ncontinence, falls and hip fractures are common public health problems, especially among older women. These conditions will increasingly burden the health care system as the population ages.

The aims of this thesis were to establish prevalence and incidence of urinary incontinence and its subtypes and double incontinence (i.e concurrent urinary and fecal incontinence) as well as their associated risk factors among older women with hip fracture. In addition, the studies sought to determine potential associations between incontinence and increased mortality, changes in living arrangements, and mobility.

The study population consisted of women aged ≥ 65 treated for their first hip fracture in the Seinäjoki Central Hospital between 2007 and 2019. Urinary and double incontinence were found to be highly prevalent and closely related to functional disability. Those women who reported double incontinence, were found to be an especially vulnerable group. Key modifiable risk factors included depressive mood and constipation associated with urinary incontinence, and delayed removal of urinary catheter and poor nutrition associated with double incontinence. Urgency urinary incontinence was the most common subtype of urinary incontinence, while mixed urinary incontinence was associated with most factors. Poor mobility and living in an institution at the time of the fracture predicted incident urinary and double incontinence, and respectively, both predicted decreasing mobility during 1-year follow-up. Double incontinence also predicted the need for more supported living arrangements. However, neither urinary nor double incontinence predicted increased mortality independently.

We found connection between incontinence and functional disability and other factors related to frailty repeatedly across all the studies. It is likely that incontinence serves as a marker for frailty in these patients and predicts possible challenges during the rehabilitation phase post-fracture. Incontinence should be actively screened and systematically managed in both primary and secondary prevention of falls, as well as part of rehabilitation programme after a hip fracture. Additional research is warranted to establish possible causality.