Accidental bowel leakage (ABL) is a stigmatizing condition and may result in self-limited physical activity and potentially impacting overall physical function among older adults. The association between ABL and age-related changes in physical function is unknown. We aimed to investigate the relationship between ABL and physical performance and sarcopenia among older adults. We hypothesize that older initially well-functioning adults with ABL at baseline will have a greater decline in their physical function by year 4.

We analyzed a retrospective cohort of well-functioning, white and black women and men ages 70-79 years enrolled in the prospective longitudinal cohort of the Health, Aging, and Body Composition (Health ABC) study. ABL was characterized at baseline using a validated question assessing the symptom and severity of ABL. Participants with ABL were included in the exposed group and those without were controls. Physical function was measured by the Short Physical Performance Battery (SPPB) and the Health ABC physical performance battery (PBB) that includes an assessment of usual and fast walking speed and balance measures (timed chair stands and standing balance). Sarcopenia was determined using grip strength, gait speed, and appendicular skeletal muscle mass index parameters. Univariate and multivariate analyses were performed to compare physical function and sarcopenia measures between exposed and control groups accounting for age, gender, race, BMI, study site, diabetes, hypertension, and cardiovascular disease and using a significance level of 0.05.

Of the 3,075 participants in the Health ABC cohort, 1,262 answered the question on ABL and were included in the analysis: 106 (8%) had ABL and 1156 (92%) did not. Mean age and BMI of this cohort was 73 years and 27 kg/m2, respectively. There were no demographic differences based on gender or presence of ABL. ABL was most prevalent among Non-Hispanic whites in comparison to Blacks (p=0.005) and women compared to men (p=0.04). Higher parity was significantly associated with ABL (p=0.009) as was more impactful depression scores, p<0.0001. Participants with ABL had poorer physical performance (PPB) scores compared to those without ABL, mean(SD) 1.95(0.04) and 2.02(0.02), p=0.037, respectively. While SPPB scores were similar between participants with and without ABL (p=0.23), repeated chair stand speed and standing balance time was lower among participants with ABL [mean(SD) repeated chair stands, 58.8(1.78) seconds compared to 61.8(0.85) seconds, p=0.08; mean(SD) standing balance 0.31(0.01) seconds vs 0.33(0) seconds, p=0.046, respectively].

Sarcopenia measures were present among 884/1262 participants; 47% (47/99) of women with ABL and 31% (22/70) of men with ABL without a significant difference based on gender, p=0.94. There were no significant differences in usual or fast gate speed, or grip strength.

We present a novel observation that physical performance declined more significantly among older women and men with ABL. Balance measures such as timed chair stands and standing balance may be important markers of weakness impacting this observation. Robust prospective studies are needed to characterize the relationship between ABL and poor physical performance.