Treatment Gaps in Women Aged 65 Years and Older with Stress or Stress-Predominant Mixed Urinary Incontinence: Age-Stratified Patterns of Active Therapy, Containment Use, Frailty, and Anxiety

Background and Objectives: Older women with stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence (MUI) may remain dependent on pads or diapers despite clinically important symptoms. We described age-related care patterns and examined whether age remained associated with a predefined treatment gap after accounting for frailty and symptom burden. Materials and Methods: This single-center observational study combined record review (December 2023-April 2026) with a one-time questionnaire assessment (19 June-3 August 2026). The analysis included 480 women aged ≥65 years in three equal age groups (65-74, 75-84, and ≥85 years; n = 160 each). The treatment gap required an International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form score ≥8, at least one pad or diaper per day, containment-only current management, and no active treatment during the preceding 12 months. Frailty and anxiety were assessed with the FRAIL scale and Geriatric Anxiety Inventory. Multivariable logistic regression examined factors associated with the treatment gap and a positive anxiety screen. Results: Treatment-gap prevalence was 33.8%, 44.4%, and 55.0% across increasing age groups. Supervised pelvic floor muscle training declined from 55.0% to 40.0% and 25.0%; active treatment in the preceding year from 50.0% to 35.0% and 20.0%; and previous continence surgery from 30.0% to 18.1% and 8.1%. After adjustment, age was not independently associated with the treatment gap. Higher symptom scores (adjusted odds ratio [aOR] 1.10 per point, 95% confidence interval [CI] 1.02-1.19) and stress-predominant MUI (aOR 1.53, 95% CI 1.03-2.25) remained associated. A positive anxiety screen was associated with symptom severity, MUI, nighttime containment, and social-activity limitation. Conclusions: Containment dependence increased and active-treatment exposure decreased with age; however, symptom burden and incontinence phenotype explained more of the adjusted treatment-gap risk than chronological age. Regular reassessment may help distinguish appropriate containment from potentially remediable under-treatment.