Incontinence is a common, bothersome, and potentially disabling condition in the geriatric population. It is defined as the involuntary loss of urine or stool in sufficient amount or frequency to constitute a social and/or health problem. Figure 8-1, illustrates the prevalence of urinary incontinence across various settings. The prevalence depends on the definition used. Incontinence ranges in severity from occasional episodes of dribbling small amounts of urine to continuous urinary incontinence with concomitant fecal incontinence.
Prevalence of urinary incontinence (UI) in the geriatric population. “Regular UI” is more often than weekly and/or the use of a pad. (Percentages range in various studies; those shown reflect approximate averages from multiple sources.)
Approximately one in three women and 15% to 20% of men older than age 65 years have some degree of urinary incontinence. Between 5% and 10% of community-dwelling older adults have incontinence more often than weekly and/or use a pad for protection from urinary accidents. The prevalence is as high as 60% to 80% in many nursing homes, where residents often have both urinary and fecal incontinence. In community and institutional settings, incontinence is associated with both impaired mobility and poor cognition.
Physical health, psychological well-being, social status, and the costs of health care can all be adversely affected by incontinence (Table 8-1). It can be a precipitating factor in the decision to seek nursing home care. Urinary incontinence is curable or controllable in many geriatric patients, especially those who have adequate mobility and mental functioning. Even when it is not curable, incontinence can always be managed in a manner that keeps people comfortable, makes life easier for caregivers, and minimizes the costs of caring for the condition and its complications.
TABLE 8-1.Potential Adverse Effects of Urinary Incontinence ||Download (.pdf) TABLE 8-1. Potential Adverse Effects of Urinary Incontinence
Skin irritation and breakdown
Recurrent urinary tract infections
Falls (especially with nighttime incontinence)
Stress on family, friends, and caregivers
Predisposition to institutionalization
Supplies (padding, catheters, etc)
Labor (nurses, housekeepers)
Management of complications
Many older people are embarrassed and frustrated by their incontinence and either deny it or do not discuss it with a health professional. It is therefore essential that specific questions about incontinence be included in periodic assessments and that incontinence be noted as a problem when it is detected in institutional settings. Examples of such questions include the following:
“Do you have trouble with your bladder?”
“Do you ever lose urine when you don’t want to?”
“Do you ever wear padding to protect yourself in case you lose urine?”
This chapter briefly reviews the pathophysiology of geriatric incontinence and provides detailed information on the evaluation ...