About

Alayne D. Markland, DO, MSc, is a tenured Professor and holds the D. Kevin Barnes, MD and Dottie Barnes Presidential Endowed Chair in the Division of Geriatrics within the Department of Internal Medicine at the University of Utah. She also serves as the Executive Director of the Center on Aging and is an investigator at the Salt Lake City Geriatric Research, Educational, and Clinical Center (GRECC) at the Salt Lake City VA Health Care System. Dr. Markland is a nationally and internationally recognized expert in lower urinary tract disorders, women’s health, and aging, with broad expertise encompassing population-based studies, multicenter clinical trials, and implantation studies aimed at increasing access to incontinence care through technology. Her overarching research goal focuses on optimizing community-based life functioning by preventing and treating geriatric syndromes in older individuals, with a specific emphasis on lower urinary tract symptoms and incontinence, which have significant implications for personal dignity and quality of life. She serves as both principal investigator and co-investigator on numerous NIH, VA, and AHRQ-funded projects to improve access to behavioral interventions and prevent lower urinary tract symptoms across the lifespan. Dr. Markland has received continuous NIH and VA funding throughout her career, has served as an ad-hoc member on NIH and VA study sections, and has published over 190 peer-reviewed publications with more than 10,000 citations. Her clinical expertise in geriatric medicine spans over 20 years, focusing on treating adults with lower urinary tract symptoms at university and VA clinics, and her research includes analyzing population-based data, conducting clinical intervention studies, and leveraging mobile health technology to increase access to care. She is also dedicated to mentoring early-stage investigators in her field.

Research topics

• Nursing
• Medicine
• Internal medicine
• Political Science
• Urology
• Computer Science
• Social Science
• Sociology
• Management science
• Public relations
• Gerontology
• Engineering
• Physical therapy
• Intensive care medicine
• Engineering ethics

Selected publications

• Optimizing remote access to Urinary Incontinence Treatments for Women Veterans: Identifying salient features of participants’ experiences with two delivery modalities

  Continence · 2026-02-14

  articleOpen accessSenior authorCorresponding

  Behavioral treatments are recognized as evidence-based approaches for treatment of urinary incontinence (UI) in women. However, many women do not have in-person access to qualified providers, which has led to the emergence of remote methods of delivery for behavioral treatment. The purpose of this study was to identify salient features of participants’ experiences with two modalities for remote delivery of behavioral treatment for UI within a pragmatic randomized trial. Individual qualitative interviews were conducted to explore the views and experiences of women Veterans who completed behavioral treatment delivered by a mobile health application (MyHealtheBladder, MHB) or video visit via VA Video Connect (VVC). The study was conducted at 3 Southeast VA healthcare systems (April 2020 - September 2023). MHB consisted of 56 self-administered daily sessions delivered remotely over 8 weeks. VVC consisted of a single session with a specialized UI provider. After the first 8 weeks, women identified as nonresponders (based on self-reported symptom improvement) were randomized to an additional VVC session or no session. A hybrid qualitative content analysis integrating deductive and inductive methods was conducted to identify the most frequently occurring and highly emphasized topics. Of the 188 women Veterans who completed the first 8-week treatment, 41 completed the interview. Participants focused on three topics: (1) encountering technical and logistical issues in access and use; (2) interacting with the program content; and (3) finding motivation, encouragement, and inspiration. Participants in both arms of the study spoke of the importance of the structure and process of content presentation, emphasizing mechanisms for reminders, review and feedback. They also valued the woman Veterans’ UI stories and provider verbal and nonverbal expressions of care and support as sources of motivation and encouragement. MHB participants reported far fewer challenges with accessing information compared to their VVC counterparts. Future mobile health programs should incorporate mechanisms for smooth navigation of MHB and timely provider feedback, as well as strategies to ensure patients can access VVC and are prepared for participation in ways that optimize their engagement with the behavioral treatment program.

