The study comes at a moment when two global trends are colliding with devastating consequences. By 2030, one in six people worldwide will be over the age of 60, a proportion expected to double by 2050. At the same time, humanitarian crises driven by conflict, climate change, and disasters are increasing in both number and duration. The United Nations High Commissioner for Refugees has warned that the biological and social burdens of aging may emerge earlier in life among displaced populations, because chronic undernutrition, trauma, disease, and ageism accelerate physical decline. Yet despite this demographic reality, older people remain largely absent from the design and delivery of humanitarian programming, and older women are the most neglected of all.

To map this landscape of neglect, the research team conducted a global qualitative scoping study, interviewing 19 humanitarian practitioners drawn from 16 organizations working across Europe, the Middle East and North Africa, sub-Saharan Africa, Latin America and the Caribbean, and Asia. Half of the participating organizations operated at the local level and half internationally, spanning older persons’ organizations, disability-serving groups, and sexual and reproductive health and gender-based violence agencies. The researchers used purposive and snowball sampling, guided by a six-member advisory board of experts on older women and women with disabilities in emergencies, and followed COREQ standards for qualitative reporting. Transcripts were double-coded by two analysts, with discrepancies resolved through consensus, and interviews continued until thematic saturation was reached.

The findings paint a picture of layered, mutually reinforcing exclusion. Perhaps the most foundational problem is data: humanitarian needs assessments and monitoring systems routinely fail to disaggregate information by age, sex, and disability, and even when they do, the oldest age brackets are so thinly represented that the full picture cannot be seen. One practitioner described the situation bluntly, noting that data is often not disaggregated at all, and that even when it is, older age groups are not represented well enough to reveal what is actually happening. This statistical erasure has cascading consequences: if older women do not appear in assessments, they do not appear in budgets, program designs, or service delivery plans.

Displacement itself compounds the problem in ways that challenge standard humanitarian assumptions. Practitioners described how older women frequently remain behind during acute emergencies—a choice that is only nominally voluntary. Many feel like a burden and decline to relocate; others want to stay and protect their property, as observed extensively in Ukraine, where massive displacement over years of conflict has left large numbers of older men and women in active combat zones. The study found a striking absence of inclusive evacuation protocols and policies, meaning that those least able to flee are the most likely to be left alone without support, cut off from health services, clean water, adequate food, and safety.

Economic precarity emerged as another central theme, one that both drives and conceals abuse. Aid packages are rarely tailored to older women’s needs, and cash assistance programs often fail them in practice: mobility limitations may prevent travel to distribution points, while digitalized social protection systems create dependency on others to access benefits. That dependency opens the door to exploitation. Practitioners reported cases in which relatives collected money on behalf of older women and then withheld it—a form of financial abuse made possible by the very systems designed to deliver aid. Underlying these structural failures, practitioners identified a corrosive ageist perception that older women, especially those with disabilities, cannot contribute during displacement, leading to the systematic deprioritization of their needs.

The health and protection consequences are severe and, the study argues, deeply interconnected. Older women experience sexual violence, physical assault, denial of resources, and psychological abuse, yet are largely excluded from gender-based violence programming, which is designed primarily for women of reproductive age. Those who live alone are particularly vulnerable, and those who cannot flee are violated in place. Within homes, elder abuse and neglect by caregivers—often daughters-in-law—was reported across settings as diverse as Lebanon, Ukraine, and Indonesia, and remains underreported due to cultural sensitivity and the power families hold over the person being abused. On the health side, practitioners described missed cancer screenings, late-stage cancer diagnoses with no access to treatment or palliative care, elevated rates of HIV and sexually transmitted infections, and unmanaged incontinence, all compounded by weak referral systems and the stigma and shame that keep older women from reporting violence or seeking care.

The researchers frame these barriers through an ecological model, showing how exclusion operates at every level simultaneously. Structurally, the data gap renders older women invisible before any program can be designed. At the institutional and community levels, inaccessible services, mobility limitations, and evacuation failures constrain help-seeking. At the individual level, economic insecurity intensifies dependency on others, which simultaneously increases exposure to abuse and reduces autonomy to escape it. Assumptions that older women are asexual or no longer in need of sexual and reproductive health care silence conversations about menopause, pelvic floor disorders, and conflict-related sexual violence, embedding stigma within the very institutions meant to provide protection.

