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Background and aim: We aimed to capture the breadth of health outcomes that have been associated with the presence of Urinary Incontinence (UI) and systematically assess the quality, strength, and credibility of these associations through an umbrella review and integrated meta-analyses. Methods: We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p-values, 95% prediction intervals, heterogeneity, small-study effects, and excess significance. We graded the evidence from convincing (Class I) to weak (Class IV). Results and discussion: From 3172 articles returned in search of the literature, 9 systematic reviews were included with a total of 41 outcomes. Overall, 37 out of the 41 outcomes reported nominally significant summary results (p< 0.05), with 22 associations surviving the application of a more stringent p-value (p< 10−6). UI was associated with worse scores than controls in female sexual function (Class II), while it was also associated with a higher prevalence of depression (odds ratio [OR] = 1.815; 95% confidence interval [CI]: 1.551–2.124), and anxiety (OR = 1.498; 95% CI: 1.273–1.762) (Class IV). UI was associated with poorer quality of life (QoL), higher rate of mortality (hazard ratio = 2.392; 95% CI: 2.053–2.787) an increase in falls, frailty, pressure ulcers, diabetes, arthritis, and fecal incontinence (Class IV). Conclusions: UI is associated with female sexual dysfunction, with highly suggestive evidence. However, the evidence of other adverse outcomes including depression, anxiety, poorer QoL, higher mortality, falls, pressure ulcers, diabetes, arthritis, fecal incontinence, and frailty is only weak. A multidimensional approach should be taken in managing UI in the clinical setting.

Background: Previous studies on the association between pain and cognitive decline or impairment have yielded mixed results, while studies from low- and middle-income countries (LMICs) or specifically on mild cognitive impairment (MCI) are scarce. Thus, we investigated the association between pain and MCI in LMICs and quantified the extent to which perceived stress, sleep/energy problems, and mobility limitations explain the pain/MCI relationship. Methods: Data analysis of cross-sectional data from six LMICs from the Study on Global Ageing and Adult Health (SAGE) were performed. MCI was based on the National Institute on Aging-Alzheimer's Association criteria. "Overall in the last 30 days, how much of bodily aches or pain did you have?” was the question utilized to assess pain. Associations were examined by multivariable logistic regression analysis and meta-analysis. Results: Data on 32,715 individuals aged 50 years and over were analysed [mean (SD) age 62.1 (15.6) years; 51.7% females]. In the overall sample, compared to no pain, mild, moderate, and severe/extreme pain were dose-dependently associated with 1.36 (95% CI = 1.18–1.55), 2.15 (95% CI = 1.77–2.62), and 3.01 (95% CI = 2.36–3.85) times higher odds for MCI, respectively. Mediation analysis showed that perceived stress, sleep/energy problems, and mobility limitations explained 10.4%, 30.6%, and 51.5% of the association between severe/extreme pain and MCI. Conclusions: Among middle-aged to older adults from six LMICs, pain was associated with MCI dose-dependently, and sleep problems and mobility limitations were identified as potential mediators. These findings raise the possibility of pain as a modifiable risk factor for developing MCI.

Background: Dynapenic abdominal obesity (DAO) may be associated with an increased risk of disability. However, to date, this has not been investigated in low- and middle-income countries (LMICs), while the mediators are largely unknown. Aims: Therefore, we aimed to investigate the association between DAO and activities of daily living (ADL) disability, and to identify potential mediators among older adults from six LMICs. Methods: Cross-sectional, nationally representative data from the WHO Study on global AGEing and adult health were analyzed. Data on 20,198 adults aged ≥ 60 years were analyzed [mean (SD) age 69.3 (13.1) years; 54.1% females]. Dynapenia was defined as handgrip strength of < 26 kg for men and < 16 kg for women. Abdominal obesity was defined as waist circumference of > 88 cm for women and > 102 cm for men. DAO was defined as having both dynapenia and abdominal obesity. Disability was defined as severe or extreme difficulty in conducting at least one of six types of ADL. Multivariable logistic regression and mediation analysis were conducted. Results: Compared to no dynapenia and no abdominal obesity, DAO was significantly associated with 2.08 (95%CI = 1.37–3.17) times higher odds for ADL disability Mediation analysis showed that diabetes (mediated percentage 4.7%), hypertension (7.2%), and angina (7.7%) were significant mediators in the association between DAO and ADL disability. Conclusions: DAO was associated with increased odds for ADL disability among older adults from LMICs. Future longitudinal studies are warranted to assess temporal associations, and whether addressing or preventing DAO can impact on future occurrence of disability.

Background: Sedentary behavior, or time spent sitting, may increase risk for dynapenic abdominal obesity (DAO), but there are currently no studies on this topic. Aims: Therefore, we investigated the association between sedentary behaviour and DAO in a nationally representative sample of older adults from six low- and middle-income countries. Methods: Cross-sectional data from the Study on Global AGEing and Adult Health were analysed. Dynapenia was defined as handgrip strength < 26 kg for men and < 16 kg for women. Abdominal obesity was defined as waist circumference of > 88 cm (> 80 cm for Asian countries) for women and > 102 cm (> 90 cm) for men. DAO was defined as having both dynapenia and abdominal obesity. Self-reported sedentary behavior was categorized as ≥ 8 h/day (high sedentary behaviour) or < 8 h/day. Multivariable multinomial logistic regression was conducted. Results: Data on 20,198 adults aged ≥ 60 years were analyzed [mean (SD) age 69.3 (13.1) years; 54.1% females]. In the overall sample, ≥ 8 h of sedentary behavior per day (vs. <8 h) was significantly associated with 1.52 (95%CI = 1.11–2.07) times higher odds for DAO (vs. no dynapenia and no abdominal obesity), and this was particularly pronounced among males (OR = 2.27; 95%CI = 1.42–3.62). Highly sedentary behavior was not significantly associated with dynapenia alone or abdominal obesity alone. Discussion: High sedentary behaviour may increase risk for DAO among older adults. Conclusions: Interventions to reduce sedentary behaviour may also lead to reduction of DAO and its adverse health outcomes, especially among males, pending future longitudinal research.

