Objectives: Frailty is a clinical syndrome that is prevalent in older patients >65 years old, distinct from associated co-morbidities and associated with adverse health outcomes including falls, hospitali-zation and death. Although frailty has been found to be prevalent in older patients seeking treatment for pelvic floor disorders, the association between prolapse (POP) and frailty is not established. Our aim was to determine if existing POP is associated with frailty using baseline data from the Women's Health Initiative Hormone Therapy Clinical Trial (WHI-HT). Material(s) and Method(s): The WHI-HT cohort of women is well described and involved postmenopausal women aged 5079 years. Participants completed questionnaires on demographics, medical comorbidities and health behaviors at baseline, and underwent physical measurements. POP (uterine prolapse, cystocele, rectocele) was recorded from pelvic examination in the WHI-HT as follows: none, grade 1 (in vagina), 2 (to introitus) or 3 (outside vagina). Frailty in this study was defined using the Fried Frailty Index to include >3 of the following: muscle weakness, slow walking speed, exhaustion, low physical activity and unintentional weight loss. Each of these components was measured by self-report or examination in the WHI. Multinomial logistic regression using multiple imputations to account for missing covariates and frailty variables at baseline was based on 11,885 postmenopausal women aged 65 to 79 years, excluding women with Parkinson's disease as this condition may share similar phenotypes with frailty. Result(s): At baseline, 17%, 20%, and 36% of participants had grade 1 or greater uterine prolapse, rectocele or cystocele, respectively. Baseline POP grade 1 or greater (uterine prolapse, rectocele, cystocele) was independently associated with frailty (OR = 1.21, 95% CI = 1.08-1.38; OR = 1.24, 95% CI = 1.071.44; OR = 1.21, 95% CI = 1.071.37; respectively) after adjusting for previously published independent predictors of frailty. Conclusion(s): POP is an independent risk factor for frailty. Recognition of this risk factor for frailty could have profound implications in improving the quality of life and function of older women.
Thomaier, L., Tian, J., Wallace, R., Walston, J., Bandeen-Roche, K., & Chen, C. (2018). 35: Pelvic organ prolapse and frailty: A subanalysis of the women’s health initiative hormone therapy clinical trial. American Journal of Obstetrics and Gynecology, 218(2), S915. https://doi.org/10.1016/j.ajog.2017.12.054