Crucially, the study does not portray older women solely as victims. Practitioners repeatedly emphasized the vital social roles older women play as caregivers, knowledge holders, and respected community figures. In some settings, an older woman helping a person with disabilities may face fewer questions and receive more community support than an external aid worker. Practitioners described using respected elders as allies to reach younger women and girls, to speak with male leaders, and to guide program design. Older people were identified as effective catalysts for spreading information, teaching skills, and driving income generation—approaches that build sustainable purpose rather than dependency. The study suggests that mixed-age programming, rather than singling out older women, may be particularly promising, and that older women should be included in project leadership, not merely consulted in focus groups.

The authors call for a fundamental reorientation of humanitarian practice: institutionalizing age- and sex-disaggregated data systems with the training and analytic capacity to capture nuanced age bands; designing universally accessible sexual and reproductive health and gender-based violence programs; conducting participatory research directly with older women rather than only about them; and partnering with local older persons’ organizations on community-based and intergenerational programming. They also raise an uncomfortable ethical question about how donor-defined metrics of success may lead age-targeted services to be judged unworthy of investment, and argue that humanitarian protection principles—non-discrimination and accessibility for all—demand renewed commitment. As the world ages and crises multiply, the study makes clear that a humanitarian system that cannot see older women cannot claim to be equitable, effective, or ethical.

Subject of Research: Health and protection needs of older women in humanitarian settings

Article Title: Overlooked health and protection needs of older women in humanitarian settings: A qualitative study of practitioners

Article References: Falb, K. L., Stevenson, M., Hiscock, D., & Lasater, M. (2026). Overlooked health and protection needs of older women in humanitarian settings: A qualitative study of practitioners. PLOS Aging and Health, 1(3), e0000044. https://doi.org/10.1371/journal.page.0000044

Image Credits: AI Generated

DOI: 10.1371/journal.page.0000044

Keywords: older women, humanitarian crises, gender-based violence, sexual and reproductive health, ageism, displacement, elder abuse, humanitarian data, economic precarity, qualitative research, aging population, incontinence

The headline numbers are striking. During follow-up, 11.3 percent of children with nocturnal enuresis went on to receive a diagnosis of ADHD or autism spectrum disorder, compared with just 5.6 percent of children in the matched control group. After adjusting for age, sex, comorbidities, and concomitant medication use using Cox proportional hazards models, the researchers calculated an adjusted hazard ratio of 1.87, with a 95 percent confidence interval of 1.83 to 1.91. That means children with bedwetting had an 87 percent higher hazard of receiving one of these neurodevelopmental diagnoses than their peers. Notably, the estimates were similar when ADHD and autism spectrum disorder were analyzed individually, suggesting the association is not driven by one condition alone but reflects a broader overlap between bedwetting and neurodevelopmental differences.

Nocturnal enuresis, the involuntary passage of urine during sleep in children old enough to be expected to be dry, is one of the most common childhood conditions worldwide. It arises from a complex interplay of factors, including nocturnal polyuria, reduced bladder capacity, and an elevated arousal threshold that prevents the child from waking when the bladder signals fullness. Most children outgrow it, and standard treatments such as the antidiuretic hormone desmopressin or the enuresis alarm are effective for many. But clinicians have long observed that a subset of children respond poorly to treatment or remain in therapy for years, and the new study provides the strongest population-level evidence yet that this treatment-resistant group may include a substantial proportion of children with undiagnosed neurodevelopmental conditions.

The study’s second major finding may prove even more consequential for clinical practice. Among children with nocturnal enuresis, those who were diagnosed with ADHD or autism spectrum disorder during the course of their bedwetting treatment spent dramatically longer in therapy than children without these diagnoses. The median treatment duration was 5.2 years for children with co-occurring ADHD or autism, compared with just 0.8 years for neurotypical children, a more than sixfold difference. In other words, while most children without neurodevelopmental conditions resolved their bedwetting within months, children with ADHD or autism often remained in treatment for years, a pattern consistent with the idea that underlying neurodevelopmental differences can make the behavioral and physiological pathways to nighttime dryness harder to achieve.

The researchers also uncovered a temporal nuance with practical implications. Children who received an ADHD diagnosis early in their enuresis course had a shorter treatment duration than those diagnosed later in the course of therapy. This suggests that the timing of recognition matters: when clinicians and families identify a neurodevelopmental condition early, treatment can be adapted to the child’s needs sooner, potentially shortening the overall journey. Conversely, delayed diagnosis may mean months or years of standard enuresis therapy that fails to account for the child’s underlying neurology, prolonging frustration for families and consuming healthcare resources without addressing the full picture.

