Geriatrics / Gériatrie Urinary Incontinence in Older Adults

Urinary incontinence (UI) is defined as an involuntary loss of urine in sufficient volume or frequency as to constitute a medical, hygienic, or psychosocial problem. In its mildest form, incontinence may present as an occasional dribbling of small amounts of urine – an inconvenience to which the patient adapts to well. In severe cases it is a potentially devastating condition with serious health consequences. It is associated with significant functional decline and frailty resulting in increased risk of institutionalization and even death. In the frail community-dwelling elderly, onset of UI is a leading cause for nursing home placement [1]. In Lebanon, where nursing home placement is not customary, UI introduces an additional layer of physical, emotional, and financial burden on homebound frail elderly and their caregivers. The prevalence of UI increases with age and frailty. It is up to twice as common in women than in men. Approximately 1 in 3 women and 1 in 5 men over the age of 65 have some degree of incontinence, and 5% to 10% of community-dwelling elderly experience sufficient incontinence as to require modification of lifestyle and/or use daily incontinent pads [2]. By the age of 80 years, 15% to 40% of community-dwelling elderly have experienced incontinence [3]. In frail homebound or nursing home residents, the prevalence increases to 60% to 80 % [4]. Despite the high prevalence of UI in the elderly and its profound impact on quality-of-life, UI continues to be under-reported and under-diagnosed. The reluctance of patients as well as providers to address the problem is due, in part, to the stigma associated with incontinence and the false belief that it is an unavoidable consequence of aging (Table I). This negative stereotypical bias hinders a frank discussion of the problem at the primary-care level and therefore delays timely intervention. It is estimated that 50% to 70% of incontinent persons do not seek help for their problems [5], and in a survey of primary care physicians, most enquired about incontinence in 25% or fewer of their patients [6]. For these reasons, it is essential that questions about incontinence be included in the routine assessment of every older patient.