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 or stress-predominant mixed urinary incontinence may rely on pads or diapers despite bothersome symptoms. We examined age-stratified treatment patterns and whether age remained associated with a 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 questionnaire assessment (19 June–3 August 2026). Within the 65–74, 75–84, and ≥85-year strata, 185, 182, and 183 women were screened; after 25, 22, and 23 exclusions or incomplete assessments, respectively, 160 evaluable women remained in each stratum. The treatment gap required International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) score ≥ 8, daily pad/diaper use, pad/diaper-only management, and no active treatment in the previous 12 months. Frailty and anxiety were assessed with the fatigue, resistance, ambulation, illnesses, and loss of weight (FRAIL) scale and Geriatric Anxiety Inventory. Results: Treatment-gap prevalence was 33.8%, 44.4%, and 55.0%. Supervised pelvic floor muscle training declined from 55.0% to 40.0% and 25.0%; recent active treatment 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. Higher ICIQ-UI SF scores [adjusted odds ratio (aOR) 1.10 per point, 95% confidence interval (CI) 1.02–1.19] and stress-predominant mixed incontinence (aOR 1.53, 95% CI 1.03–2.25) remained associated. Conclusions: Containment dependence increased and active-treatment exposure decreased with age, but symptom burden and phenotype explained more adjusted risk than age. Regular reassessment may distinguish appropriate containment from remediable under-treatment.