Urinary Incontinence in Frail Older Adults

Abstract and Introduction

Abstract

In the frail elderly population, urinary incontinence is generally caused by a combination of factors affecting the lower urinary tract. Assessment and management of incontinence must be comprehensive with the goal of identifying and treating all potential contributing factors.

Introduction

The proportion of Americans over age 65 years has more than tripled, from 4.1% in 1990 to 14.5% in 2014. Moreover, persons turning 65 years of age and older in 2014 had an additional 19.3 years added to their life expectancy. The number of persons 75 to 85 years of age is 17 times greater than in 1990, and the population 85 years of age or older is 50 times greater in size (Administration on Aging, Administration for Community Living, U.S. Department of Health and Human Services, 2015). One effect of the aging population is an increase in the number of frail older adults. Frailty is characterized by ageassociated declines in physiologic reserve and function across multiple organ systems (Chamberlain et al., 2016). This clinically recognized syndrome is a major concern in the geriatric population and is associated with a number of adverse outcomes, including worsening disability and increased risk for hospitalization, nursing home admission, and death (Clegg, Young, Iliffe, Rikkert, & Rock wood, 2013).

The prevalence of urinary incontinence (UI) also increases with age. Among adults 65 years of age and older who responded to the National Health and Nutrition Examination Surveys during 2007–2010, 43% reported UI, with an estimated prevalence of moderate to severe incontinence of 24% (Gorina, Schappert, Bercovitz, Elgaddal, & Kramarow, 2014). No studies examining the prevalence of UI among frail older adults across care settings were identified. Studies have, however, examined the prevalence of UI in nursing homes and home health care; both settings included many older frail adults. Xu and Kane (2013) reported a prevalence rate of 65.8% in residents in all Medicare or Medicaid-licensed nursing homes in Minnesota. Two studies report the prevalence of UI in frail, homebound older adults, with rates at 40.2% to 51% (Gorina et al., 2014; Landi et al., 2003).

Table 1. Common Factors Outside the Age-Related Changes in Lower Urinary Tract Iunction that Contribute to Urinary Incontinence in Frail Elders
Factor	Examples
Medications	Diuretics, alpha adrenergic agonists, alpha adrenergic antagonists, anticholinergics, calcium channel blockers, sedatives and hypnotics, AcE inhibitors, opioid analgesics, and cholinesterase inhibitors.
Medical illnesses	Diabetes mellitus, heart failure, degenerative joint disease, chronic lung disease, and sleep apnea.
Neurologic and psychiatric conditions	Stroke, Parkinson's disease, normal pressure hydrocephalus, dementia, and depression.
Functional impairment	Physical, cognitive.
Disorders of the lower urinary tract or surrounding structures	Urinary tract infection, constipation/fecal impaction, prostatic hypertrophy.
Environmental issues	Inaccessible toileting facilities, unavailable caregivers to assist with toileting, over and misuse of continence aids (e.g., pads).