Purpose: We determined the incidence and predictors of incident urinary incontinence over 3 years in community dwelling older adults. Materials and Methods: A population based, prospective cohort study was conducted with a random sample of Medicare beneficiaries stratified to be 50% black, 50% men and 50% rural. In-home baseline assessment included standardized questionnaires and short physical performance battery. Three annual followup interviews were conducted by telephone. Incontinence was defined as any degree of incontinence occurring at least once a month in the last 6 months. Results: Participants were 490 women and 496 men 65 to 106 years old (mean age 75). Prevalence of incontinence at baseline was 41% in women and 27% in men. Three-year incidence of incontinence was 29% (84 of 290) in women and 24% (86 of 363) in men. There were no differences by race in prevalent or incident incontinence. In multivariable logistic regression models for women, significant independent baseline predictors of new incontinence included stroke (OR 3.4, p = 0.011), less than monthly incontinence (OR 3.3, p = 0.001), past or current postmenopausal estrogen (OR 2.3, p <0.006), slower time to stand from a chair 5 times (OR 1.3, p <0.045) and higher Geriatric Depression Scale Score (OR 1.2, p = 0.016). For men significant independent baseline predictors of new incontinence included less than monthly incontinence (OR 4.2, p <0.001) and lower score on the composite Physical Performance Score (OR 1.2, p <0.001). Conclusions: Prevalence of incontinence among community dwelling older adults was high with an additional 29% of women and 24% of men reporting incident incontinence over 3 years of followup. Infrequent incontinence is a strong risk factor for developing at least monthly incontinence in both men and women. © 2008 American Urological Association.