Urinary incontinence in the elderly: attitudes and experiences of general practitioners. A focus group study.

OBJECTIVE To assess general practitioners' (GPs') attitudes to urinary incontinence in elderly patients and their experiences in the application of the Dutch College of General Practitioners' guideline in daily practice. DESIGN Two existed groups of six GPs working in villages and seven GPs working in urban practices. METHOD Two focus-group discussions with recording of discussions and transcription. Transcripts were analysed by two independent researchers. RESULTS During the discussions three main themes of attitudes came forward: (1) therapeutic nihilism of GPs and low motivation of patients, (2): GPs experienced lack of time because of difficulties in explaining the therapy and because of impaired mobility of older patients, (3) because of the complexity of the problem and co-morbidity, GPs as well as patients were reluctant to treat the UI. The most remarkable findings in the application of the guideline were: (1) because of the barriers mentioned above, physical examination did not take place in spite of GPs' conviction as to the benefit of it; (2) GPs' knowledge of treatment options in the elderly with UI is substandard. CONCLUSION Several patient (comorbidity, impaired mobility, low motivation, and acceptance of the problem) and GP factors (therapeutic nihilism, lack of time and knowledge) interfere with good management of UI in the elderly.