Managing urinary incontinence in older people.

Urinary incontinence is defined by the International Continence Society as involuntary urinary leakage. The condition is common among older people. It affects more than a fifth of people aged over 85 years, according to a recent cohort study, although this is probably an underestimate. Urinary incontinence has both physical and psychological consequences, including damage to skin, urinary tract infections, an increased risk of falls, avoidance of going far from home, and a feeling of alienation. Urinary incontinence can also be difficult for carers to manage, and a cohort study of about 6000 patients found that urinary incontinence was second only to dementia as a reason for admission to long term care. In the United Kingdom, the 2001 report National Se rvice Framework for Older People highlighted a need for continence services to be integrated across primary, acute, and specialist care. A recent national audit of continence care for older people found that urinary incontinence is poorly managed both in the community and in secondary care. Fundamental assessments such as rectal examination and measurement of the post-void residual volume (the volume of urine remaining in the bladder after voiding) were rarely performed and management plans relied on containment rather than treatment of the underlying cause. This review will examine evidence from systematic reviews, randomised controlled trials, cohort studies, and case series and discuss current guidelines for the management of stress and urge urinary incontinence in older people. How common is it? Estimates of the prevalence of urinary incontinence vary widely owing to differing study populations, definitions of incontinence, and methods of study. A study of individuals living in community dwellings reported a prevalence of 21%, with higher prevalence in women and in individuals aged over 65 years. In a recent cohort study of individuals aged over 85 years, severe or profound urinary incontinence was reported by 21%. Urinary incontinence is probably under-reported, and older people are more likely to delay seeking help. Embarrassment, the erroneous belief that urinary incontinence is part of normal ageing, and a lack of awareness that treatment is available are reasons for under-reporting.