The association between urinary incontinence and falls among older adults in Brazil: nationally representative evidence from ELSI-Brazil (2019-2021)

Falls represent a major public health concern among older adults, leading to injuries, functional decline, and increased health-care utilization. Urinary incontinence (UI) has been identified as a potential risk factor for falls, yet evidence from nationally representative data in low- and middle-income countries remains limited. This study is the first to examine the association between UI and falls among Brazilian older adults and to assess whether this relationship is moderated by health and functional conditions. We hypothesize that UI increases the likelihood of falls and that this association is stronger among individuals with better health and functional status, but attenuated among those with greater vulnerability, consistent with compensatory behaviors that reduce exposure to fall risk. We use data from the second wave of ELSI-Brazil (2019-2021), including community-dwelling adults aged 50 years and older. Binary logistic regression models are estimated sequentially, followed by interaction models assessing moderation by selected indicators of health and functional conditions. UI is significantly associated with a higher likelihood of falls in the unadjusted model, and this association remains statistically significant after adjustment, although attenuated with the inclusion of health-related and sociodemographic variables. Health and functional conditions—including self-rated health, difficulty with activities of daily living (ADL), obesity, and self-reported diagnosis of arthritis or rheumatism and depression are independently associated with an increased risk of falls. Interaction analyses indicate that the association between UI and falls is moderated by self-rated health, difficulty with ADL, and arthritis or rheumatism, with a weaker association among more vulnerable individuals, consistent with compensatory and adaptive behaviors that reduce exposure to situational risk. These findings show that UI is not only an independent correlate of falls but also a context-dependent risk factor. Integrating UI assessment and management into fall-prevention strategies may contribute to reducing preventable falls among older adults in Brazil.