  PublisherDOI

• Pelvic Floor Myofascial Pain With Palpation and Lower Urinary Tract Symptoms

  Urogynecology · 2026-04-14

  article

  IMPORTANCE: In women with pelvic floor disorders, pelvic floor myofascial pain with palpation is associated with lower urinary tract symptoms, but the prevalence in community-dwelling women is unknown. OBJECTIVES: Our study describes the prevalence of pelvic pain with palpation in community-dwelling women and its association with bladder health and symptoms. STUDY DESIGN: A subset of adult women from a large population-based, regionally representative cohort across 8 geographic regions of the United States was examined for pain with palpation of the obturator internus and levator ani muscles. Participants were not excluded on the basis of pain or urinary symptoms at baseline. Bladder health and urinary symptoms were measured using validated questionnaires. Linear and Poisson regression were used to examine associations between baseline pain and changes in bladder health and symptoms at follow-up. RESULTS: Of 502 participants, 56% had pain (46% mild [1-3/10], 8% moderate [4-6/10], 2% severe [7-10]; mean 1.1±1.6) on examination. At baseline, higher pain scores were associated with worse bladder function (β, -1.4, CI, -2.6, -0.1), and greater urinary symptoms (β, 0.4, CI, 0.1, 0.8). Baseline pain on palpation was associated with the development of new bothersome urinary symptoms (β, 1.1, CI, 1.0, 1.2) and painful urinary symptoms (β, 1.2, CI, 1.0, 1.3) over 1-2 years. CONCLUSION: Pain with palpation of the pelvic floor musculature is common in community-dwelling women and is significantly associated with urinary symptoms at baseline and with new-onset urinary symptoms over time. Pelvic muscle pain with palpation may be important to consider in the assessment of factors associated with urinary symptoms and as a precursor to bladder pain.

  PublisherDOI

• Associations between psychological and trauma-related factors and urinary incontinence severity and treatment response among women veterans

  American Journal of Obstetrics and Gynecology · 2026-04-01

  articleOpen accessSenior author
  PublisherOA PDFDOI

• Lower Urinary Tract Symptoms and Cognitive Impairment Among Participants in the <scp>REGARDS</scp> Cohort Study

  Journal of the American Geriatrics Society · 2026-04-08

  articleOpen access1st authorCorresponding

  BACKGROUND: To understand cross-sectional associations between lower urinary tract symptoms (LUTS) and specific cognitive domains, we examined cognitive performance in older adults with and without LUTS. METHODS: The study comprised a subset of Black and White participants, aged 45 and older, enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) national, longitudinal cohort study 2003-2007. Computer-assisted telephone interviews were conducted for follow-up every 6 months including an established cognitive battery: Six-Item Screener (SIS) for cognitive impairment, animal naming, letter F naming, word list learning, and delayed recall for verbal fluency/executive function and verbal memory. Validated LUTS questionnaires were administered beginning in 2020 at 6-month intervals. Separate linear and logistic regression models for men and women estimated associations between LUTS and cognitive battery scores, adjusting for covariates. RESULTS: From the 10,464 participants (6026 women, 4438 men), 70% of women reported LUTS (mean age 69 ± 8 years) versus 62% of men (mean age 63 ± 7 years). More Black men reported LUTS compared to White men, 69% versus 59% (p < 0.001), respectively, without differences among Black and White women. Men and women with LUTS had decreased odds of being cognitively intact based on the SIS, OR 0.65, 95% CI 0.50, 0.85 and OR 0.64, 95% CI 0.46, 0.78, respectively. Men with LUTS had lower scores for Animal Naming (β -0.42, 95% CI -0.75, -0.08) and Delayed Recall (β -0.18, 95% CI -0.30, -0.05). Women with LUTS had lower test scores for Letter F Naming (β -0.29, 95% CI -0.55, -0.04), Word List Learning (β -0.40, 95% CI -0.68, -0.11) and Delayed Recall (β -0.13, 95% CI -0.25, -0.02). CONCLUSIONS: Older adults with LUTS have subtle differences in cognitive function, especially in new learning, verbal memory, and verbal fluency/executive function that should be considered in treatment decisions.

  PublisherDOI

• The association between depressive symptoms and lower urinary tract symptoms and impact among women: Investigating behavioural, cognitive and physiological pathways

  British Journal of Health Psychology · 2025-01-21

  articleOpen accessSenior author

  OBJECTIVE: Mechanistic studies are needed to understand why depressive symptoms are associated with poorer physical health. The objective of this study was to examine whether behavioural, cognitive and physiological factors mediated an association between depressive symptoms, measured in early adulthood, and lower urinary tract symptoms (LUTS) and their impact, a composite variable measured in mid-life adulthood, among women in the Coronary Artery Risk Development in Young Adults study, conducted in four regions of the United States. DESIGN: Prospective cohort study. METHODS: Data were examined for 871 women. Depressive symptoms were measured and averaged across Years 5, 10 and 15. Year 20 health behaviour combined information about smoking, physical activity and diet. Year 25 cognitive function combined performance on different cognitive tests. Year 25 metabolic syndrome combined standard risk criteria for waist circumference, triglycerides, high-density lipoprotein, blood pressure and glucose. A cluster analysis of urinary incontinence, other LUTS and impact data-collected two years after Year 25-was used to group women into one of four categories: no or very mild symptoms with no impact (bladder health) versus mild, moderate or severe symptoms/impact. RESULTS: Structural equation modelling showed a statistically significant direct path between depressive symptoms and LUTS/impact. Tests of indirect paths showed that health behaviours, cognitive function and metabolic syndrome did not mediate the association between depressive symptoms and LUTS/impact. CONCLUSIONS: Depressive symptoms in early adulthood appear to be associated with LUTS and their impact in mid-life adulthood over and above health behaviours, cognitive function and metabolic syndrome.

