There is a fundamental knowledge gap and potential missed opportunity related to the current lack of understanding about the relationship between lower urinary tract symptoms (LUTS) and frailty among older men. Older men with LUTS are more likely to suffer from falls, fractures, functional impairment, poor health- related quality of life, and mortality, but our current LUTS treatments do not target these outcomes. Further, we have limited understanding of how frailty and other systemic processes of aging, which are strongly associated with functional impairment, may contribute to the development of LUTS. Our long-term goal is to improve health-related quality of life and functional outcomes among older men with LUTS by creating a novel holistic framework for understanding the contribution of non-urologic and aging factors to the development of LUTS as well as the impact of LUTS on frailty and functional outcomes. The objective of this application is to evaluate the direction and strength of longitudinal associations between LUTS and frailty in order to identify preceding and potentially modifiable risk factors. Our central hypothesis is that the relationship between LUTS and frailty is bidirectional, such that LUTS are independently associated with worsening frailty and that frailty is independently associated with worsening LUTS. This hypothesis will be tested by leveraging the prospective, observational Osteoporotic Fractures in Men (MrOS) Study to pursue the following specific aims:
Aim 1) To determine the longitudinal association between frailty and worsening LUTS;
and Aim 2) To determine the longitudinal association between LUTS severity and worsening frailty. This project is innovative because it combines and leverages two previously distinct conceptual models ? it builds upon our prior work demonstrating the strong cross-sectional association between LUTS and frailty to evaluate frailty as a previously unexplored predictor or mechanism of LUTS and LUTS as an unexplored predictor or mechanism of frailty. The proposed research is significant because a comprehensive evaluation of these longitudinal relationships is needed in order to identify novel frailty or LUTS mechanisms and treatments as well as early frailty indicators. For example, men with frailty-associated LUTS may require different interventions than the prostate and bladder-focused therapies that are currently recommended. Alternatively, treatments for certain LUTS domains may prevent or reverse frailty and subsequent functional impairment. This research will result in an improved understanding of the potential bidirectional and reciprocal relationship of these conditions and will identify novel mechanisms to inform the development of new interventions to improve or maintain health-related quality of life and physical function among older men with LUTS.
The proposed research is relevant to public health because the majority of men will experience lower urinary tract symptoms in their lifetime and, yet, existing treatments have important limitations in older men. Understanding new mechanisms and downstream effects of lower urinary tract symptoms will lead to novel individualized treatments which improve or maintain health-related quality of life and physical function in older men. Thus, the proposed research is relevant to the NIA?s strategic goal to understand the dynamics of the aging process and to improve the health, well-being, and independence of older adults.
