How often do you urinate because you cannot defer the sudden desire to urinate? “never, less than once a week, once a week or more, about once a day, 2–4 times a day, and 5 times a day or more”). If data on medications lacking, the authors could debate the subject in the discussion and in the limitation of the study. Response: Thank you very much for the insightful comment. We agree that diuretics could worsen UUI. Contrary to anticholinergics (described as “bladder medication” in the manuscript), use of diuretics may be a confounding factor. This might be considered as another limitation regarding residual and unmeasured confounding factors in our study. As such, we added some sentences and a reference to the Discussion. Changes: Lines 299–302 Fifth, this study may have unmeasured residual confounders because of the nature of observational research. For example, this study did not adjust for the use of diuretics, which may worsen UUI symptoms and might therefore be a potential confounding factor [32]. [32] Ekundayo OJ, Markland A, Lefante C, Sui X, Goode PS, Allman RM, Ali M, Wahle C, Thornton PL, Ahmed A. Association of diuretic use and overactive bladder syndrome in older adults: a propensity score analysis. Arch Gerontol Geriatr. 2009;49(1): 64–68. https://doi.org/10.1016/j.archger.2008.05.002. Comment 2: Discussion: The majority of older adults with urinary incontinence present nocturnal lower urinary tract symptoms. Nocturia as well as urinary incontinence in older people is associated with high morbidity and mortality. This aspect could be mentioned in the discussion session. Please see references Denys MA et al. Int J Urol. 2017 and Galizia et al. J Am Med Dir Assoc. 2012. Response: We entirely agree that nocturia is another important urinary symptom associated with LOI or death among older adults. Following the reviewer’s suggestion, we added text and a reference regarding nocturia to the Discussion. Changes: Lines 245–247 Although several previous studies revealed an association between nocturia and LOI or death [21, 22], it was unclear whether such an association was present for UUI. For example, some studies showed that UUI (not SUI) affected falls, fractures, and mobility impairment, [10,11] evidence illustrating the association between UUI and LOI is scarce. [21] Denys MA, Decalf V, Kumps C, Petrovic M, Goessaert AS, Everaert K. Pathophysiology of nocturnal lower urinary tract symptoms in older patients with urinary incontinence. Int J Urol. 2017;24(11): 808–815. https://doi.org/10.1111/iju.13431. [22] Galizia G, Langellotto A, Cacciatore F, Mazzella F, Testa G, Della-Morte D et al. Association between nocturia and falls-related long-term mortality risk in the elderly. J Am Med Dir Assoc. 2012;13(7): 640–644. https://doi.org/10.1016/j.jamda.2012.05.016. Comments from Reviewer #2 Comment: The Authors investigated the longitudinal association of urgency urinary incontinence with loss of independence (LOI) or death among independent community dwelling older adults. Data derived from a population-based cohort study in Japan in which 1,580 participants aged ≥65 years were enrolled in 2010. Urgency urinary incontinence (UUI) was measured by a questionnaire based on the definition of UUI from the International Continence Society. The primary outcome was defined as incidence of LOI or death. After the check-up in 2010, the outcome was monitored until March 2014. A multivariable Cox proportional hazard analysis was performed to estimate the hazard ratio for the outcome and for LOI and death separately. Ten potential confounders were adjusted in the analysis. Among all participants, 328 reported UUI. The incidence rates of the outcome were 20.4 and 11.4 (per 1,000 person–years) among participants with and without UUI, respectively. After multivariable adjustment, those who experienced UUI showed a substantial association with LOI or death (HR, 1.65; 95% CI, 1.01–2.68). However, they did not show such an association with LOI alone (HR, 1.07; 95% CI, 0.49–2.33). On the other hand, those with UUI exhibited a substantial association with death (HR, 2.23; 95% CI, 1.22–4.31). I found this study of interest, well designed, and conducted. Response: We thank the reviewer for this precise summary of our study and the positive comments. Comment 1: Only one point of criticism is the lack of cognitive status evaluation and incident disability. Please, consider to cite this reference: Solfrizzi V, Scafato E, Lozupone M, Seripa D, Giannini M, Sardone R,Bonfiglio C, Abbrescia DI, Galluzzo L, Gandin C, Baldereschi M, Di Carlo A, Inzitari D, Daniele A, Sabbà C, Logroscino G, Panza F; Italian Longitudinal Study on Aging Working Group. Additive Role of a Potentially Reversible Cognitive Frailty Model and Inflammatory State on the Risk of Disability: The Italian Longitudinal Study on Aging. Am J Geriatr Psychiatry. 2017 Nov;25(11):1236-1248. Response: We thank the reviewer for providing us with an important viewpoint and suggesting the related paper. We agree that cognitive impairment plays an important role in UI and its treatment. In addition, as the reviewer indicates, cognitive frailty is associated with LOI and death among older adults. Considering these points, we added text and references to the Discussion, including the reference suggested by the reviewer. Changes: Lines 302–304 Furthermore, this study did not investigate cognitive function, which is an important factor in UUI, LOI, and death among older adults [33,34]. Further studies that address the aforementioned limitations are needed. [33] Booth J, Kumlien S, Zang Y. Promoting urinary continence with older people: key issues for nurses. Int J Older People Nurs. 2009;4(1): 63–69. https://doi.org/10.1111/j.1748-3743.2008.00159.x. [34] Solfrizzi V, Scafato E, Lozupone M, Seripa D, Giannini M, Sardone R et al. Additive role of a potentially reversible cognitive frailty model and inflammatory state on the risk of disability: The Italian Longitudinal Study on Aging. Am J Geriatr Psychiatry. 2017;25(11): 1236–1248. https://doi.org/10.1016/j.jagp.2017.05.018. In addition to the above comments, we have re-numbered the references following the insertion of new references. Attachments Attachment Submitted filename: Response_to_reviewer_20201218.docx https://doi.org/10.1371/journal.pone.0245724.r002
7 Jan 2021 Decision Letter - Pasquale Abete, Editor Urgency urinary incontinence, loss of independence, and increased mortality in older adults: A cohort study PONE-D-20-34134R1 Dear Dr. YAMAMOTO, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Pasquale Abete Academic Editor PLOS ONE Additional Editor Comments (optional): No further comments. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: All comments have been well addressed and the manuscript is now worthy to be considered for publications Reviewer #2: I have no more suggestions to improve the manuscript that i find suitable for publication in the present form ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No https://doi.org/10.1371/journal.pone.0245724.r003
Formally Accepted
11 Jan 2021 Acceptance Letter - Pasquale Abete, Editor PONE-D-20-34134R1 Urgency urinary incontinence, loss of independence, and increased mortality in older adults: A cohort study Dear Dr. Yamamoto: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Prof. Pasquale Abete Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0245724.r004

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