  PublisherOA PDFDOI

• A mixed-methods scoping review on bladder self-care practices in women with and without lower urinary tract symptoms

  Continence · 2025-11-25

  articleOpen access

  This scoping review synthesized literature on women's bladder self-care practices by: 1) describing study characteristics; 2) identifying questionnaires used to assess self-care; and 3) summarizing behaviors relevant to bladder health. Five databases and reference lists were searched through April 2025 for qualitative, quantitative, and mixed-methods studies. Ninety-seven studies were included, identifying 107 behaviors grouped into four domains: Toileting and Bladder Management, Personal Care and Hygiene Practices, Lifestyle and Behavioral Strategies, and Therapeutic Interventions. Most studies focused on women with urinary symptoms, with few population-based samples. No comprehensive, validated questionnaire assessing the full scope of bladder self-care was identified. Women engage in diverse behaviors that may influence bladder health. A validated, multidimensional questionnaire is needed to assess these behaviors, identify risk and protective factors, and guide preventive interventions.

  PublisherDOI

• Community-Engaged Language and Cultural Adaptation of a Mobile Health Behavioral Incontinence Management Program

  Innovation in Aging · 2025-12-01

  articleOpen access

  Abstract Language and cultural barriers prevent many midlife and older ethnic minority women from accessing first-line behavioral management interventions for urinary incontinence, despite these techniques’ proven effectiveness. This interdisciplinary, community-engaged project adapted an interactive smartphone program for behavioral incontinence management (MyHealtheBladder) to enable its use by midlife and older Latina and Chinese American women with limited English proficiency. Using Barrera and Castro’s cultural adaptation framework, we engaged geriatrician and incontinence experts, health communication scientists, and community advocates, in addition to Latina and Chinese American women with incontinence across the aging spectrum. The adaptation process involved systematic review and translation of program content, iterative discussion and refinement by community partners, and content pilot testing in Spanish- and Chinese-speaking women aged 46-77 years with weekly incontinence. Community engagement revealed universal challenges in discussing clinical and anatomical concepts related to incontinence, while identifying culture-specific considerations including varying comfort levels with bladder/bowel discussions, preferences for medical versus colloquial terminology, and differing expectations regarding patient self-management versus clinician consultation. The adaptation process resulted in multiple changes to the language or terminology used to describe toileting activities, pelvic anatomy, and patient-clinician interactions, as well as patient case examples used to reinforce behavioral management techniques. Results demonstrate how meaningful community partnership can identify both shared and distinct cultural needs in health intervention adaptation. The project’s community-engaged approach addressed language barriers while honoring cultural values and communication preferences, offering a model for adapting digital health interventions for diverse aging populations facing similar barriers for sensitive health conditions.

  PublisherDOI

• Financial Strain Across 25 years and Men’s Lower Urinary Tract Symptoms: A Life Course Perspective

  American Journal of Men s Health · 2025-03-01 · 1 citations

  articleOpen accessSenior author

  This research utilizes Coronary Artery Risk Development in Young Adults (CARDIA) cohort study data to examine whether financial strain is associated with subsequent lower urinary tract symptoms among men and whether healthcare barriers, health risk behaviors, and comorbid conditions explain this association. CARDIA recruited Black and White participants aged 18 to 30 years at baseline (1985–1986) from four United States cities. The analytic sample was comprised of men with complete data for analyses involving financial strain trajectories across 7 assessments ( n = 602) and mediation tests of data collected at 4 assessments ( n = 634). The outcome variable, assessed when the mean age of men was 50 years, was the American Urologic Association Symptom Index score, recoded into four symptom categories: none (6.3%); mild (62.6%), moderate (28.5%), and severe (2.6%). Symptom category was regressed on financial strain variables, adjusting for age, race, education, and self-reported benign prostatic hyperplasia. Regression analyses and structural equation modeling tested potential mediators. Compared to not being financially strained across early and midlife adulthood, experiencing more than one shift in financial strain was associated with 84% greater odds (95% confidence interval [1.24, 2.75]) of being categorized into a worse symptom category. Structural equation modeling showed that both difficulty receiving healthcare and depressive symptoms explained an association between difficulty paying for medical care and worse symptoms. Additional research is needed to confirm findings and examine other mechanisms that may further explain associations between financial strain and symptoms, such as stress responses. Accumulated evidence may inform future prevention interventions, including integrated healthcare approaches.

