Incontinence in frail elderly persons: Report of the 6th International Consultation on Incontinence

Gibson, William; Johnson, Theodore M.; Kirschner‐Hermanns, Ruth; Kuchel, George A.; Markland, Alayne D.; Orme, Susie; Ostaszkiewicz, Joan; Szonyi, George; Wyman, Jean F.; Wagg, Adrian

doi:10.1002/nau.24549

Cited by 41 publications

(36 citation statements)

References 113 publications

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“…Hence, the high prevalence of poor nutrition probably also reflects a high rate of frailty in our study population. Advancing age and cognitive disorders are well known risk factors for both UI and DI [6,10,32,35]. We observed an association with age over 90 and UI, as well as diagnosis of cognitive disorder and UI.…”

Section: Discussionsupporting

confidence: 55%

Factors associated with urinary and double incontinence in a geriatric post-hip fracture assessment in older women

et al. 2022

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Background Incontinence and hip fractures are common in older people, especially women, and associated with multiple adverse effects. Incontinence is a risk factor for falls. Aims We aimed to investigate the prevalence of urinary (UI) and double incontinence (DI, concurrent UI and faecal incontinence), and to identify factors associated with UI and DI 6 months post-fracture. Methods A prospective real-life cohort study was conducted consisting of 910 women aged ≥ 65 who were treated for their first hip fracture in Seinäjoki Central Hospital, Finland, between May 2008 and April 2018. Continence status was elicited at baseline and 6 months postoperatively at our geriatric outpatient clinic where all participants underwent a multidisciplinary comprehensive geriatric assessment (CGA) consisting of an evaluation of cognition, nutrition, mood, mobility, and functional ability. Results At baseline, 47% of the patients were continent, 45% had UI and 8% had DI, and at follow up, 38%, 52%, and 11%, respectively. The mean age of the patients was 82.7 ± 6.8. Both UI and DI were associated with functional disability and other factors related to frailty. The associations were particularly prominent for patients with DI who also had the worst performance in the domains of CGA. We identified several modifiable risk factors: depressive mood (odds ratio [OR] 1.81; 95% confidence interval [CI] 1.16–2.84) and constipation (OR 1.48, 95% CI 1.02–2.13) associated with UI and, late removal of urinary catheter (OR 2.33, 95% CI 1.31–4.14), impaired mobility (OR 2.08, 95% CI 1.05–4.15), and poor nutrition (OR 2.31, 95% CI 1.11–4.79) associated with DI. Conclusions This study demonstrates a high prevalence of UI and DI in older women with hip fracture and modifiable risk factors, which should be targeted in orthogeriatric management and secondary falls prevention. Patients with DI were found to be an especially vulnerable group.

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Section: Discussionsupporting

confidence: 55%

Factors associated with urinary and double incontinence in a geriatric post-hip fracture assessment in older women

et al. 2022

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“…Ideally, interventions would support PLWD to regain their continence. Many PLWD are unlikely to regain independent continence (dry, not dependent on on-going treatment) as their disease progresses, and for frail older people, dependent continence (dry with assistance) and contained incontinence (dry with products such as disposable absorbent pads) are seen as the treatment goals where independent continence is not achievable [ 13 ]. Moreover, it has been hypothesised that the poor containment of incontinence (rather than incontinence itself) is a key factor influencing carer strategies and their decisions regarding care home admission [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

A qualitative study and preliminary model of living with dementia and incontinence at home: beyond containment

et al. 2021

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Background most people living with dementia (PLWD) will develop incontinence problems with associated harmful consequences. Well-contained incontinence is often the main treatment goal. It would therefore be expected that poorly contained incontinence would have a negative impact. Aim to investigate differences in how well-contained or poorly contained incontinence impacts on the experience of living with incontinence for PLWD at home and their carers. Design secondary analysis of a qualitative study. Methods semi-structured interviews were undertaken with PLWD, carers and healthcare professionals (continence or dementia nurses). PLWD and carers were recruited via www.joindementiaresearch.nihr.ac.uk and via dementia/carer groups. Nurses were recruited via their employers. Interviews were recorded and transcribed verbatim. Framework analysis was used. Results forty-five people (twenty-six carers, two PLWD, nine continence nurses and eight dementia nurses) participated. Despite poorly contained incontinence, some PLWD/carer dyads appeared relatively unaffected by incontinence. Conversely, one or both members of some dyads who achieved good containment found incontinence care highly challenging. Four themes were identified, together forming a preliminary model of incontinence containment and impact, as follows: Conclusion reliable containment is an important goal for PLWD living at home and their carers, but it is not the only goal. Other factors, such as behaviours that challenge or carer coping strategies, can mean that even well-contained incontinence can have a negative impact. This paper proposes a preliminary model for evaluation.

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“…It is advisable to discuss the treatment goals with patients and their caregivers. The International Consultation on Incontinence (ICI) reported 4 potential goals of treatment (independent continence, controlled incontinence/ dependent continence, contained incontinence, and incontinence) in frail older men and women with UI and proposed a management algorithm [74]. After active case identification in all frail elderly people, the ICI also recommends starting an assessment of relevant comorbidities, ADL, QoL, and the goals of treatment for patients and caregivers.…”

Section: Managementmentioning

confidence: 99%

“…For patients with significant postvoid residual urine volume, they recommend constipation treatment, medication review, alpha-blocker use for men, and catheter drainage. For stress UI, lifestyle interventions and behavioral therapies are recommended [74,75].…”

Section: Managementmentioning

confidence: 99%

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A Review of Aging and the Lower Urinary Tract: The Future of Urology

Nishii

2021

Int Neurourol J

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Lower urinary tract symptoms (LUTS) are common among elderly people, with significant effects on individuals, caregivers, and the wider health care system. As the elderly population with multiple comorbidities is increasing, the burden of LUTS will increase. This review describes the demographic trends in the aging society, changes in lower urinary tract function with aging, and deterioration of physical and cognitive function in aging, as well as what has been done regarding geriatric urology and what urologists should do to meet the health care needs of the aging population. Frailty and dementia are unmissable factors in the evaluation of elderly patients. Numerous reports have described associations between LUTS and frailty and between LUTS and dementia. Urologists must be aware of the multiplex physical, cognitive, and social characteristics of elderly people. Maintaining a geriatric viewpoint in the diagnosis, treatment, and management of elderly individuals with LUTS will fulfill the unmet needs of elderly people. It is also essential to discuss the treatment and management goals of LUTS with patients and caregivers. Active case identification, appropriate evaluations of LUTS and comorbidities, and a multidisciplinary approach with other health-care professionals are recommended for better treatment and management.

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Incontinence in frail elderly persons: Report of the 6th International Consultation on Incontinence

Cited by 41 publications

References 113 publications

Factors associated with urinary and double incontinence in a geriatric post-hip fracture assessment in older women

Factors associated with urinary and double incontinence in a geriatric post-hip fracture assessment in older women

A qualitative study and preliminary model of living with dementia and incontinence at home: beyond containment

A Review of Aging and the Lower Urinary Tract: The Future of Urology

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