Background: Sleep duration may influence risk for sarcopenia but studies on this topic are scarce, especially from low and- middle-income countries (LMICs). Thus, the aim of the present study was to investigate the association between sleep duration and sarcopenia among adults aged ≥ 65 years from five LMICs (China, Ghana, India, Russia, South Africa). Methods: Cross-sectional, community-based data from the WHO study on global ageing and adult health (SAGE) were analysed. Sarcopenia was defined as having low skeletal muscle mass (SMM) and weak handgrip strength, while severe sarcopenia was defined as having low SMM, weak handgrip strength, and slow gait speed. Self-reported sleep duration in the past two nights were averaged and classified as ≤ 6, > 6 to ≤ 9, and ≥ 9 h/day. Multivariable logistic regression analysis was conducted. Results: Data on 13,210 adults aged ≥ 65 years [mean (SD) age 72.6 (11.3) years; 55.0% females] were analyzed. In the overall sample, compared to > 6 to ≤ 9 h/day of sleep duration, > 9 h/day was associated with 1.70 (95% CI 1.15–2.51) and 1.75 (95% CI 1.08–2.84) times higher odds for sarcopenia and severe sarcopenia, respectively. No significant associations were observed among males, but associations were particularly pronounced among females [i.e., OR = 2.19 (95% CI 1.26–3.81) for sarcopenia, and OR = 2.26 (95% CI 1.20–4.23) for severe sarcopenia]. Conclusions: Long sleep duration was associated with an increased odds of sarcopenia and severe sarcopenia in LMICs, particularly in females. Future studies should investigate whether addressing long sleep duration among females can lead to lower risk for sarcopenia onset in LMICs.

Background: Urinary incontinence (UI) and low quality of life (QoL) are two common conditions. Some recent literature proposed that these two entities can be associated. However, no attempt was made to collate this literature. Therefore, the aim of this study was to conduct a systematic review and meta-analysis of existing data to estimate the strength of the association between UI and QoL. Methods: An electronic search of major databases up to 18th April 2020 was carried out. Meta-analysis of cross-sectional and case–control studies comparing mean values in QoL between patients with UI and controls was performed, reporting random-effects standardized mean differences (SMDs)?±?95% confidence intervals (CIs) as the effect size. Heterogeneity was assessed with the I2. Results: Out of 8279 articles initially screened, 23 were finally included for a total of 24,983 participants, mainly women. The mean age was?=?50 years in 12/23 studies. UI was significantly associated with poor QoL as assessed by the short-form 36 (SF-36) total score (n?=?6 studies; UI: 473 vs. 2971 controls; SMD?=?-?0.89; 95% CI -?1.3 to -?0.42; I2?=?93.5) and by the sub-scales of SF-36 and 5/8 of the domains included in the SF-36. Similar results were found using other QoL tools. The risk of bias of the studies included was generally high. Conclusions: UI is associated with a poor QoL, with a strong level of certainty. This work, however, mainly based on cross-sectional and case–control studies, highlights the necessity of future longitudinal studies for better understanding the importance of UI on QoL.

Background: To explore the association between sexual activity and change in cognitive function over 4 years in a representative sample of older adults in England. Methods: Data were from 1963 men and 2513 women participating in Wave 6 (2012/2013) and Wave 8 (2016/2017) of the English Longitudinal Study of Ageing. Participants reported whether or not they had engaged in any sexual activity in the last year. Cognitive function was assessed with tests of immediate and delayed recall. Adjusted general linear models were used to test associations between sexual activity and changes in cognitive function. Results: Men who were sexually active at baseline had better preservation in immediate (0.18 points, 95% CI 0.07–0.29, p= 0.002) and delayed recall (0.19 points, 95% CI 0.08–0.29, p= 0.001) over 4-year follow-up. No significant associations were observed for women. Discussion: Strengths of this study include large, representative sample, longitudinal design and adjustment for a wide range of potential confounders. The observational nature of our study means we cannot deduce the exact direction of effect of our findings. In addition, cognitive ability test scores in older people may reflect not only a possible decline, but also their peak prior cognitive ability; but we did not have any information regarding the trajectories of their cognitive function during the lifespan. Conclusion: Health practitioners should be encouraged to screen older men relating to their sexual activity to identify those who may be at risk of cognitive decline. Older men will be heartened to know that sexual activity may aid in the prevention of age-related decline in cognition.

The free radical theory of aging has been receiving a lot of attention in the past years. The aim of this study was to examine the correlation between oxidative damage, antioxidant enzyme activities and plasma antioxidant potential with clinical parameters in elderly people. Elderly subjects over 80 years old were included in the study. Clinical data were collected based on the Cumulative Illness Rating Scale (n= 132). In addition, blood samples were collected to determine biochemical and oxidative stress. The results showed that the mean age of the participants was 85.1 ± 4.0 years old. Diabetic patients presented higher plasma protein carbonyl levels when compared with non-diabetic, and plasma levels of thiobarbituric acid-reactive substances were correlated to serum triglyceride and LDL fraction. In contrast, a lower plasma total antioxidant capacity presented a relation with the presence of diabetes and arterial hypertension. In addition, healthy elderly subjects presented a higher plasma total antioxidant capacity. Thus, it seemed that plasma antioxidant potential is a better predictor of successful aging in the elderly than oxidative damage parameters or plasma antioxidant enzyme activities.