  PublisherDOI

• Recommendations From the Women's Preventive Services Initiative on Breast Cancer Screening for Women at Average Risk and Patient Navigation Services for Breast and Cervical Cancer Screening

  Obstetrics and Gynecology · 2025-07-17 · 1 citations

  article

  The Women's Preventive Services Initiative (WPSI) expanded its previous breast cancer screening recommendation-initiate annual or biennial mammography screening for women at average risk of breast cancer between the ages of 40 and 50 years-by including additional imaging and pathology evaluation as part of the screening process if needed. Consistent with the previous recommendation, screening should continue through at least age 74 years, and age alone should not be the basis for discontinuing screening. To increase utilization of screening recommendations, the WPSI also issued a new recommendation to provide patient navigation services for breast and cervical cancer screening. To update its 2016 breast cancer screening recommendation, the WPSI found no new evidence of benefits and harms of screening. However, additional studies reported that gaps in insurance coverage contributed to incomplete follow-up after an initial abnormal mammogram for many women. For its new patient navigation recommendation, the WPSI evaluated 42 randomized controlled trials of patient navigation services for breast and cervical cancer screening and follow-up that showed increased rates compared with usual care. Patient navigation services involve person-to-person contact and are individualized to the patient's specific needs. Services include but are not limited to person-centered assessment and planning, health care access and health system navigation, referrals to support services, and patient education. The new recommendations are intended to expand breast cancer screening follow-up and to improve access and equity for cancer screening. Beginning in 2026, under the Affordable Care Act, these services will be covered without copay or deductible charges for most eligible women.

  PublisherDOI

• Association of menopausal status and hormone use with bladder health and lower urinary tract symptoms in US women: results from the RISE FOR HEALTH study

  Menopause The Journal of The North American Menopause Society · 2025-04-29 · 3 citations

  articleOpen access

  OBJECTIVES: Most previous studies of genitourinary symptoms associated with menopause focus on comparisons of postmenopausal to premenopausal women and less is known about bladder health during menopause. We evaluated associations of menopause status and hormone use with bladder health and lower urinary tract symptoms (LUTS). METHODS: Data were collected from May 2022 to December 2023 from a regionally representative cohort of community-dwelling adult women in the United States. Bladder health and LUTS were measured using validated questionnaires. Analyses included multivariable linear and logistic regression models. RESULTS: Of 3,423 eligible participants, 3,126 responded to menopause and hormone use questions. Of these, 1,226 were premenopausal, 260 perimenopausal, and 1,640 postmenopausal. Premenopausal women reported hormone use more often than perimenopausal or postmenopausal women (38.3% vs. 21.5% and 13.2%). Across multiple bladder health scales (BHS, range 0-100) and bladder function indices (BFI, range 0-100), perimenopause and postmenopause status were associated with worse scores compared with premenopause status. Perimenopausal women were more likely to report urgency UI [OR 2.27, (95% CI: 1.49-3.46)] and other LUTS compared to premenopausal women. Hormone use was associated with worse bladder health in postmenopausal women [postmenopause/hormone -6.0 Overall BHS, (95% CI: -9.8 to -2.2)] and BFI [postmenopause/hormone BFI -4.8, (95% CI: -7.4 to -2.2)]. CONCLUSIONS: Promotion of bladder health and LUTS prevention is important as women approach the menopause transition. Hormone use was infrequently reported in perimenopausal and postmenopausal women and was associated with worse bladder health postmenopause.

  PublisherOA PDFDOI

Recent grants

• Role of Vitamin D in the Prevention and Progression of Urinary Incontinence

  NIH · $1.4M · 2018–2023

• NIH Grant R21DK096201

  NIH · $582k · 2017

• Pathways to Lower Urinary Tract Symptoms Prevention in Adolescent and Adult Women.

  NIH · $4.5M · 2015–2026

• Impact of a Hospital Mobility Program on Function after Discharge

  NIH · 2016–2021

• NIH Grant I01RX000315

  NIH · 2012

Frequent coauthors

• Kathryn L. Burgio

  Geriatric Research Education and Clinical Center

  321 shared

• Camille P. Vaughan

  Geriatric Research Education and Clinical Center

  311 shared

• Patricia S. Goode

  210 shared

• Holly E. Richter

  University of Alabama at Birmingham

  169 shared

• Theodore M. Johnson

  Emory University

  137 shared

• Linda Brubaker

  University of California, San Diego

  133 shared

• Emily S. Lukacz

  Harlow College

  100 shared

• David T. Redden

  Edward Via College of Osteopathic Medicine

  86 shared

Education

• M.D.

  University of Utah

• M.S.

  University of Utah

Awards & honors

• NIDDK-funded U01 grant
• two NIDDK-funded R01 grants
• implementation consortium grant from the Agency for Healthca…
• NIA K24 Mid-career Award in Aging Research