Prevalence, management and outcomes of medically complex vulnerable elderly patients with urinary incontinence in the United States

Abstract

SummaryObjectivesTo assess the prevalence, patient–physician communication, treatment and health outcomes associated with urinary incontinence (UI) among the medically complex vulnerable elderly (MCVE) in the United States (US).MethodsData from the 2006 to 2012 Medicare Health Outcomes Survey (HOS) were used. MCVE patients were aged 65+ years with a HOS VE score ≥ 3. UI was reported as a small, big or no problem. Descriptive statistics were used to assess patient–physician communication and treatment. Multivariable regression analyses were performed to assess the association of small or big UI problems with various outcomes.ResultsThe annual UI prevalence increased among MCVE [from 35.8% (2006) to 38.6% (2012)]. MCVE with big UI problems communicated with their physicians more often than those with small UI problems (77.9% and 49.6%, respectively); however, treatment of UI remained low (48.5% and 29.1%, respectively). Physical component summary (PCS) and mental component summary (MCS) scores were lower among MCVE with small or big UI problems compared with those with no UI problems, respectively. The decrements in PCS and MCS scores associated with big UI problems were greater than the decrements associated with any of the other assessed conditions. MCVE with small or big UI problems, respectively, were more likely to report past falls, depression and activity daily living limitations vs. those without UI. The odds of having experienced these outcomes were greater for those with big UI vs. small UI problems.ConclusionsUrinary incontinence prevalence in the USA increased among MCVE from 2006 to 2012, although treatment of UI remained low. UI problems, particularly big UI problems, adversely impact health outcomes. Efforts to better identify and manage UI among the MCVE are needed.

Prevalence and Possible Risk Factors for Urinary Incontinence: A Cohort Study in the City of Izmir

“…UI affects more than 200 million people worldwide, and approximately 25 million adult Americans and the cost of UI exceeds $19 billion per year [3,12] . The prevalence of UI in women may vary between countries and races, which is reported as 23.8% in Korea, 20.7% in Qatar, 38.6% in the USA, 62.2% in Chile, 52.3% in Brazil, 5.2% in Nigeria, and 23.7% in Norway [2-5, 13, 14] .…”

“…Study design may also be another factor influencing the incidence rates of UI. Most of the studies were designed at outpatient clinics [3][4][5][6] and some of them had retrospective design [3] . Telephone interviews were used to collect data in some studies [2] .…”

“…The other subtypes comprised of nocturnal enuresis, postural incontinence, continuous incontinence, insensible incontinence, and coital incontinence. UI is a worldwide health problem with prevalence rates of 25-45% in most of the reported studies which increases with aging [2][3][4][5] . This variation depends on the differences among the surveys according to their design, differences between the characteristics of cohorts (age, comorbidities, etc.…”

“…UI considerably reduces the QoL of women and it leads to depression [7] . However, most of the patients do not regard their symptoms as abnormal or serious and some of them do not consult a doctor because of shyness [3] . Data comparing the risk factors, severity, and impact on QoL of different UI subtypes are scarce in the existing literature.…”

The vulnerable elderly and bladder dysfunction: is this ‘urinary incompetence’?

“…This paper by Luo et al. in this month's issue of IJCP presents new quantitative information and confirmation of several findings about the relationship between ageing, vulnerability and UI. The results of this paper deepen our understanding of UI through knowledge of functional impairments and quality of life.…”