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This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #29, #42, #69, #70, #71, #76

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LEARNING OBJECTIVES

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Learning Objectives

  • Identify different types of urinary incontinence based on clinical assessment.

  • Describe initial management strategies for incontinence in the older adult, which involve soliciting patient preferences and goals for care.

  • Determine when referral to a urologic or gynecologic specialist is indicated.

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Key Clinical Points

  1. Incontinence in the older adult is often the result of potentially reversible and modifiable conditions.

  2. Multicomponent interventions, including lifestyle and behavioral therapies, are effective first-line treatments for incontinence in the older adult.

  3. Treatment of incontinence in the older adult, particularly drug therapy, should involve consideration of patient preferences and comorbid conditions.

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DEFINITION AND EPIDEMIOLOGY

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Defined as the complaint of any involuntary leakage of urine, urinary incontinence is a common and bothersome condition in older adults. The prevalence of incontinence increases with age and with increasing frailty, and is 1.3 to 2.0 times greater in older women than in older men. Among community-dwelling older women, the prevalence of any urinary incontinence is approximately 35%; among older men, it is approximately 22%. The prevalence of daily urinary incontinence in older community-dwelling persons is approximately 12% for women and 5% for men. The prevalence approaches 60% among nursing home residents. Incontinence ranges in severity from occasional episodes of dribbling small amounts of urine to continuous urine leakage with concomitant fecal incontinence. In addition, many older people who do not “leak urine” still may have bothersome lower urinary tract symptoms such as urgency, frequency, and nocturia that require changes in lifestyle and/or the use of pads.

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Physical health, psychological well-being, social status, and the costs of health care can all be adversely affected by incontinence. Urinary incontinence can be cured or greatly improved, especially in those who have adequate mobility and mental functioning. Even when not curable, incontinence can always be managed to allow for more patient comfort, make life easier for caregivers, and minimize costs of caring for the condition. Because many older patients are embarrassed to discuss their incontinence and may not be aware that treatment is available, it is essential for specific questions about incontinence to be included in periodic assessments and for incontinence to be noted as a problem (Table 53-1). This chapter briefly reviews the pathophysiology of urinary incontinence in older persons, provides detailed information on the evaluation and management of this condition, and briefly reviews fecal incontinence.

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Table Graphic Jump Location
TABLE 53-1ASKING ABOUT URINARY INCONTINENCE

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