What might explain the biological link between bedwetting and neurodevelopmental conditions? The authors and the broader literature point to shared pathways rather than a single cause. ADHD and autism spectrum disorder both involve differences in brain regions that regulate arousal, attention, and executive function, and the same arousal systems govern the ability to wake in response to a full bladder. Children with ADHD may also struggle with the behavioral components of enuresis management, such as adhering to fluid schedules, remembering to take medication, or responding consistently to alarm training. In autism, sensory processing differences and difficulties with interoception, the perception of internal bodily signals, may blunt the child’s awareness of bladder sensations both while awake and asleep. Shared genetic factors may also contribute, as family studies have long hinted at overlapping heritability between elimination disorders and neurodevelopmental conditions.

The methodological strength of the study lies in its scale and design. Because it drew on complete national registers covering all Danish residents under 18 over nearly three decades, it avoided the selection biases that plague clinic-based studies, which tend to capture only children referred to specialist care. The 1:3 matching of children with enuresis to controls without the condition allowed the researchers to isolate the association between bedwetting and subsequent neurodevelopmental diagnoses, while the adjustment for comorbidities and concomitant medications helped guard against confounding. Register-based diagnosis of ADHD and autism spectrum disorder in Denmark has been validated in previous research, lending credibility to the outcome measures. As with all observational studies, however, the association does not prove that bedwetting causes neurodevelopmental conditions or vice versa; the most plausible interpretation is that both reflect shared underlying neurobiology.

The clinical implications are immediate and actionable. The authors conclude that underlying ADHD or autism spectrum disorder should be considered in children with treatment-refractory nocturnal enuresis, meaning bedwetting that does not respond to standard therapy or that requires unusually prolonged treatment. For pediatricians, this reframes a stubborn case of bedwetting not merely as a urological problem but as a potential early flag for neurodevelopmental screening. Because ADHD and autism diagnoses are often delayed, particularly in children without obvious behavioral difficulties, a condition as visible and commonly reported as bedwetting could serve as an accessible entry point for earlier identification. Earlier recognition, in turn, opens the door to tailored support for the child at home and school, and to enuresis treatment strategies adapted to the child’s attention, sensory, and behavioral profile.

For parents, the findings should prompt awareness rather than alarm. The vast majority of children who wet the bed do not have ADHD or autism, and bedwetting alone is not a diagnosis of anything. Roughly one in ten children with enuresis in the study received a neurodevelopmental diagnosis during follow-up, meaning most did not. But the doubling of relative risk is large enough that persistent or treatment-resistant bedwetting warrants a conversation with a pediatrician about the child’s broader development, including attention, communication, social interaction, and sensory sensitivities. Families caught in years of unsuccessful alarm training or repeated medication trials may find in this research an explanation for why standard approaches were not working, and a rationale for asking about a wider developmental assessment.

The study, which received no external financial support and was conducted under Denmark’s framework permitting register-based research without individual consent, adds to a growing recognition that childhood conditions long treated in isolation, from sleep problems to elimination disorders to developmental differences, are often interwoven. With more than half a million children followed across 28 years of national data, it stands as one of the most definitive demonstrations that the bladder and the brain tell a shared story. For the millions of families navigating bedwetting, and for the clinicians treating them, the message is clear: when the standard playbook fails, look deeper. The child’s nighttime struggles may be the first visible signal of a neurodevelopmental profile that, once recognized, changes the entire course of care.

Subject of Research: Association between nocturnal enuresis and ADHD or autism spectrum disorder in children and its impact on treatment duration

Article Title: ADHD and autism spectrum disorder in children with nocturnal enuresis: association and impact on treatment duration — a nationwide register-based cohort study

Article References: Polcwiartek, L. B., Jørgensen, C. S., Kragholm, K., Andersen, M. P., Torp-Pedersen, C., Borch, L., Dossche, L., & Hagstrøm, S. (2026). ADHD and autism spectrum disorder in children with nocturnal enuresis: association and impact on treatment duration — a nationwide register-based cohort study. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07635-3

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07635-3

Keywords: nocturnal enuresis, ADHD, autism spectrum disorder, children, pediatrics, neurodevelopmental disorders, register-based cohort study, epidemiology, bedwetting, treatment duration, Denmark, incontinence