Clinical details were noted and urodynamic studies carried out on 100 elderly patients referred to an incontinence clinic, of whom 48 attended as day patients.
We compared imipramine with placebo in a double-blind study in Leicester, in elderly incontinent patients. The results revealed that 14 out of 19 patients became dry after imipramine and six out of 14 after placebo treatment. Patients on imipramine also tended to become drier sooner. However, these results must only be taken as preliminary evidence of drug effect since statistical analysis between drug and placebo did not reach significance. The results do, however, confirm the great benefit of habit-retraining which all patients received. It is now our practice to try this alone first, and to reserve drugs for slow or nonresponders, because of their possible adverse effects.
Physiotherapy is a safe and effective means of decreasing the symptoms and signs of stress incontinence. Fourteen out of 19 women became dry or improved sufficiently not to warrant wearing any protective garment over a 4-week treatment period. The use of a novel machine to measure pelvic floor squeeze did not improve the success of physiotherapy alone in this condition but may have an important role in instructing the patient on the correct use of the pelvic floor muscles.
We assessed the management of urinary incontinence amongst older people in residential and nursing homes and examined strategies for continence care in the homes. A random sample of local authority and private residential and nursing homes was drawn from an earlier census of long-term care. Strategies for continence care, the standard of care provided and the need for more help were determined by means of a structured questionnaire and the observations of a continence adviser. A random selection of residents in each of the homes was assessed for the presence, severity and symptoms of urinary incontinence, for symptom control and physical dependency. Eighty-seven per cent of the homes used pads and 83% daytime toileting to promote continence care but only 52% practised night-time toileting and 49% the use of clear toilet signs. A greater emphasis was placed on incontinence management rather than continence promotion, the latter being "good' in only 32% of homes. Although the majority of homes reported having adequate access to aids and appliances, 39% of residents had severe symptoms of urinary incontinence resulting in bed-wetting and wetting of clothing. Substantial social and psychological effects were found; 87% of residents needed changes in their management of the condition and incontinence management was "good' in only 47% of homes. Although 73% of homes were optimistic about offering good continence care, they were infrequently supported by continence nurses (30% of homes) or specialist continence doctors (9% of homes). Consequently 57% requested more help from the specialist services. The high prevalence of severe and uncontrolled symptoms of urinary incontinence combined with the lack of support received by the homes for the management of these residents indicated the urgent need for a greater input from the specialist continence service.
A prevalence survey of disturbed micturition in the elderly identified 7% with important degrees of disorder, 1% with lesser disorder and 1% who were catheterized. Incontinence, urgency, frequency and nocturia were the symptoms most commonly reported. Fifty-three per cent of people describing incontinence used preventive aids but one third of these continued to experience wetting of external clothing. Crude categorization of dysfunction on the basis of symptoms suggested that a component of unstable bladder was present in approximately 4% of the elderly population.
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